阿利斯基伦和通道阻断剂阿姆洛迪平因组合作为高血压控制的初始治疗策略 (ACCELERATE):一个随机的平行组试验
Morris J Brown1, Gordon T McInnes, Cheraz Cherif Papst
1Clinical Pharmacology Unit, Department of Medicine, University of Cambridge, Cambridge, UK. m.j.brown@cai.cam.ac.uk
Lancet (London, England)
|January 18, 2011
概括
开始使用阿利斯基伦和安洛迪平的联合治疗显著改善了高血压患者的早期血压控制. 这种方法是安全有效的,为实现目标血压目标提供了单一治疗的优越替代方案.
科学领域:
- 心血管医学 心血管医学
- 临床药理学 临床药理学
- 高血压研究 高血压研究
背景情况:
- 短期研究表明,初始组合疗法可以提高血压控制.
- 基本高血压影响了成年人口的很大一部分.
- 早期和有效的血压管理对于预防心血管并发症至关重要.
研究的目的:
- 为了评估是否与阿利斯基伦和安洛迪平的初始联合治疗优于单一治疗早期血压控制.
- 评估初始单一疗法是否影响后续组合疗法的有效性.
- 为了确定组合治疗是否导致与单一治疗相比出现过多的不良事件.
主要方法:
- 一个双盲,随机,并行组优势试验,涉及10个国家的146个地点.
- 招募的患者 (年龄≥18岁) 基本高血压和静脉压在150-180毫米升之间.
- 随机分配给阿利斯基伦,安洛迪平,或阿利斯基伦加安洛迪平,然后是16-32周的组合阶段.
主要成果:
- 初始组合疗法显示,与单一疗法相比,静脉血压 (6.5 mm Hg) 的降低显著更大 (p<0.0001).
- 在24周后,两组之间静脉压降低的差异为1.4mm Hg (p=0.059).
- 导致戒断的不良事件在不同组中是可比的,最常见的是外周胀,低血压和静止性低血压.
结论:
- 建议使用阿利斯基伦加安洛迪平联合治疗以例行初始降低高血压 (>150 mm Hg).
- 组合疗法在血压管理方面提供了卓越的早期有效性.
- 初始组合治疗的安全性概况是可以接受的.
相关概念视频
01:25Antihypertensive Drugs: Direct Renin Inhibitors
The renin-angiotensin-aldosterone system (RAAS) is an intricate physiological pathway involving numerous enzymes and hormones, including renin, angiotensin-converting enzyme (ACE), angiotensin I and II, and aldosterone. Imbalances within this system increase the production of angiotensin II and aldosterone. Increased angiotensin II levels promote vasoconstriction and blood pressure elevation. Concurrently, higher aldosterone levels stimulate sodium and water reabsorption in the kidneys,...
01:18Antihypertensive Drugs: Action of Calcium Channel Blockers
Calcium ions are essential to contract smooth muscle cells in blood vessels. They enter these cells through voltage-dependent calcium channels, specifically L-type calcium channels in the cell membrane. These L-type calcium channels are integral to the excitation-contraction coupling process in smooth muscle. When a stimulus is received by smooth muscle cells, their membrane depolarizes. This alteration in membrane potential instigates the opening of L-type calcium channels. As a result,...
01:28Hypertension IV: Drug Therapy and Lifestyle Modifications
Multiple classes of antihypertensive medications are employed in treating hypertension. The most commonly recommended first-line treatments include:Thiazide Diuretics, such as chlorthalidone, increase sodium and water excretion from the body, reducing blood volume and blood pressure.Angiotensin-converting enzyme inhibitors, like lisinopril, block the conversion of angiotensin I to II, a potent vasoconstrictor lowering blood pressure.Angiotensin II Receptor Blockers (ARBs) prevent angiotensin II...
01:25Antianginal Drugs: Calcium Channel Blockers and Ranolazine
Angina pectoris, a primary symptom of ischemic heart disease, requires careful pharmacological interventions. In this context, calcium channel blockers (CCBs) and ranolazine have emerged as crucial pharmacotherapeutic agents, providing deep insights into the complexities of angina management.
CCBs, a diverse class that includes dihydropyridines (nifedipine) and diphenylalkylamines (verapamil and diltiazem), exert their effect by blocking calcium channels in cardiac and smooth muscle cells. This...
CCBs, a diverse class that includes dihydropyridines (nifedipine) and diphenylalkylamines (verapamil and diltiazem), exert their effect by blocking calcium channels in cardiac and smooth muscle cells. This...
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
01:30Antihypertensive Drugs: Angiotensin II Receptor Blockers
In the renin-angiotensin-aldosterone system, a hormone called angiotensin II plays a crucial role. It binds to the AT1 receptors in vascular smooth muscles coupled with Gq proteins. The activation of these receptors activates an enzyme called phospholipase C, which releases two molecules: inositol trisphosphate and diacylglycerol. These molecules cause a chain reaction that leads to the phosphorylation of myosin light chains and promotes interaction between actin and myosin, leading to smooth...