第1筆 /總和 1 筆
/ 1 筆
頁籤選單縮合
題名 | Fixed dose Telmisartan/Indapamide SR Combination Therapy in Systemic Hypertension in Taiwanese Adults=Telmisartan/Indapamide SR固定劑量之合併治療法對臺灣成人本態性高血壓之療效 |
---|---|
作者 | 黃耀星; 蔡坤炎; 林慶正; 李智雄; | 書刊名 | Medical Journal of South Taiwan |
卷期 | 1:1 民95.06 |
頁次 | 頁16-24 |
分類號 | 418.221 |
關鍵詞 | 24小時血壓監測; Telmisartan/indapamide合併療法; 血壓日夜變動; Ambulatory BP monitoring; Telmisartan/indapamide combination therapy; Circadian rhythm; |
語文 | 英文(English) |
中文摘要 | 背景:過去數十年來對高血壓之治療有些進展。由於不同級藥物低劑量之合併療法可有效降壓而具耐性,而且副作用少,因而被2003年歐洲心臟學會高血壓學會及JNC VII之高血壓治療準則所推薦。在學理上長效型Indapamide(Indapamide SR, IndSR)及長效型血管緊張肽素II阻斷劑(ARB)、Telmisartan(Tel)之合併使用具藥理協同作用;而適用於輕、中度高血壓。但這種合併療法在亞洲的報告很少。目的:本研究的目的在用兩次二十四小時血壓監測(ABPM)來探討一天服用一次低劑量Tel/Ind SR之合併療法,對國人高血壓之降壓效果及其副作用。方法:共34例未治療過之高血壓病人進入此研究。病人平均二十四血壓分類依JNC VII之標準。有前期高血壓、第一或二期高血壓者,每天服用Telmisartan 40ng/Indapamide SR 1.5mg,連續服用八週。病人每四週回診一次,量水銀血壓及報告有無相關副作用。但如第五週座位舒張壓仍≧95mmHg,則考慮Tel劑量加到每天80 mmHg或加入第三種抗壓劑,但這些病例則排除在外。而藥物對新陳代謝方面的影響,則在使用該藥物前及使用後第八週檢測血清鈉、鉀、尿酸及空腹血糖值。藥物接受度則在每次回診時,算其剩餘的藥片數來評估。並詢問是否有相關的副作用發生。結果:共二十九例完成該研究。平均年齡五十三歲,男性十三例、女性十六例。在二十九例使用後之二十四小時平均血壓由146±19 / 92±11mmHg降到127±21 / 80±11mmHg(p<0.0005 / 0.0005)。白天(上午六點到下午六點)血壓由151±19 / 95±11降到129±20 / 82±11mmHg(p<0.0005 / 0.0005),夜間(下午六點至翌日上午六點),血壓由142±21 / 89±12降到125± 22 / 79± 22mmHg(p<0.0005 / 0.0005)。白天降壓較夜間多。合併治療前血壓之日夜變動曲線在上午十一點達最高峰(peak)而最低點(nadir)在夜間十二點。用合併療法治療後,血壓呈有意義下降達二十三小時,並且仍保持有與原來相似之日夜血壓變動曲線。二十四小時平均心跳不變。四例訴頭暈,其中二例可能與血壓下降有關,因此該兩例停用Indapamide SR,而發生低血鉀者為兩例,暫停用Ind-SR。結論:本研究證實Telmisartan/Indapamide SR固定低劑量之合併療法,對台灣成人本態性高血壓可有效控制其血壓達二十三小時,並維持原來日夜變動曲線。少數病例發生輕微副作用,如頭暈、低血鉀等。耐性尚良好,全體有效率約76%。是有效之合併療法。 |
英文摘要 | Background: Antihypertensive therapy has evolved considerably during the past several decades. Two drug combinations at low dosages have been found to be effective and well tolerated, as recommended by 2003 ESH/ESC and JNC VII hypertensive-guidelines. Few studies have examined the efficacy of this combination therapy in Asian patients.Ojective: The aim of this open-label, uncontrolled study was to assess the 24-h effectiveness and tolerability of once-daily fixed dose Tel/lnd-SR combination therapy by using noninvasive ambulatory BP monitoring (ABPM) in Chinese patients.Methods: A total of 34 patients with untreated essential hypertension were enrolled. Patients with prehypertension, stage I or II hypertension(as defined by the Seventh Report of Joint National Committee on pressure)were treated with Tel 40mg/plus Ind-SR 1.5mg/day combination therapy once-daily for 8 weeks. The patients were seen in the clinic every 4 weeks to have office BP and heart rate checked .However, if their supine diastolic BP was ≧95mmhg or more, the dose of telmisartan was increased to 80mg/day or a third drug was added and they were exclude from the study. Metabolic effects including serum sodium, potassium, uric acid and fasting plasma glucose determinations were carried out before and after 8 weeks of therapy. Medication compliance was carried out by counting the tablets at each visit and the tablets returned at the end of the study. Any adverse events possible related to combotherapy were asked and reported by patients.Results: A total of 29 patients (age 52±8 yrs ), 13 men and 16 women completed the study. Mean 24-h systolic /diastolic BP after Tel/lnd-SR combotherapy was significantly decreased compared with baseline values (127±21/80±11 vs. 146±19/92±11 mm Hg; p<0.0005/0.0005). Mean daytime (6 A.M. to 6 P.M.) BP decreased from 151±19/95±11 to 129± 20/82± 11 mm Hg (p<0.0005/0 .0005) and night time BP (6 P.M. to 6 A.M.) from 142± 21/89± 12 to 125± 22/79± 22 mm Hg (p<0.0005/0.0005). BP reduction was more pronounced during the day. Before treatment, the circadian rhythm showed a peak BP at 11 A.M. and a nadir at 12 P.M. After treatment, significant BP reduction (P<0.05/0.05) was observed throughout 23 of the 24 hourly mean points. The circadian rhythm of BP was preserved as indicated by similar BP standard deviations (23± 3/14± 2 vs. 23±2/14± 1 mm Hg). Mean heart rate did not change. Dizziness was reported in 4 patients, of which 2 were thought to be possible related to excessive BP reduction. Indapamide SR was premature terminated in these 2 patients. Hypokalemia was found in another 2 patients.Conclusions: A fixed low-dose combination of telmisartan/indapamide-SR therapy produced significant BP reduction through-out 23 of the 24 hourly mean points pre-serving circadian BP cycles and is generally well toterated in Taiwanese patients. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。