Rognstad Stine, Søraas Camilla L, Bergland Ola U, Høieggen Aud, Strømmen Magnus, Helland Arne, Opdal Mimi S
Department of Pharmacology, Oslo University Hospital.
Institute of Clinical Medicine, University of Oslo.
Ther Drug Monit. 2021 Feb 1;43(1):116-125. doi: 10.1097/FTD.0000000000000806.
Therapeutic drug monitoring (TDM) involves the measurement of serum drug concentrations to optimize pharmacotherapy. Traditionally, blood pressure measurements alone, and not TDM, have been used to evaluate the antihypertensive drug response. However, approximately 50% of hypertensive patients treated with lifestyle changes and antihypertensive drugs fail to achieve blood pressure control. Serum drug concentration measurements could be useful to select the optimal drugs in adjusted doses and to identify nonadherence. Implementation of TDM in clinical routine for antihypertensive drugs depends on established serum reference ranges.
Commonly used antihypertensive drugs were identified based on prescription data. The authors performed a review of authoritative literature on reported serum drug concentrations and calculated expected concentrations from previously reported pharmacokinetic parameters with commonly prescribed daily doses. Finally, serum drug concentrations in samples from patients undergoing antihypertensive treatment were measured.
Serum reference ranges for 24 frequently used antihypertensive drugs were established based on results from 3 approaches.
Serum drug concentration measurements, interpreted in light of the established reference ranges, together with blood pressure measurements and other clinical data, may help identify nonadherent patients and tailor individual antihypertensive treatment when deviant drug responses appear in line with the concept of personalized medicine.
治疗药物监测（TDM）涉及测量血清药物浓度以优化药物治疗。传统上，仅通过测量血压而非TDM来评估抗高血压药物的反应。然而，约50%接受生活方式改变和抗高血压药物治疗的高血压患者未能实现血压控制。血清药物浓度测量有助于选择调整剂量的最佳药物并识别不依从情况。抗高血压药物临床常规中TDM的实施取决于既定的血清参考范围。
根据处方数据确定常用的抗高血压药物。作者对已报道的血清药物浓度的权威文献进行了综述，并根据先前报道的药代动力学参数和常用每日剂量计算预期浓度。最后，测量接受抗高血压治疗患者样本中的血清药物浓度。
基于三种方法的结果建立了24种常用抗高血压药物的血清参考范围。
根据既定参考范围解释的血清药物浓度测量结果，连同血压测量和其他临床数据，可能有助于识别不依从患者，并在出现异常药物反应时根据个性化医疗的概念调整个体抗高血压治疗。
