对4种抗高血压药物的血压反应的异质性:随机临床试验
Johan Sundström1,2, Lars Lind1, Shamim Nowrouzi1
1Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
JAMA
|April 11, 2023
概括
个性化高血压治疗可以显著降低平均4. 4毫米血压. 每个人对血压药物的反应各不相同, 这突显出需要量身定制的治疗策略.
科学领域:
- 心血管医学
- 临床药理学
- 高血压研究
背景情况:
- 高血压是导致过早死亡的主要全球风险因素.
- 有许多治疗方法可以降低血压,但最佳的个性化药物选择仍然不清楚.
研究的目的:
- 量化针对个体患者的特定抗高血压药物类别的潜在益处.
- 研究患者对不同血压药物反应的异质性.
主要方法:
- 一个随机,双盲,交叉试验,涉及270名1级高血压患者.
- 参与者接受了四种药物类别的连续治疗:利西诺普里尔,坎德沙坦,氨酸和阿姆洛迪平.
- 混合效应模型分析了个体治疗反应,并估计了个性化治疗的益处.
主要成果:
- 观察到不同药物类别对血压反应的显著个体间变异 (P < .001).
- 个性化治疗策略显示可能进一步降低系统血压平均4. 4毫米升.
- 特定药物类别的比较显示了某些患者亚组的有效性明显不同.
结论:
- 患者对抗高血压药物治疗的反应存在显著的异质性.
- 这些发现支持个性化医疗方法在高血压管理中优化血压控制的可能性.
相关概念视频
Hypertension IV: Drug Therapy and Lifestyle Modifications
24
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...
24
Hypertension III: Clinical Manifestations and Diagnostic Studies
36
Hypertension is asymptomatic and also referred to as the "silent killer" until it progresses to a severe stage or causes target organ disease. Patients may experience symptoms stemming from the strain on blood vessels and tissues in various organs or the heart's increased workload.Physical exams might show no abnormalities other than high blood pressure. Signs of vascular damage, when present, correspond to the organs supplied by the affected vessels, leading to target organ damage. For...
36
Hypertension and Regulation of Blood Pressure
2.2K
Hypertension, the most common cardiovascular disease, is diagnosed through repeated measurements of elevated blood pressure. Its risks, including damage to the kidney, heart, and brain, are directly proportional to blood pressure levels. Starting from 115/75 mm Hg, the risk of cardiovascular disease doubles with each increment of 20/10 mm Hg. The diagnosis relies on blood pressure measurements, not on patient symptoms, as hypertension is often asymptomatic until end-organ damage is imminent or...
2.2K
Antihypertensive Drugs: Direct Renin Inhibitors
721
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,...
721
Chronopharmacokinetics: Circadian Rhythms and Influence on Drug Response
99
Circadian rhythms are cyclic changes that are crucial in plasma drug concentrations. Various standard circadian parameters, including core body temperature, heart rate, and other cardiovascular factors, directly impact disease states and the therapeutic response to drug therapy.
The time of drug administration is an important factor to consider, as it can influence the toxic dose of a drug. For example, a study conducted by Prins et al. in 1997 examined the effects of the timing of...
The time of drug administration is an important factor to consider, as it can influence the toxic dose of a drug. For example, a study conducted by Prins et al. in 1997 examined the effects of the timing of...
99
Antihypertensive Drugs: Vasodilators
586
Vasodilators, primarily affecting the smooth muscles within arterial and venous walls, are commonly used for hypertension treatment. Medications such as minoxidil and hydralazine primarily target arteries and arterioles, while sodium nitroprusside acts on arterioles and venules. Minoxidil, functioning as a prodrug, is metabolized by hepatic sulfotransferase into its active form, minoxidil sulfate, after oral administration. This metabolite binds to the sulfonylurea receptor (SUR) component of...
586


