一项试验比较了两种联合治疗——替米沙坦加氢氯噻嗪：氨氯地平加氢氯噻嗪，结果表明替米沙坦的联合治疗（MicardisPlus）保持了老年高血压病人24小时内收缩压的更好控制。这项开放性研究是周四在美国老年病学会2005年会上报告的。
“关于本研究有趣的是它表明你能把老年人的高血压降到一个低水平，而且不会有任何副作用”，主要研究人员、哥本哈根大学的尼尔丹（Steen Neldam）说。
本研究比较了替米沙坦加氢氯噻嗪（HCTZ）和氨氯地平加HCTZ用于收缩期高血压为主的老年高血压病人。共招募了683名病人，60岁或以上，基线收缩压大于140mmHg，舒张压不超过95mmHg，平均24小时动脉收缩压大于125mmHg。
经过2～4周的安慰剂插入期后，病人被随机分为或替米沙坦（80mg）加氢氯噻嗪（12.5mg）（n=354），或氨氯地平（10mg）加氢氯噻嗪（12.5mg），治疗6周。以24小时动态监测来评估效果。替米沙坦治疗的病人收缩压平均降低了19.3mmHg，而氨氯地平组的平均降了17.2mmHg（p=0.001）。前组不仅收缩压改善更大，而且也控制更好。24小时动脉血压小于130mmHg的两组分别为69.5%和58.3%（p=0.0175）。
替米沙坦的耐受性似乎好于氨氯地平，前组8%报告有药物相关的不良事件，而后组为33.4%。两组最常见的主诉都是外周性水肿。
Angiotensin II Inhibitor Combo Controls Systolic Hypertension in Elderly
ORLANDO (Reuters Health) May 13 - The results of a trial comparing two combination therapies -- telmisartan plus hydrochlorothiazide to amlodipine plus hydrochlorothiazide -- suggest that the telmisartan combination (MicardisPlus) maintains better control of systolic pressure over a 24-hour period in older hypertensive adults.
The findings of this open-label study were reported here Thursday at the American Geriatrics Society 2005 annual meeting.
"The interesting thing about this study is that it shows that you can treat hypertension in elderly people to a low level -- where you might have thought you would get quite a bit of dizziness -- blood pressure can be diminished to a very good level without any side effects," said principal investigator Dr. Steen Neldam, of the University of Copenhagen.
Patients in the telmisartan arm reduced their systolic pressure by an average of 19.3 mm Hg, while those in the amlodipine arm reduced systolic pressure by an average of 17.2 mm Hg (p = 0.001).
The study, A comparison of Telmisartan plus HCTZ with amlodipine plus HCTZ in Older Patients with predominantly Systolic hypertension (ATHOS), enrolled 683 patients, age 60 or older, with baseline systolic pressure of more than 140 mm Hg, diastolic pressure not exceeding 95 mm Hg and a mean 24-hour ambulatory systolic blood pressure greater than 125 mm Hg.
After a 2- to 4-week placebo run-in, patients were randomized to telmisartan (80 mg) plus hydrochlorothiazide (12.5 mg) (n=354) or amlodipine (10 mg) plus hydrochlorothiazide (12.5 mg) for 6 weeks. Efficacy was assessed with 24-hour ambulatory monitoring.
Patients in telmisartan arm not only achieved a greater reduction in systolic pressure, they also demonstrated better control; 69.5% of the telmisartan patients recorded 24-hour mean systolic blood pressures of less than 130 mm Hg compared with 58.3% of those in the amlodipine arm (p = 0.0175).
Finally, telmisartan appeared to be better tolerated than amlodipine. Eight percent of patients in the telmisartan arm reported drug-related adverse events compared with 33.4% of patients in the amlodipine arm. In both groups peripheral edema was the most common complaint.
The study was funded by Boehringer Ingelheim, which makes and markets MicardisPlus. |
|
