4つの主要なクラスのクロスオーバーローテーションによる抗高血圧治療の最適化
J E Dickerson1, A D Hingorani, M J Ashby
1University of Cambridge, Clinical Pharmacology Unit, Addenbrooke's Hospital, UK.
Lancet (London, England)
|June 22, 1999
まとめ
高血圧の患者は,異なる血圧薬に対するさまざまな反応を示します. 提案された"AB/CD"ルールのように,体系的な薬剤のローテーションは,エッセンシャル高血圧の治療効果を最適化することができます.
科学分野:
- 心臓病学 心臓病学
- 薬理学 薬理学とは
- 臨床高血圧の研究研究
背景:
- 抗高血圧薬の伝統的な比較は,並列グループを使用しています.
- この研究では,若い未治療の高血圧患者の4つの主要な抗高血圧薬のクラスのクロスオーバーローテーションを調査しました.
研究 の 目的:
- 体系的な薬物の回転によって達成された単療法による応答率を評価する.
- 異なる抗高血圧薬のクラスに対する患者の反応の個々の変動性を評価する.
主な方法:
- 血管新生変換酵素 (ACE) 阻害剤,ベータブロッカー,カルシウムチャネルブロッカー,利尿剤のクロスオーバー・ローテーションは56人の高血圧患者で実施されました.
- 個々の薬物反応は,薬剤のクラス間の重複性と相関性を評価した.
- 治療の成功は,ローテーション後に目標血圧 (<または = 140/90 mm Hg) を達成した患者の割合で測定されました.
主要な成果:
- 抗高血圧薬に対する患者の反応の有意な変動が観察されました.
- 系統的なローテーションにより,単独療法での成功率は39%から73% (p=0.0001) に増加した.
- ACE阻害剤とβ阻害剤 (r=0.5),およびカルシウムチャネル阻害剤と利尿剤 (r=0.6) に対する反応との間には相関が認められた.
結論:
- エッセンシャル高血圧は,薬剤反応の個体間の有意な変動を示し,潜在的に基礎疾患の異質性によるものです.
- 複数の治療法によるシステマティックなローテーションは,抗高血圧治療の最適化に不可欠です.
- "AB/CD"ルールは,2つの相関ペアからそれぞれ1つの薬物を最初に選択することによって,ローテーションを短縮するために提案されています.
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