在日本,在没有控制的高血压患者中,萨库比特里尔/瓦尔萨坦和 thiazide 利尿剂之间的比较
Kazuo Kobayashi1,2, Mari Sotozawa3, Keiichi Chin4
1Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Kanagawa Prefecture, Japan. k-taishi@xc4.so-net.ne.jp.
概括
在耐高血压患者中,萨库比特里尔/瓦尔沙坦与 thiazide 利尿剂相比,显示出更好的血压控制和更好的代谢标志物. 这种新型组合疗法也显示出更好的治疗耐受性,降低了不良事件中止率.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 腎臟病學 (nephrology) 是一種醫學.
背景情况:
- 在日本,尽管胺-血管素系统 (RAS) 抑制剂和通道阻塞剂的患病率很高,但在高血压治疗中,胺利尿剂的使用不足.
- 控制不良的高血压患者往往需要额外的治疗策略,而不仅仅是标准RAS抑制剂和通道阻塞剂.
- 评估替代抗高血压药物如萨库比特里尔/瓦尔萨坦与已知治疗方法如 thiazides 相比,对于优化患者护理至关重要.
研究的目的:
- 为了比较sacubitril/valsartan与 thiazide利尿剂在RAS抑制剂和通道阻塞剂控制不充分的高血压患者中的疗效和安全性.
- 为了评估降低血压 (BP),目标BP实现率,以及两种药物类别之间的治疗耐受性.
主要方法:
- 一项涉及耐药高血压患者的比较研究,分为一种 thiazide (THZ) 组 (n=306) 和一种 sacubitril/valsartan (SacVal) 组 (n=433).
- 使用逆概率加权的倾向性得分分析,以尽量减少混因素.
- 进行了办公室和家庭血压监测,对代谢参数 (尿酸,HbA1c,eGFR) 的评估和不良事件报告.
主要成果:
- 与THZ组相比,SacVal组在4个月内实现了明显更高的目标血压率 (37%对26%,p<0.001).
- 两组都显示出显著的血压降低,但SacVal治疗与因不良事件而导致停药率显著降低 (3%对10%,p<0.001).
- 与 thiazides 相比,sacubitril/valsartan 治疗导致系统性血压,尿酸和糖化血红蛋白 A1c 水平显著降低,以及较高的估计膜过率 (eGFR).
结论:
- 萨库比特里尔/瓦尔萨坦提供了与 thiazide 利尿剂相比较的血压降低,具有更好的耐受性和对代谢参数的有益影响.
- 这项研究表明,萨库比特里尔/瓦尔沙坦是耐药高血压患者的可行且潜在的有利替代品,特别是那些患有 thiazides 的不良影响的人.
- 这些发现支持在管理难以控制的高血压时扩大使用萨库比特里尔/瓦尔萨坦,考虑到其有利的代谢概况和安全性.
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