Rangoonwala B, Schulz W, Bauer B
Medical Department, Hoechst AG, Hoechst Marion Roussel, Frankfurt am Main, Germany.
Br J Clin Pract. 1996 Dec;50(8):454-65.
First-line antihypertensive monotherapy is effective in reducing blood pressure to within the normal range in approximately 50% of patients. Normalisation in the remaining patients may require a combination of two or more drugs. This review considers the clinical efficacy and tolerability of combinations involving angiotensin-converting enzyme (ACE) inhibitors. The efficacy of combinations with diuretics or calcium antagonists, as initial therapy or in patients with inadequate responses to monotherapy, has been demonstrated in many trials. With combination therapy, normalisation rates approaching 80% can be achieved using submaximal doses of both components. Therapy with both combinations is well tolerated; with ACE inhibitors reducing the diuretic metabolic effects or counteracting some calcium antagonist-associated vasodilatory effects. Data on ACE inhibitors with beta-blockers are limited. When patients respond inadequately to first-line monotherapy, the increasing availability of drug combinations will allow individual selection of the most appropriate combination, taking account of additional risk factors and concomitant disease.
一线降压单药治疗在约50%的患者中可有效将血压降至正常范围。其余患者的血压正常化可能需要两种或更多药物联合使用。本综述探讨了涉及血管紧张素转换酶（ACE）抑制剂的联合用药的临床疗效和耐受性。利尿剂或钙拮抗剂联合用药作为初始治疗或用于对单药治疗反应不佳的患者，其疗效已在许多试验中得到证实。采用联合治疗时，使用两种成分的亚最大剂量可使血压正常化率接近80%。两种联合用药的耐受性良好；ACE抑制剂可减轻利尿剂的代谢作用或抵消一些与钙拮抗剂相关的血管舒张作用。关于ACE抑制剂与β受体阻滞剂联合用药的数据有限。当患者对一线单药治疗反应不佳时，随着药物联合种类的增加，可根据其他危险因素和伴发疾病，选择最适合个体的联合用药方案。
