高血压综合疗法:印度专家的见解

Peeyush Jain, S. C. Jha
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摘要

心血管疾病(CVDs)对全球健康构成重大挑战,而印度在心血管疾病相关的发病率和死亡率方面承受着不成比例的负担。高血压(HTN)是心血管疾病的主要风险因素,影响着近 30% 的印度人口。达到目标血压(BP)水平是降低心血管风险的关键,因此需要积极的降压治疗。联合疗法已成为高血压治疗的基石,尤其是在高危患者中。这篇综述深入探讨了印度心脏病专家对联合疗法治疗高血压的文献和观点。尽管当代降压药物疗效显著,但仍有相当一部分患者无法通过单一疗法达到目标血压水平。联合疗法具有协同作用,可解决高血压发病机制中的多种途径。最新的指南建议首先使用两药联合治疗,在耐药的情况下再过渡到三药联合治疗。与单一疗法相比,联合疗法不仅能加强血压控制,还能降低心血管事件和死亡风险。高血压的最佳治疗需要个性化的方法,考虑患者的个体情况和合并症,如冠状动脉疾病(CAD)、糖尿病(DM)、血脂异常和心力衰竭(HF)。在这种情况下,联合疗法在降低心血管风险方面发挥着关键作用。ARB/CCB联合疗法,尤其是替米沙坦/氨氯地平,在不同的患者群体(包括有代谢风险因素和肾功能损害的患者)中显示出显著的疗效和耐受性。专家建议在印度强调个体化治疗、患者教育、早期诊断和开始双重疗法的重要性。专家还强调了提高用药依从性和依从性的策略,如单药双联或三联疗法。此外,了解更新的治疗方案和非接触式诊断仪器对于优化高血压管理至关重要。总之,联合疗法是高血压管理的基石,可提高疗效、耐受性和心血管保护。专家建议指导下的定制方法对于解决印度日益增长的高血压负担和减少心血管疾病的社会经济影响至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Combination therapy for hypertension management: insights from the Indian experts
Cardiovascular diseases (CVDs) pose a significant global health challenge, with India bearing a disproportionate burden of CVD-related morbidity and mortality. Hypertension (HTN) is a major risk factor for CVDs, affecting nearly 30% of the Indian population. Achieving target blood pressure (BP) levels is crucial for reducing cardiovascular risk, necessitating aggressive antihypertensive therapy. Combination therapy has emerged as a cornerstone in HTN management, especially in high-risk patients. This review delves into the literature and perspectives of Indian cardiologists on combination therapy for HTN management. Despite the efficacy of contemporary antihypertensive medications, a substantial proportion of patients fail to reach target BP levels with monotherapy. Combination therapy offers synergistic effects, addressing multiple pathways involved in HTN pathogenesis. Recent guidelines recommend initiating treatment with two-drug combinations, transitioning to three-drug combinations in resistant cases. Combination therapy not only enhances BP control but also reduces the risk of cardiovascular events and mortality compared to monotherapy. Optimal management of HTN requires personalized approaches, considering individual patient profiles and comorbidities such as coronary artery disease (CAD), diabetes mellitus (DM), dyslipidemia, and heart failure (HF). In such cases, combination therapy plays a pivotal role in mitigating cardiovascular risks. ARB/CCB combination therapy, particularly telmisartan/amlodipine, demonstrates significant efficacy and tolerability across various patient populations, including those with metabolic risk factors and renal impairment. Expert recommendations highlight the importance of individualized therapy, patient education, early diagnosis, and initiation with dual therapy in India. Strategies to improve medication adherence and compliance, such as single-pill double or triple combinations, are emphasized. Moreover, awareness of newer treatment options and contactless diagnostic instruments is crucial for optimizing HTN management. In conclusion, combination therapy stands as a cornerstone in HTN management, offering enhanced efficacy, tolerability, and cardiovascular protection. Tailored approaches guided by expert recommendations are essential to address the growing burden of HTN and reduce the socioeconomic impact of CVDs in India.
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