美国卫生系统初步组合抗高血压疗法的趋势
Jaejin An1,2, Hui Zhou1,2, Liang Ni1
1Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
American journal of hypertension
|December 24, 2025
概括
对于高血压 (BP) 的初始组合治疗显示出更好的BP控制,但近年来下降. 持续支持符合指南的护理对于有效的高血压管理至关重要.
科学领域:
- 心脏病学 心脏病学
- 公共卫生 公共卫生
- 药物治疗 药物治疗
背景情况:
- 建议初始组合治疗用于高血压管理.
- 一个综合医疗系统在2005年采用了组合疗法.
- 本研究评估了初始组合治疗的趋势及其对血压控制的影响.
研究的目的:
- 评估高血压初始组合疗法使用的年度趋势.
- 评估初始组合疗法与治疗后血压控制之间的关联.
- 确定影响组合治疗策略的采用和下降的因素.
主要方法:
- 一项涉及221,384名开始抗高血压治疗的患者的连续横截面研究 (2008-2024年).
- 每年开始组合治疗的患者的计算年龄和性别标准化比例.
- 估计的患病率 (PR) 达到BP目标 (<140/90 mmHg和<130/80 mmHg) 组合与单一治疗,调整为共变量.
主要成果:
- 最初的组合疗法使用在2011年达到顶峰 (45%) 并且到2024年下降到27%.
- 在所有治疗前的系统性血压水平中,下降是一致的.
- 初始组合疗法与改善的血压控制有关 (<140/90 mmHg的PR为1.09,<130/80 mmHg的PR为1.31).
结论:
- 尽管血压控制得到改善,但初始组合治疗的使用却有所减少.
- 这一趋势凸显了高血压的指导方针一致护理的潜在差距.
- 需要持续努力,以促进基于证据的组合疗法,以实现最佳的高血压管理.
相关概念视频
01:28Hypertension IV: Drug Therapy and Lifestyle Modifications
556
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...
556
01:25Antihypertensive Drugs: Direct Renin Inhibitors
1.2K
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,...
1.2K
01:30Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors
2.2K
Angiotensin-converting enzyme (ACE), a vital component of the renin-angiotensin-aldosterone system, is abundant in lung endothelial cells. ACE converts the inactive decapeptide, angiotensin I, into the active octapeptide, angiotensin II. This potent vasoconstrictor narrows blood vessels, increasing resistance to blood flow and elevating blood pressure. Angiotensin II also stimulates aldosterone production, encouraging kidney cells to reabsorb more sodium and water from urine, thereby increasing...
2.2K
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
869
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...
869
01:30Heart Failure V: Medical Management
195
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
195
01:30Antihypertensive Drugs: Angiotensin II Receptor Blockers
2.4K
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...
2.4K