Randomized trial comparing the velocities of the antihypertensive effects on home blood pressure of candesartan and candesartan with hydrochlorothiazide.
Randomized trial comparing the velocities of the antihypertensive effects on home blood pressure of candesartan and candesartan with hydrochlorothiazide.
复制标题
比较坎地沙坦和坎地沙坦与氢氯噻嗪对家庭血压的降压作用速度的随机试验。
DOI：
10.1038/hr.2015.64
复制
发表时间：
2015
影响因子：
5.4
通讯作者：
Imai Y on behalf of The J-HOME-CARD Study group.
中科院分区：
文献类型：
--
作者：
Hosaka M;Metoki H;Satoh M;Ohkubo T;Asayama K;Kikuya M;Inoue R;Obara T;Hirose T;Imai Y on behalf of The J-HOME-CARD Study group.
我们的目的是使用家庭血压 (BP) 测量来评估 8 mg 坎地沙坦 / 6.25 mg 氢氯噻嗪 (HCTZ) 联合疗法（联合方案）和增加坎地沙坦剂量（12 mg；最大剂量方案）的降压效果和达到最大降压效果的时间（稳定时间）。进行了一项前瞻性、多中心、开放标签、随机、比较试验。单独使用 8 mg 坎地沙坦未能达到足够血压控制（收缩压 (SBP)⩽ 135 mm Hg）的原发性高血压患者被随机分为两组：联合方案 (n= 103) 和最大剂量方案 (n= 103)。随机分组后第 8 周，家庭早晨 SBP 下降，联合方案中为 11.4±1.3 mm Hg，最大剂量方案中为 7.8±1.2 mm Hg。随机分组后 8 周时，与最大剂量方案相比，联合方案使家庭早晨 SBP 额外降低 4.0 mm Hg（95% 置信区间 (CI)：0.8–7.2 mm Hg，P= 0.01）。联合治疗方案的最大降压效果和家庭 SBP 稳定时间分别为 9.4 mm Hg 和 37.1 天（P<0.0001）。最大剂量方案以非常平缓的斜率降低家庭收缩压，估计的最大效果和估计的稳定时间不显着（P>0.2）。联合方案达到目标血压的比率（家庭早晨收缩压<135 mm Hg）显着高于最大剂量方案（52.4% vs. 30.1%，P=0.002）。总之，与增加坎地沙坦剂量相比，从 8 mg 坎地沙坦改为联合治疗在降低家庭 SBP 和更快达到目标血压方面更有效。
We aimed to evaluate the hypotensive effect and the time to attain the maximal antihypertensive effect (stabilization time) of 8 mg candesartan/6.25 mg hydrochlorothiazide (HCTZ) combination therapy (combination regimen) and therapy with an increased candesartan dose (12 mg; maximum dose regimen) using home blood pressure (BP) measurements. A prospective, multicenter, open-label, randomized, comparative trial was conducted. Essential hypertensive patients who failed to achieve adequate BP control (systolic BP (SBP)⩽ 135 mm Hg) on 8 mg candesartan alone were randomized to two groups: the combination regimen (n= 103) and the maximum dose regimen (n= 103). Home morning SBP reduction at 8 weeks after randomization was 11.4±1.3 mm Hg in the combination regimen and 7.8±1.2 mm Hg in the maximum dose regimen. The combination regimen provided additional reduction of 4.0 mm Hg (95% confidence interval (CI): 0.8–7.2 mm Hg, P= 0.01) in home morning SBP over the maximum dose regimen at 8 weeks after randomization. The maximal antihypertensive effect and stabilization time for home SBP were 9.4 mm Hg and 37.1 days (P< 0.0001), respectively, with the combination regimen. The maximum dose regimen decreased home SBP with a very gentle slope, and estimated maximal effect and estimated stabilization time were not significant (P> 0.2). The rate of achieving target BP (home morning SBP< 135 mm Hg) was significantly higher with the combination regimen than with the maximum dose regimen (52.4 vs. 30.1%, P= 0.002). In conclusion, changing from 8 mg candesartan to combination therapy was more effective in reducing home SBP and achieving goal BP more rapidly than increasing the candesartan dose.