新型固定劑量降壓制劑安博諾-理論與實(shí)踐-張維忠

1、新型固定劑量降壓制劑安博諾理論與實(shí)踐降壓治療發(fā)展的總趨勢 強(qiáng)化 優(yōu)化 簡化 降壓治療模式的歷史演進(jìn) 序貫治療(sequential monotherapy) 階梯治療(stepped-care) 聯(lián)合治療(Combination)不同降壓機(jī)制藥物聯(lián)合治療的降壓效應(yīng)療效(A+B) = 療效(A) + 療效(B)療效(A+B) 療效(2A) 或 療效(2B) Trials testing two pressure lowering drugs separately and in combinationExpected fall in systolic blood pressure (mm Hg)O

2、bserved fall in systolic blood pressure (mmHg)0-10-20-30-40-40-30-20-100Line of identityLaw MR. BMJ 2003;326:1427不同降壓機(jī)制藥物聯(lián)合治療的不良反應(yīng)不良反應(yīng)(A+B) 不良反應(yīng)(A) + 不良反應(yīng)(B)不良反應(yīng)(A+B) 不良反應(yīng)(2A) 或 140 mmHg, 130 mmHg in type 2 diabetes; entry criterion at each stage of the study was DBP 70-109 mmHg; mean DBP at baselin

3、e = 91.3 mmHg. Some patients were at goal DBP at baseline.* Goal: SBP 140 mmHg, DBP 90 mmHg, except patients with type 2 diabetes: SBP 130 mmHg, DBP 80 mmHg.BP = blood pressure; DBP = diastolic blood pressure; SBP = systolic blood pressure.DBP GoalSBP GoalINCLUSIVE Blood Pressure Goal Attainment at

4、Week 18INCLUSIVE Blood Pressure Goal Attainment at Week 2, 10, and 18 by Age GroupAge Group 65 years 65 yearsSBP goal (%) At Week 2 3 4 At Week 10 57 52 At Week 18 79 73DBP goal (%) At Week 2 27 63 At Week 10 65 86 At Week 18 78 96Am J Geriatr Cardiol. 2008;17:27RAPiHD Severe Study Design, Results a

5、nd ConclusionsStudy DesignPrimary endpointIrbesartan150mgForce-titrate toirbesartan300mgPlacebolead-in(washout)Irbesartan/HCTZ150mg/12.5mgForce-titrate toirbesartan/HCTZ300mg/25mgRWeek 5Week 1Neutel JM et al. J Clin Hypertens 2006;8:850857*Change in SeSBP from Baseline (mmHg)*Neutel JM et al. J Clin

6、 Hypertens 2006;8:850857Combination Therapy Achieves More Rapid Blood Pressure Reductions Compared with Monotherapy Significantly More Patients in the Combination Group Had Controlled Blood Pressure*Subjects with Controlled Blood Pressure (%)* Neutel JM et al. J Clin Hypertens 2006;8:850857Irbesarta

7、n Irbesartan + HCTZSimilar Low Rates of Laboratory Marker Abnormalities Observed in Both Treatment GroupsIrbesartan/HCTZ(n=468)Irbesartan(n=227)Elevated creatinine3.01.8Elevated LFTs0.20High potassium0.61.3Low potassium00High glucose0.90High cholesterol00High uric acid0.20BP Goal Achevement in Patie

8、nts with Uncontrolled HypertensionResults of the Treat-to-Target Post-Marketing Survey with IrbesartanSchrader J, et al. Clin Drug Invest 2007;27:783-796在日常臨床實(shí)踐中, Irb/HCTZ治療14200例血壓未獲控制的德國高血壓患者, 觀察治療9個月時的降壓療效和不良反應(yīng)。Reductions in diastolic BP (DBP) and systolic BP (SBP) compared with baseline at 3 and

9、 9 months in patients with mild, moderate or severe hypertension treated with a fixed combination of irbesartan 150mg /HCTZ 12.5mg once daily as first-line combination therapy0-10-20-30-40-50-60-700-10-20-30-40-50-60-700-10-20-30-40-50-60-70Mild hypertension(SBP 140-159 or DBP 90-99mm Hg)Moderate hypertension(SBP 160-179 or DBP 99-109mm Hg)Severe hypertension(SBP 180 or DBP 110mm Hg)DiastolicSystolicDiastolicSystolicDiastolicSystolic3 months9 monthsBP reduction (mm Hg)-6.1-9.8-15.6-20.2-11.7-14.1-23.7-29-13.3-18.5-46.7-60.5Treat-to-Target:安博諾(150