Brguljan Hitij Jana, Gaciong Zbigniew, Simić Dragan, Vajer Péter, Zelveian Parounak, Chazova Irina E, Jelaković Bojan
University Medical Centre Ljubljana, Department of Hypertension, Medical University Ljubljana, Slovenia.
University Clinical Center of the Medical University of Warsaw, Department of Internal Medicine, Hypertension and Vascular Diseases, Warsaw, Poland.
J Hypertens. 2025 Mar 1;43(3):387-396. doi: 10.1097/HJH.0000000000003901. Epub 2024 Nov 7.
There are noticeable sex differences in the treatment response to antihypertensives, with limited data on the response to single pill combinations. The aim of the PRECIOUS trial was to assess the treatment response to perindopril/amlodipine and perindopril/amlodipine/indapamide dual and triple single-pill combination in men and women.
Four hundred and forty adults with essential hypertension were assessed in the 16-week interventional, open-label, prospective, international, multicentre trial. Based on the previous antihypertensive therapy, patients were assigned to either perindopril/amlodipine 4/5 mg or perindopril/amlodipine/indapamide 4/5/1.25 mg, with the initial dose up-titrated in 4-week intervals in case of uncontrolled blood pressure. An additional analysis was performed for sex- and age-related differences on the blood pressure response and arterial stiffness in men and women aged 35-74 years.
Women achieved better overall blood pressure control in all age groups, except for the 35-44 age group. Women presented higher average 24 h aortic augmentation indexes than men, but had more pronounced decreasing trends. The pulse wave velocity was only age-dependent, with reductions slightly greater in women. Both the aortic augmentation index and pulse wave velocity were significantly decreased in all groups compared to baseline.
The results of the PRECIOUS trial contribute significant data to the expanding body of evidence on sex differences in hypertension, including the aspect of age-related changes during the life course of women. The differences between same-aged men and women tend to be smaller with advancing age, but with a greater treatment response in women in all age groups for all observed blood pressure parameters and arterial stiffness.
ClinicalTrials.gov identifier NCT03738761.
抗高血压药物的治疗反应存在显著的性别差异，而关于单片复方制剂反应的数据有限。PRECIOUS试验的目的是评估培哚普利/氨氯地平和培哚普利/氨氯地平/吲达帕胺双联和三联单片复方制剂在男性和女性中的治疗反应。
在这项为期16周的干预性、开放标签、前瞻性、国际性、多中心试验中，对440名原发性高血压成人进行了评估。根据先前的抗高血压治疗情况，患者被分配接受培哚普利/氨氯地平4/5毫克或培哚普利/氨氯地平/吲达帕胺4/5/1.25毫克治疗，若血压控制不佳，初始剂量每4周递增一次。对年龄在35 - 74岁的男性和女性的血压反应和动脉僵硬度进行了与性别和年龄相关差异的额外分析。
除35 - 44岁年龄组外，所有年龄组的女性总体血压控制情况更好。女性的平均24小时主动脉增强指数高于男性，但下降趋势更明显。脉搏波速度仅与年龄有关，女性的下降幅度略大。与基线相比，所有组的主动脉增强指数和脉搏波速度均显著降低。
PRECIOUS试验的结果为高血压性别差异这一不断扩大的证据体系提供了重要数据，包括女性生命历程中与年龄相关变化的方面。随着年龄增长，同龄男性和女性之间的差异往往会缩小，但在所有年龄组中，女性在所有观察到的血压参数和动脉僵硬度方面的治疗反应更大。
ClinicalTrials.gov标识符NCT03738761。
