Dispelling the myth of "aggressive" antihypertensive therapy.
Dispelling the myth of "aggressive" antihypertensive therapy.
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消除“积极”抗高血压治疗的神话。
DOI：
10.1111/j.1524-6175.2005.05293.x
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发表时间：
2006
期刊：
影响因子：
--
通讯作者：
Ofili,ElizabethO
中科院分区：
文献类型：
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作者：
Ofili,ElizabethO
精心设计的随机试验数据证明了强化高血压管理方法在降低发病率和死亡率方面的有效性。基于这些数据，指南建议一般人群的血压目标为<140/90 mm Hg，高危患者的目标较低。临床试验还表明，大多数患者至少需要两种降压药才能达到目标。尽管有这样的证据基础，但只有大约三分之一的高血压患者接受了足够的治疗，使血压达到<140/90 mm Hg。医生可能不愿意使用多种降压药来达到这一目标，因为他们可能认为这是“积极的”，并不总是符合患者的最佳利益，尤其是那些被认为是低风险的患者。这种看法可能建立在以下几个误区上：1)该方法需要一个复杂的、耗时的从滴定到反应的策略，在此期间患者可能无法随访；2)增加服药负担，降低患者服药依从性；3)增加了治疗相关的副作用；4)成本效益不高。含有两种抗高血压药物的固定剂量组合的可用性应该有助于消除这些误解。仔细选择有效的、耐受性良好的、每日一次的、固定剂量的联合用药，可以在广泛的患者中迅速达到目标血压，并鼓励患者配合治疗。这种配方也具有成本效益。因此，使用多种药物作为固定剂量组合降低血压是一种认识到导致高血压的多种病理生理变化的策略。
Data from well designed randomized trials have proven the effectiveness of an intensive approach to hypertension management in reducing morbidity and mortality. Based on these data, guidelines recommend a blood pressure goal of <140/90 mm Hg in the general population, with lower goals for high‐risk patients. Clinical trials also show that most patients will require at least two antihypertensive agents to reach goal. Despite this evidence base, only about one third of individuals with hypertension receive sufficient therapy to attain a blood pressure of <140/90 mm Hg. Physicians may be reluctant to use multiple antihypertensive agents to achieve this goal because they may consider it to be “aggressive” and not always in the best interests of the patient, especially in those deemed at low risk. Such perceptions may be founded on several myths: 1) the approach demands a complex, time‐consuming titration‐to‐response strategy, during which the patient may be lost to follow‐up; 2) it increases the pill burden, which will decrease patient compliance; 3) it increases treatment‐related side effects; and 4) it is not cost‐effective. The availability of fixed‐dose combinations containing two antihypertensive agents should help to dispel these myths. Careful selection of efficacious, well tolerated, once‐daily, fixed‐dose combinations allows goal blood pressure to be achieved quickly in a broad range of patients and encourages patient concordance with therapy. Such formulations are also cost‐effective. Thus, reducing blood pressure using multiple drugs as fixed‐dose combinations is a strategy that recognizes the multiple pathophysiologic changes that lead to hypertension.