心不全の管理について. I. 薬物療法による治療
D W Baker1, M A Konstam, M Bottorff
1Health Sciences Program, RAND, Santa Monica, Calif.
JAMA
|November 2, 1994
まとめ
アンジオテンシン変換酵素 (ACE) 阻害剤は,すべての心不全患者のために推奨されます. 利尿剤,ディゴキシン,イソソルビド・ディニートレート,およびヒドララジンなどの他の薬剤は,患者の症状と耐性に基づいた特定の役割を持っています.
科学分野:
- 心臓病学 心臓病学
- 薬理学 薬理学とは
背景:
- 左心室収縮性機能不全による心不全は,重要な臨床的課題である.
- 効果的な薬理学的管理は,患者のアウトカムを改善するために不可欠です.
研究 の 目的:
- 心不全の薬理学的治療のための専門家パネルの勧告を要約する.
- 心不全の管理における臨床的意思決定の指針を提供すること.
主な方法:
- 1966年から1993年にかけての英語研究の体系的レビュー.
- 有効性に関する大規模な見通し試験と,有害性に関するより小さな研究を含む.
- 予め定義された品質基準に基づくランダム化臨床試験の分析.
主要な成果:
- アンジオテンシン変換酵素 (ACE) 阻害剤は,心不全の第一線療法です.
- ACE阻害剤の定位を容易にするために,利尿剤は慎重に使用する必要があります.
- ディゴキシンは,ACE阻害剤や利尿剤に耐性のある症状のある患者だけに予約されています.
結論:
- ACE阻害剤は,適格性のあるすべての心不全の患者に投与されるべきである.
- 利尿剤の賢明な使用は,最適なACE阻害剤用量を確保するために不可欠です.
- イソソルビド・ディニートレート/ヒドララジンなどの代替治療は,ACE阻害剤不耐症または耐火性症状の選択肢です.
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