頁籤選單縮合
題 名 | 血管收縮素接受器阻斷劑之臨床應用=The Clinical Use of Angiotensin Ⅱ Antagonists |
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作 者 | 曾慶孝; | 書刊名 | 內科學誌 |
卷 期 | 10:4 1999.08[民88.08] |
頁 次 | 頁133-138 |
分類號 | 418.22 |
關鍵詞 | 血管收縮素接受器阻斷劑; 血管收縮素轉化酶抑制劑; 腎素-血管收縮素-皮質醛酮系統; 高血壓; 心臟衰竭; Angiotensin receptor antagonist; Angiotensin converting enzyme inhibitor; Renin-angiotensin-aldosterone system; Hypertension; Heart failure; |
語 文 | 中文(Chinese) |
中文摘要 | 針對第一型血管收縮素接受器有特異性阻斷作用的藥物(血管收縮素接受器阻斷 劑,angiotensin II receptor antagonist, ARA)近年被用來治療高血壓及心臟衰竭。這 類藥物具有短期使用安全性高、副作用少,每天只要服用一次,而降壓效果不錯等特性。 目前的臨床試驗亦指出它有降低尿酸、降低膽固醇及不影響血糖控制等優點,它也可能具 有腎臟保護功能。Losartan 為第一個此類藥物,當使用於降血壓時,它的使用劑量為每 天50~100mg,在必要時可加上hydrochlorothiazide (HCTZ) 12.5~25mg。Valsartan為另 一個此類藥物,它的一般使用劑量為每天80mg,可逐漸增加至320mg。Losartan與HCTZ併 用時有增強降血壓作用,及避免HCTZ單獨使用時發生低血鉀症的副作用。目前有研究指出 losartan使用於心臟衰竭時其死亡率比captopril低,但此結果仍須大型長期的臨床試驗 證實。由於ARA的副作用發生率較低,因此臨床上使用時病人的遵從性比較高。Losartan 使用者中,約有1.5%的病人會發生鉀離子昇高(≧5.5mEq/L),1.9%發生可回復性肝功能異 常,而約2.3%~2.8%的病人因無法耐受副作用而必須停藥。ARA由於可能具有胎兒毒性,因 此不適合用於懷孕婦女。雖然ARA具有許多優點,但長期使用的副作用,仍然不是很清楚 ,它使用在亞洲人或華人的作用是否與研究對象大多數是白人一致,而對於糖尿病病人的 使用是否與無糖尿病者相似,它對腎臟是否確有保護功能等問題,仍有待進一步的研究。 |
英文摘要 | Angiotensin II receptor antagonists(ARAs)have specific effect on the blockade of angiotensin II receptor of subtype1. They have been used to treat hypertension and heart failure in recent years. These agents have the benefits of being safe, having satisfactory pressure lowering effect but few side effects, and being effective while taken once daily. Moreover, they probably have the effects of renal protection and lowering of uric acid and cholesterol. They also would not influence blood glucose control when used in diabetic patients. Losartan is the first ARA in clinical use. Its usual daily dose is 50-100mg. It can also be used in combination with hydrochlorothiazide (HCTZ) 12.5-25mg. Valsartan is another ARA. Its usually recommended dosage is 80mg once daily. Dosage can be titrated to 320mg per day. The combination of losartan with HCTZ can enhance the pressure lowering effect and prevent the hypokalemic effect of HCTZ. Losartan has been reported to be more effective than captopril in reducing mortality when used to treat heart failure. However, this benefit requires further confirmation. Because of the low incidence of side effects, the compliance to ARA is expected to be better than other antihypertensive agents. About 1.5% of the patients taking losartan experience hyperkalemia (≧5.5 mEq/L) and 1.9% have impaired liver function which is reversible; while 2.3%-2.8% can not tolerate the adverse effect and withdrawl of the medication is necessary. Because of the possible effect of fetotoxicity, it is contraindicated for pregnant women. Although ARAs have many advantages, its long-term safety is still unkown. Whether the safety profile and clinical effects in the Asian or Chinese populations are the same with those in the Caucasians, and the same in both the diabetic and non-diabetic patients, are still unknown. Its renal protective effect also requires further confirmation. (J Intern Med Taiwan 1999;10:133-138) |
本系統中英文摘要資訊取自各篇刊載內容。