A review of telmisartan in the treatment of hypertension: blood pressure control in the early morning hours.
A review of telmisartan in the treatment of hypertension: blood pressure control in the early morning hours.
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DOI：
10.2147/vhrm.2006.2.3.195
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发表时间：
2006
影响因子：
2.9
通讯作者：
Gosse P
中科院分区：
文献类型：
--
作者：
Gosse P
在诊所测量血压可能会提供血压控制的错误印象。动态血压监测（ABPM）可以自动记录血压的昼夜变化，并在整个给药间隔内评估降压药物的疗效。动态血压能更有效地预测心血管风险；为了改善长期预后，在清晨醒来后和服用下一剂药物之前的高风险时刻控制血压变得非常重要。为了在清晨控制血压，服用长效降压药是必不可少的。替米沙坦是一种血管紧张素II受体阻滞剂，终末消除半衰期为24小时，由于其高亲脂性，分布体积大。替米沙坦80mg单药治疗的疗效已被ABPM证实，与雷米普利10mg和缬沙坦80mg相比，在给药间隔的最后6小时，其平均值的降低更为显著。此外，与缬沙坦160 mg相比，替米沙坦80 mg在漏给剂量后提供了更好的血压控制。当与氢氯噻嗪（HCTZ） 12.5 mg联合时，替米沙坦40mg和80mg在给药间隔结束时比氯沙坦/HCTZ （50/12.5 mg）更有效。此外，与缬沙坦/HCTZ （160/12.5 mg）相比，替米沙坦/HCTZ在肥胖合并2型糖尿病和高血压患者最后6小时平均收缩压（SBP）和舒张压（DBP）的降低幅度更大。最近来自一大组患者的数据显示，80毫克替米沙坦比5-10毫克雷米普利更有效地控制清晨血压飙升，因此，可能对长期心血管风险有更大的有益影响。这一假设正在正在进行的替米沙坦单用和雷米普利联合全球终点试验（ONTARGET）项目中得到验证
Measurement of blood pressure in the clinic may provide a false impression of blood pressure control. Ambulatory blood pressure monitoring (ABPM) allows the automatic recording of the circadian variation in blood pressure and evaluation of the efficacy of antihypertensive medication throughout the dosing interval. Ambulatory blood pressure provides more effective prediction of cardiovascular risk; blood pressure control at the time of heightened risk in the early morning after waking and before taking the next dose of medication is becoming important in order to improve long-term prognosis. To achieve blood pressure control in the early morning, a long-acting antihypertensive agent is essential. Telmisartan, an angiotensin II receptor blocker, as well as having a terminal elimination halflife of 24 h, has a large volume of distribution due to its high lipophilicity. The efficacy of telmisartan 80 mg monotherapy has been demonstrated using ABPM, with superior reduction in mean values for the last 6 h of the dosing interval compared with ramipril 10 mg and valsartan 80 mg. In addition, telmisartan 80 mg provides superior blood pressure control after a missed dose compared with valsartan 160 mg. When combined with hydrochlorothiazide (HCTZ) 12.5 mg, telmisartan 40 mg and 80 mg is more effective than losartan/HCTZ (50/12.5 mg) at the end of the dosing interval. Furthermore, greater reductions in last 6 h mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) are achieved with telmisartan/HCTZ (80/12.5 mg) than with valsartan/HCTZ (160/12.5 mg) in obese patients with type 2 diabetes and hypertension. Recent data from a large group of patients show that telmisartan 80 mg controls the early morning blood pressure surge more effectively than ramipril 5–10 mg and, thus, may have a greater beneficial effect on long-term cardiovascular risk. This supposition is being tested in the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) programme