聯(lián)合用藥的降壓治療優(yōu)于單一用藥雙倍劑量治療

1、聯(lián)合用藥的降壓治療優(yōu)于單一用藥雙倍劑量治療(2009-04-01 12:09:28) 轉(zhuǎn)載MedWire News: Blood pressure (BP) reduction from combining drugs from different classes can be predicted on the basis of additive effects, and is approximately five times greater than doubling the dose of a single drug, a study indicates.MedWire 新聞：一項研究顯示

2、，不同種藥物的聯(lián)合用藥的降壓作用是疊加的效應(yīng)，大概是單種藥物雙倍劑量的五倍藥效。Effectiveness of low-dose drug combinations as initial treatment for BP reduction relies on the effects of the combined drugs being additive.低劑量藥物的初始降壓效果依賴于聯(lián)合用藥的疊加作用。To examine the evidence for this, a team from the London Queen Marys School of Medicine and De

3、ntistry, UK, led by David Wald, conducted a meta-analysis of 42 factorial trials involving 10,968 participants in which combinations of any two of thiazides, beta-blockers, ACE inhibitors (ACEIs), and calcium channel blockers (CCBs) were tested against each drug given alone and placebo.為找到研究的證據(jù)，來自英國

4、倫敦女王瑪麗口腔醫(yī)學(xué)與臨床醫(yī)學(xué)院的David Wald領(lǐng)導(dǎo)的實驗小組對10968名參加者進(jìn)行了42個析因試驗并進(jìn)行薈萃分析。試驗者從噻嗪類利尿藥、-受體阻斷劑、血管緊張素轉(zhuǎn)化酶抑制劑、鈣通道阻滯劑中選取2種聯(lián)合用藥，或是單用一種藥物和安慰劑。With thiazide used alone, the mean placebo-subtracted reduction in systolic blood pressure was 7.3 mmHg, and 14.6 mmHg combined with a drug from another class. The corresponding r

5、eductions were 9.3 mmHg and 18.9 mmHg with beta-blocker, 6.8 mmHg and 13.9 mmHg with ACEI, and 8.4 mmHg and 14.3 mmHg with CCB.噻嗪類利尿藥單用的平均收縮壓減少7.3 mmHg而聯(lián)合用藥是減少 14.6 mmHg。相應(yīng)的-受體阻斷劑單用和聯(lián)用分別減少9.3 mmHg 和18.9 mmHg，ACEI單用和聯(lián)用分別減少6.8 mmHg 和13.9 mmHg，CCB單用和聯(lián)用分別減少8.4 mmHg 和14.3 mmHg。The expected blood pressure

6、 reduction from two drugs together, assuming an additive effect, closely predicted the observed blood pressure reductions. The ratios of the observed to expected incremental blood pressure reductions from combining each class of drug with any other over that from one drug were, respectively, for thi

7、azides, beta-blockers, ACEIs, and CCBs: 1.04, 1.00, 1.16, and 0.89. The overall average was 1.01.原先假設(shè)的期望中的兩種藥物的聯(lián)合作用的效果接近于實測得到的降壓值。聯(lián)合用藥的血壓降低的值比單用血壓降低的值增加的比率分別是：噻嗪類利尿藥、-受體阻斷劑、血管緊張素轉(zhuǎn)化酶抑制劑、鈣通道阻滯劑1.04, 1.00, 1.16, 0.89?？偟钠骄凳?.01。Comparison of results with those of a published meta-analysis of different

8、doses of the same drug showed that doubling the dose of one drug had approximately one fifth of the equivalent incremental effect (0.22).對藥物的不同劑量的藥效結(jié)果的薈萃分析顯示雙倍劑量的單用藥物的藥效只有聯(lián)合用藥的1/5（0.22）。Writing in the American Medical Journal, the researchers conclude: “The results leave little doubt over the advant

9、ages of adopting low-dose combination blood pressure-lowering treatment as routine initial therapy for all, instead of a monotherapy and stepped-care approach.”發(fā)表于美國醫(yī)學(xué)雜志，作者寫道：“研究結(jié)果表明采用低劑量聯(lián)合用藥的降壓方法作為常規(guī)治療方案比單一療法和逐步療法更有優(yōu)勢?！盩hey also note: “Low-dose therapy has the advantage of reducing adverse effects

10、that are strongly dose related Using more than two drugs in combination also would increase efficacy”.他們還寫道：“低劑量的優(yōu)勢還在于可以減少副作用這是與劑量有關(guān)的兩種以上藥物的聯(lián)合應(yīng)用有助增加藥效?！本幾g：MedWire 新聞：一項研究顯示，不同種藥物的聯(lián)合用藥的降壓作用是疊加的效應(yīng)，大概是單種藥物雙倍劑量的五倍藥效。低劑量藥物的初始降壓效果依賴于聯(lián)合用藥的疊加作用。為找到研究的證據(jù)，來自英國倫敦女王瑪麗口腔醫(yī)學(xué)與臨床醫(yī)學(xué)院的David Wald領(lǐng)導(dǎo)的實驗小組對10968名參加者進(jìn)行了42個

11、析因試驗并進(jìn)行薈萃分析。試驗者從噻嗪類利尿藥、-受體阻斷劑、血管緊張素轉(zhuǎn)化酶抑制劑、鈣通道阻滯劑中選取2種聯(lián)合用藥，或是單用一種藥物和安慰劑。噻嗪類利尿藥單用的平均收縮壓減少7.3 mmHg而聯(lián)合用藥是減少 14.6 mmHg。相應(yīng)的-受體阻斷劑單用和聯(lián)用分別減少9.3 mmHg 和18.9 mmHg，ACEI單用和聯(lián)用分別減少6.8 mmHg 和13.9 mmHg，CCB單用和聯(lián)用分別減少8.4 mmHg 和14.3 mmHg。原先假設(shè)的期望中的兩種藥物的聯(lián)合作用的效果接近于實測得到的降壓值。聯(lián)合用藥的血壓降低的值比單用血壓降低的值增加的比率分別是：噻嗪類利尿藥、-受體阻斷劑、血管緊張素轉(zhuǎn)化酶抑制劑、鈣通道阻滯劑1.04, 1.00, 1.16,