antihypertensive agents and comorbility
參考資料: 2016 高血壓治療指引, 民眾版衛教手冊
一般而言, 降血壓藥物的好處, 來自於降壓幅度, 與藥物選擇關聯較小.
但不同的共病症仍有不同考量.
另外, 不同的藥物有不同的副作用, 有些疾病應避免選用特定藥物
高血壓藥物組合
1. ARB + Diuretic 優於 BB + Diuretic
2. CCB + ACEI 優於 BB + Diuretic
3. BB + Diuretic 相較於其他組合, 新診斷的DM個案較多.
Three large-scale RCTs have tested the superiority of one combination versus the other.242-244 In the LIFE trial, the combination of losartan (ARB) plus hydrochlorothiazide (diuretic) was compared with the combination of atenolol (beta-blocker) plus hydrochlorothiazide (diuretic), showing that ARB + diuretic combination was better than beta-blocker + diuretic combination in reducing CV endpoints, mainly stroke.242 The difference of achieved SBP was only 1.3 mmHg, lower in the ARB þ diuretic group. In the ASCOT trial, the combination of amlodipine + perindopril (CCB + ACE
inhibitor) was better than the combination of atenolol + benzofluthiazide (beta-blockerþdiuretic) in reducing total mortality and other CV endpoints with a SBP difference of 2.7 mmHg, lower in the CCB + ACE inhibitor group.243 Besides, the risk of new-onset diabetes from the combination of
beta-blocker + diuretic was higher than other combinations.367 Therefore, the combination of beta-blocker + diuretic is inferior to the combination of ARB+ diuretic or CCB + ACE inhibitor combinations.
the ACCOMPLISH trial 比較不同藥物組合對 reducing CV endpoints 差異
ACEI + CCB 與 ACEI + Diuretic 比較. 因ACEI + CCB 壓倒性的優勢, 所以實驗提早終止
對於腎功能的影響. 也是 ACEI + CCB 較優
對於糖尿病患 subgroup 也是 ACEI + CCB 較優
哪些類型藥物可以兩種組合使用
Recommended 2-drug combinations include:
✓ ARB + CCB (A + C)
✓ ACE inhibitor + CCB (A + C)
✓ ARB + thiazide diuretic (A + D)
✓ ACE inhibitor + thiazide diuretic (A + D)
✓ CCB + beta-blocker (B + C)
三種以上的血壓藥物組合, 研究較少, 不過從學理上建議可選
ACE inhibitor (or ARB) + CCB + Thiazide diuretic (A + C + D) combination
不建議合併使用的藥物包括 Unfavorable or prohibited 2-drug combinations include:
Beta-blocker + diuretic (except in heart failure)
ACE inhibitor + ARB (兩種都是作用於RAA系統renin-angiotensin system)
(ACE inhibitor or ARB) + DRI (direct renin inhibitor)
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