联合用药的降压治疗优于单一用药双倍剂量治疗

1、联合用药的降压治疗优于单一用药双倍剂量治疗(2009-04-01 12:09:28) 转载MedWire News: Blood pressure (BP) reduction from combining drugs from different classes can be predicted on the basis of additive effects, and is approximately five times greater than doubling the dose of a single drug, a study indicates.MedWire 新闻：一项研究显示

2、，不同种药物的联合用药的降压作用是叠加的效应，大概是单种药物双倍剂量的五倍药效。Effectiveness of low-dose drug combinations as initial treatment for BP reduction relies on the effects of the combined drugs being additive.低剂量药物的初始降压效果依赖于联合用药的叠加作用。To examine the evidence for this, a team from the London Queen Marys School of Medicine and De

3、ntistry, UK, led by David Wald, conducted a meta-analysis of 42 factorial trials involving 10,968 participants in which combinations of any two of thiazides, beta-blockers, ACE inhibitors (ACEIs), and calcium channel blockers (CCBs) were tested against each drug given alone and placebo.为找到研究的证据，来自英国

4、伦敦女王玛丽口腔医学与临床医学院的David Wald领导的实验小组对10968名参加者进行了42个析因试验并进行荟萃分析。试验者从噻嗪类利尿药、-受体阻断剂、血管紧张素转化酶抑制剂、钙通道阻滞剂中选取2种联合用药，或是单用一种药物和安慰剂。With thiazide used alone, the mean placebo-subtracted reduction in systolic blood pressure was 7.3 mmHg, and 14.6 mmHg combined with a drug from another class. The corresponding r

5、eductions were 9.3 mmHg and 18.9 mmHg with beta-blocker, 6.8 mmHg and 13.9 mmHg with ACEI, and 8.4 mmHg and 14.3 mmHg with CCB.噻嗪类利尿药单用的平均收缩压减少7.3 mmHg而联合用药是减少 14.6 mmHg。相应的-受体阻断剂单用和联用分别减少9.3 mmHg 和18.9 mmHg，ACEI单用和联用分别减少6.8 mmHg 和13.9 mmHg，CCB单用和联用分别减少8.4 mmHg 和14.3 mmHg。The expected blood pressure

6、 reduction from two drugs together, assuming an additive effect, closely predicted the observed blood pressure reductions. The ratios of the observed to expected incremental blood pressure reductions from combining each class of drug with any other over that from one drug were, respectively, for thi

7、azides, beta-blockers, ACEIs, and CCBs: 1.04, 1.00, 1.16, and 0.89. The overall average was 1.01.原先假设的期望中的两种药物的联合作用的效果接近于实测得到的降压值。联合用药的血压降低的值比单用血压降低的值增加的比率分别是：噻嗪类利尿药、-受体阻断剂、血管紧张素转化酶抑制剂、钙通道阻滞剂1.04, 1.00, 1.16, 0.89。总的平均值是1.01。Comparison of results with those of a published meta-analysis of different

8、doses of the same drug showed that doubling the dose of one drug had approximately one fifth of the equivalent incremental effect (0.22).对药物的不同剂量的药效结果的荟萃分析显示双倍剂量的单用药物的药效只有联合用药的1/5（0.22）。Writing in the American Medical Journal, the researchers conclude: “The results leave little doubt over the advant

9、ages of adopting low-dose combination blood pressure-lowering treatment as routine initial therapy for all, instead of a monotherapy and stepped-care approach.”发表于美国医学杂志，作者写道：“研究结果表明采用低剂量联合用药的降压方法作为常规治疗方案比单一疗法和逐步疗法更有优势。”They also note: “Low-dose therapy has the advantage of reducing adverse effects

10、that are strongly dose related Using more than two drugs in combination also would increase efficacy”.他们还写道：“低剂量的优势还在于可以减少副作用这是与剂量有关的两种以上药物的联合应用有助增加药效。”编译：MedWire 新闻：一项研究显示，不同种药物的联合用药的降压作用是叠加的效应，大概是单种药物双倍剂量的五倍药效。低剂量药物的初始降压效果依赖于联合用药的叠加作用。为找到研究的证据，来自英国伦敦女王玛丽口腔医学与临床医学院的David Wald领导的实验小组对10968名参加者进行了42个

11、析因试验并进行荟萃分析。试验者从噻嗪类利尿药、-受体阻断剂、血管紧张素转化酶抑制剂、钙通道阻滞剂中选取2种联合用药，或是单用一种药物和安慰剂。噻嗪类利尿药单用的平均收缩压减少7.3 mmHg而联合用药是减少 14.6 mmHg。相应的-受体阻断剂单用和联用分别减少9.3 mmHg 和18.9 mmHg，ACEI单用和联用分别减少6.8 mmHg 和13.9 mmHg，CCB单用和联用分别减少8.4 mmHg 和14.3 mmHg。原先假设的期望中的两种药物的联合作用的效果接近于实测得到的降压值。联合用药的血压降低的值比单用血压降低的值增加的比率分别是：噻嗪类利尿药、-受体阻断剂、血管紧张素转化酶抑制剂、钙通道阻滞剂1.04, 1.00, 1.16,