摘要
美国心、肺、血研究所于 2 0 0 2年 12月在JAMA上公布的ALLHAT研究结果提示 :高血压患者宜用价廉的噻嗪类利尿剂作为一线药物 ,其在控制高血压、预防并发症方面 ,优于钙拮抗剂 (CCB)和血管紧张素转换酶抑制剂 (ACEI)。此结论马上引起了国内外学者的广泛争议。 5个月后 ,JNC7委员会提出了高血压预防和处理新指南 ,该指南建议大多数患者服用噻嗪类利尿剂 ,单独服用或与其他任何一类抗高血压药物合用。但在ASH年会上 ,围绕ALLHAT和JNC7产生了许多分歧。本文结合我国城市和乡村抗高血压药物应用现状 ,运用Meta分析方法 ,对 2 0项国内治疗原发性高血压的临床随机化试验结果进行合并分析。系统评价了我国人群使用的各类降压药治疗原发性高血压的降压效果及安全性 ,为高血压药物在我国临床中的合理应用提供了一定的科学依据。建议 :(1)欲确定某类药物优于其他类 ,需要大量长期的、前瞻性的、大规模多中心的临床试验加以证实 ;(2 )在经济条件较好的地区选择疗效更好 ,副作用更少的药品如长效CCB、ACEI等 ;(3) 1999年WHO/ISH高血压治疗指南提出了降压治疗 4项原则 (小剂量、联合、长效、更换用药 ) ,为今后规范和推动临床高血压的治疗发挥了重要导向作用 ;(4 )在为患者选用降压药物时 ,医生不仅要注意高血压患者?
The ALLHAT officers published the long paper with their results on JAMA (12/2002): thiazide-type diuretics are superior in preventing 1 or more major forms of CVD and less expensive. They suggest this could be the first-step anti-hypertension therapy. Experts overseas or at home argued a lot on this conclusion. 5 months later, JNC 7 committee put forward the new manual to prevent hypertension: most patients should take thiazide-type diuretics. However, there were many opinions opposite of ALLHAT and JNC 7 at the ASH annul congress. Referring to the current anti-hypertension therapy in China, we summarize the available clinical trial evidence concerning the efficacy and safety of various anti-hypertension therapies used as first-line agents in China.A Meta-analysis was conducted to combine the results from 20 randomized clinical trials of anti-hypertension therapy in Chinese population published in Chinese Journal during 1995-2001. Meta-analysis results suggested: (1) It should take lots of long-term and multi-center clinical trials to prove which drug is better than the other. (2) According to the current anti-hypertension treatment in China, patients in affluent regions had better use drugs with more efficient and less adverse drug reactions, such as CCB, ACEI. (3) WHO/ISH hypertension therapy guide brought forward 4 hypertension therapy routines in 1999:small dosage, combination, long-term and changing another drug. (4) Physicians should not only think over patient's blood pressure fluctuation and the damage of organs, but also consider their income. They should select the most appropriate drug for patients.
出处
《中国全科医学》
CAS
CSCD
2004年第14期1073-1078,共6页
Chinese General Practice
