探讨中国_美国及欧洲高血压防治指南中有关药物治疗的问题

1,2(1.,100061;2.,100005):2005-09-02,:2005-10-25:(1973-),,,Tel:[phone];(1923-),,,Tel:[phone],E2mail:[e-mail]:R205;R544110513;R97214:A:1001-1978(2006)01-0014-06:,,,,,,,,24h,,,,,,2004,,,,2004,,,,:,,,35742712%,113[1],,,,,[2,3],,,,[1]2003,/(ESH/ESC)[4](NIH)[5]//(WHO/ISH)[6]200410[78],,,,,,11.1(JNC7)[5]:(ACEI)(ARB)1,,(Tab1)2003/(ESH/ESC)()[4]:ACEIARB,,,JNC7,1.2JNC7[5]JNC7,WHO2003:41ChinesePharmacologicalBulletin2006Jan;22(1):149Tab1JNC7[2]polythiazideEplerenoneACEIARBolmesartan12,,,[6],,,JNC7,ACEIARB[4],,,,[7,8]1.3,,,ARB,;;ACEIARB;ARB;,,ACEI[4],(Tab2),JNC7[5](Tab3)Tab2[4](),,,(),(),,,,,,,,,,(),,,,,(,),,,ACEI,,,,1,,,ARB2,,,,ACEI,,,51ChinesePharmacologicalBulletin2006Jan;22(1)Tab3JNC7[5]BBsACEIARBCCBsAldoANTBBs:;CCBs:;AldoANT:1.4[4578],,:,;,;JNC7,,,,,,,,[4],Tab4Tab4[4578]1BBs+++2ACEIARB+++3CCBs()BBs++-4CCBsACEI+++5CCBsARB++-6CCBs++-7BBs++-82ACEIARB++-9--+10--+BBs:;CCBs:;+:;-:1.511,,[4578]1.6,,2004,,,2002,,Jadad,Jadad13,02,02,12,Jadad3[9],1.7JNC7,,,(CNS),,[10],CNS,WHO2WHO,,[11],,,,,,,2.1Meta-,[4],,,2.2,,,,,19602,,,61ChinesePharmacologicalBulletin2006Jan;22(1)Tab5/mg12.5-500.39(25mg10)0.60-2.341.25-2.519.50(,2.5mg30)9.75-19.525-1004.00(12.5mg60)4.00-16.00ACEI25-10037.00(,12.5mg20)111.00-444.0010.00(25mg100)3.30-13.205-4036.5(,5mg10)109.50-876.0019.9(,5mg20)30.0-240.0010-4055.40(,10mg14)110.80-443.202.5-1045.50(,5mg7)91.00-364.0032.10(,5mg7)64.20-256.80ARB25-10053.50(,50mg7)107.00-428.00JNC7;20052,,ACEI,()[12]Meta-190,617%,311%,,[12]2.3,112.4,,Tab5,Tab5,;,10,,2.5,?,10ACEI5,,5?,,,,,-,,10,,,-Ca2+LNT,L[10],,,,322322A,(LDL2C),,P450(CYP),CYP3A4,CYP2C9,CYP3A4CYP2C8,,,,,2002[13],,,,71ChinesePharmacologicalBulletin2006Jan;22(1)3,,WHO,,,JNC72003,,,2004,,,,(:):[1],JiangHe,etal.[J].,2003,37(2):84-90.[2],,.2003[J].,2004,4(4):212-4.[3],,,.19972000[J].,2001,12(7):412-3.[4]CommitteeG.2003Europeansocietyofhypertension2europeanso2cietyofcardiologyguidelinesforthemanagementofarterialhyper2tension[J].JHypertension,2003,21:1011-53.[5]TheSeventhReportoftheJointNationalCommitteeonPrevention,Detection,Evaluation,andTreatmentofHighBloodPressure(JNCT):isitreallypractical[J]?NatlMedJIndia,2004,17(4):227.[6]WhitworthJA:WorldHealthOrganization,InternationalSocietyofHypertensionWritingGroup.2003WorldHealthOrganization(WHO)/InternationalSocietyofHypertension(ISH)statementonmanagementofhypertension[J].JHypertens,2003,21(11):1983-92.[7],,.2004(,)[J].,2005,5(1):64.[8],,.2004(,)[J].,2005,5(2):128.[9],,etal.()..[10]JoelG.Hardman,LeeE.Limbird.Goodman&GilmansThePharmacologicalBasisofTherapeutics,10/e[M]...10,:.[11]GuidetoGoodPrescribing.APracticalManual.Geneva:WorldHealthOrganization;1994.[12]HillSR,SmithAJ.First2Linemedicinesinthetreatmentofhyper2tension[J].AustralianPrescriber,2005,28:34-7.[13]YanL,LanF,WangZG,LiYP.Statinsandmyotoxicity[J].TrendsPharmacolSci,2003,24(3):113-4.DiscussiononChinese,AmericanandEuropeanguidelinesforthemedicinesinthetreatmentofhypertensionYANLin1,WANGZhen2gang2(1.CenterforDrugRe2evaluation,StateFoodandDrugAdministrationofChina,Beijing100061,China;2.InstituteofBasicMedicalSciences,PVMC,Beijing100005,China)Abstract:Thechoiceofmedicinesisakeypointinthetreatmentofhypertension.TherearehundredsofantihypertensivedrugsinChina,includingTraditionalChineseMedicines(TCM),chemicalmedicinesandallkindsofcompoundpreparation.ButtheratesoftreatmentandcontrolofhypertensioninChinaareverylow,thesituationofhypertensionmanagementinChinaiscritical.InthisarticlewecomparedthedifferencesinthedrugtreatmentamongChinese,AmericanandEuropeanguidelinesforthemanagementofhyperten2sion,anddiscussedtheprinciplesofchoosingantihy2pertensivedrugs.Chinese,AmericanandEuropeanguidelinesallmentionthatthespecificdrugclassesmaydifferinsomeeffectorinspecialgroupsofpa2tients,socertaincompellingindicationrequirescertainantihypertensivedrugclasses.Threeguidelinesalsoemphasizethebenefitsobtainedfromthecombinationtherapyandrecommendthelong2actingdrugsorprepa2rationswith24hefficacy.Themaindifferencesamongthethreeguidelinesiswhethertorecommendthefirst281ChinesePharmacologicalBulletin2006Jan;22(1)linedrugs.Thiazide2typediureticsarerecommendedbyAmericanguideline(JNC7)indrugtreatmentformostpatientswithuncomplicatedhypertension.ButtheEuropeanandChineseguidelinesdonotrecommendthefirst2linedrugs,andthemajorclassesofantihyper2tensiveagentsaresuitablefortheinitiationandmainte2nanceoftherapy.TraditionalChinesemedicinesareinvaluableresourceofChina,allkindsofantihyperten2siveTCMarewidelyusedintheclinical,butowingtothedeficiencyofthehigh2qualityevidenceforTCM,thepartofTCMisnotincludedinthe2004Chineseguidelineforthemanagementofhypertension.Thechoiceofantihypertensivedrugsisdeterminedbyitsef2ficacyandsafety.Whensafetyandefficacyareequal,thelowestcostdrugshouldbepreferred.Forthema2jorityofpatientswithoutacompellingindicationforan2otherclassofdrug,alowdoseofthiazidesdiureticshouldbeconsideredasthefirstchoiceinChina.2004Chineseguidelineforthemanag