降壓藥如何選擇服用更有效,

醫(yī)案日記 2023-06-01 16:43:21

降壓藥如何選擇服用更有效,

什么是藥物的谷峰比？

答：美國FDA提出了谷峰比的概念來衡量藥物的降壓效果

，即一個藥物在谷值時的降壓作用（去除安慰劑作用）與峰值時的降壓效應比值，一般認為谷峰比大于50％的藥物能避免峰效應過強而產(chǎn)生的低血壓不能有效控制的情況

。ACE抑制劑藥物中，信誼生產(chǎn)的賴諾普利片是ACE抑制劑，谷峰比大于50％

，因而它每天口服一次就能夠較好地穩(wěn)定控制一天24小時的血壓

。

血壓降到多少才為正常

？

答：美國國家高血壓預防

、檢測

、評價和治療委員會第7次報告中明確提出了降壓目標：

——單純高血壓病人

，SBP小于140mmHg

，DBP小于90mmHg

——高血壓伴糖尿病或腎病病人

，SBP小于130mmHg

，DBP小于80mmHg

什么樣的降壓藥物最為理想

？

答：中國高血壓病防治指南中明確指出了理想降壓藥物的標準：使用最小的有效劑量即可獲得可能有的療效而使不良反應減至最?div id="4qifd00" class="flower right">

?div id="4qifd00" class="flower right">

；即可以一天24小時內(nèi)穩(wěn)定降壓

，又可以有效地防止靶器官損害，并能防止從夜間較低血壓到清晨血壓突然升高而導致猝死

、腦卒中和心臟病發(fā)作；聯(lián)合用藥

，既提高降壓效果，又不增加不良反應

。像信誼藥廠生產(chǎn)的賴諾普利片和恬爾新片都是符合以上理想降壓藥物標準的合格產(chǎn)品。

一種藥物降壓無效應該怎么辦

？

答：一種降壓藥物無效，可以調(diào)整用藥或者聯(lián)合用藥治療

。

信誼藥廠生產(chǎn)的賴諾普利片（ACEI）和恬爾新片（CCB）是一組較理想的聯(lián)合用藥

，即可以加強降壓效果

，又可以改善心功能

，提供心、腎等重要臟器的保護作用

。是中國高血壓病防治指南推薦的常規(guī)用法，用量可根據(jù)病情的不同酌情調(diào)整

。

降壓藥物做成緩釋片有什么益處

？

答：緩釋制劑：口服藥物在規(guī)定溶劑中，按要求緩慢地非恒速釋放

，且每日用藥次數(shù)與相應的普通用藥比較至少減少一次或用藥間隔有所延長。降壓藥物做成緩釋片

，使得血壓在一天24小時內(nèi)的波幅更小，從而達到平穩(wěn)降壓的目的

。信誼生產(chǎn)的恬爾新緩釋片，服用后

，還可以使藥物在體內(nèi)迅速崩解

，從而使得藥物在體內(nèi)血藥的濃度迅速達到峰值

，控制血壓

，之后再緩慢釋放

，達到平穩(wěn)控制血壓的目的

。

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1. ?????a?±?????°???? (thiazide diuretics)

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4. è????????????′?II??????????????? (angiotensin II receptor antagonists, ARB ?±?)

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5. ?2 ??????é???????? (beta blockers)

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?????? JNC8 ??¨ 2014 ?1′??oè??é????????????±? (?????a?±?????°???????é??é??é??é???????????è????????????′?è????￠é?????????????????è????????????′?II???????????????) ?1????????????????????????o???????o??2????è?ˉ????°¤?????ˉ?????¤é?1??????????????§?????????è??é??????o???ˉ?¤???°?oo??????é?????????1???ˉ 55 ?2???￥???è?????é???′2è￡?è???????????é????????è????????????′?è????￠é?????????????????è????????????′?II????????????????????????é???????￠??§è?????è?????

?ˉ?èμ·?????¨???????????????é??è?????è?ˉ?￥??¤??¤????é?????é??è??????1??????????????-??o????é￡?é??

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1. ???????????¨è????????????′?II??????????????????é??é??é??é????????????????????é?′è????????é???????????

èˉ￥??￠é?????è?¨??¨ 2010 ?1′ 7 ?????? Chronobiol Int. ?????????????ˉ???????èˉ′?????????è???°? 203 ???é??è???????￡è?? (111 ????￥3??§????13??? 56.7 ?2?) é????o????????¤???????????¨?????¨?ˉ??¤??????¨?????¨ valsartan (???????¨3???è????????????′?II????????????????±????160?ˉ????)??????amlodipine (è?????é?-???é??é??é??é?????????±????5?ˉ????)??????????????¨?ˉ??¤????????????¨??????è?ˉ??????????????¤????????¨?????¨?????¨?????-?????aè?ˉ???è????¨???????????¨??|?????aè?ˉ??????????????°????????????????????ˉ??¨?¤??13???é??è?????????????? (é???????????24.7/è????????13.5?ˉ??±3?±???±)???è?????????????????é?′????ˉ1è????????é???1?????????????????-￡???????¤?é??é?????????oo??°?￠???????

2. é??è?????è?ˉ??¨???????????¨???é???????????è??????o?????????????è?????????-??o?

èˉ￥??￠é?????è?¨??¨ 2011 ?1′ 12 ??? J Am Soc Nephrol. ?????????????ˉ???????èˉ′?????????è???°? 661 ?????￠??§è??è???????????é??è?????è??é????o????????¤???????????¨???????????????é??è?????è?ˉ???é????¨?????¨?????¨????????????????????-???è?3?°??????aè?ˉ?????¨???????????¨?????¨?1??????? 5.4 ?1′è??è?a???é?′??-?????°???????????????è?ˉè????????????°??????????é?′è?????????-¤?¤????????????????è?ˉè???ˉ??????¨?????¨??????è?ˉ???è?????é??????o?69????????????è??????o????????1?é??????o? 72% ??????è?????????-??o???????è???￠????????????-é￡? (?ˉ?é??????????????é?′????????? 5 ?ˉ??±3?±???±?????????è??????o???????é￡?é??é????? 14???)???

3. ?2???????è????????????3?è￠???§???è???????ˉ?????????è?ˉ?????￥é???????????è????????????°?é??è??????1???????

èˉ￥??￠é?????è?¨??¨ 2013 ?1′????????? Chronobiol Int. ?????????è???ˉ?è?o?????????èˉ?è????ˉ?????? Hygia Project ??′?o????éa???? 11,255 ???????oo (?13??? 58.9 ?2????6,028 ?????·??§) ??-???é????o??§é??è????? (resistant hypertension????2???????è????????????3?è￠???§???) ??? 2,899 ?????￡è?? (?13??? 64.2 ?2????1,701 ?????·??§) ??????èˉ?è????-?????? 1,084 ?????¨?????¨?????¨??????é??è?????è?ˉ???1,436 ?????¨?????????è?? 379 ???????????¨?????¨?????????????????¨?????????é?????

???éa????????????°????????????è?ˉ????ˉ????????????????????????¨???????????????è???????????????????????è???????????????-¤?????¨??????????????????????????????????????¨??????????????-?¤????é?????????¤??????????è??????????????????????? 54.4??????77.3????????? 80.5???????????-?¤??????????????????? 17.6??????29.8??????31.0??????

??????è??èˉ′???é????o??§é??è???????￡è??????ˉ??2???????è?ˉ?￥???§???è??????????′?¤§?????-é￡????è????oè???????¨?????????è??????????????é￡?é??????ˉ1?o?è￠?????¤???¨èˉ?é?′??¤??-??oé????o??§é??è??????????￡è?????????????¨é??èo?è??????μ??????¨?????§ (??￥é?????è???o|?2???????èμ·????¤?é?′???è?????) ??????é??????????????è?ˉ??￥é???????????è??????????ˉè????ˉ?????a??ˉé?????????2??????1?????￥????°?é??è??????1??????????é￡?é?????

4. ?¤§é?¨???é?????è?ˉé????ˉ???????????¨è???￥?????°¤?????ˉè??????′§????′?a????????????????????é??é??é??é????????

èˉ￥??￠é?????è?¨??¨ 2013 ?1′????????? Chronobiol Int. ?????????è???ˉ?è?o?????????èˉ?è????ˉ?????? MAPEC study (??￥??￥?¤?é??èo?è??????μ??????￥é￠??μ????è??????o?????????????) ??? 2156 ???é??è???????￡è?? (?13??? 55.6 ?2????1112 ????￥3??§)??????èˉ?è??è￠?é????o?????o???????????¨?????¨?????¨?????????é??è?????è?ˉ (?????¨???)???????????????????o?è?ˉ (?????????)?????????????????¨?????????è?ˉ (?????????)???

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