メタ解析:抗高血圧薬の服従に対する薬物クラスの影響
Ian M Kronish1, Mark Woodward, Ziad Sergie
1Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY, USA. ian.kronish@mssm.edu
Circulation
|April 6, 2011
まとめ
血圧薬を服用する患者の順守は,薬剤のクラスによって異なります. アンジオテンシンII受容体阻害剤は,最も高いアデレンスを示し,利尿剤とベータブロッカーは最も低い値を示したが,全体的なアデレンスは最適以下である.
科学分野:
- 薬理学 薬理学とは
- クリニック薬局 臨床薬局
- 心血管医学 心血管医学
背景:
- 観察的研究は,異なる抗高血圧薬の薬剤クラスで異なるアデバーンス率を示しています.
- 抗高血圧薬のクラスと臨床実務における患者の遵守の間の関連を定量化することは極めて重要です.
研究 の 目的:
- 様々な抗高血圧薬のクラスに対する遵守の違いを体系的に評価し,定量化する.
- 抗高血圧薬のどのクラスが,患者のアデランスの改善または悪化と関連しているかを特定する.
主な方法:
- 2009年2月1日までの英語記事の体系的な文献検索.
- 薬の補充データを介して抗高血圧剤のアデレンスを測定した研究を含む.
- 逆変数加重ランダム効果モデルを用いたメタ分析により,危険比率をまとめました.
主要な成果:
- プールの平均アデレンス値は,β阻害薬の28%からアニオテンシンII受容体阻害薬の65%まででした.
- ACE阻害剤,CCB,利尿剤,ベータ阻害剤と比較して,アンジオテンシンII受容体阻害剤の固執度が高いことが観察されました.
- 出版バイアスを考慮すると,特定の薬剤クラスの比較では,従順性の有意な差はもはや観察されませんでした.
結論:
- 抗高血圧薬の服薬順守には,臨床環境における異なる薬剤クラスにおいて,著しい差異がある.
- 利尿剤とベータブロッカーは,最も低いアデレンス率を示したが,アニオテンシンII受容体ブロッカーのACE阻害剤は最も高い.
- 薬の全般的な服薬順守は,研究されたすべての抗高血圧薬のクラスで最適以下であった.
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