[ACC2009]降压速度：快速还是和缓？—专访Norman Kaplan、Suzanne Oparil、Henry R. Black -国际循环网

[ACC2009]降压速度：快速还是和缓？—专访Norman Kaplan、Suzanne Oparil、Henry R. Black

作者:国际循环网日期:2009/5/15 19:12:00

Black博士：钙通道阻滞剂是非常好的抗高血压药物，无论是用于起始治疗，还是作为联合治疗的用药之一。ALLHAT试验证实CCB是很好的降压选择。ACCOMPLISH试验显示，CCB与ACEI联用优于利尿剂加ACEI。ASCOT试验也是如此。这些大型临床试验给我们的治疗提供了依据。特别是对于中国人群，发生卒中的风险很高，CCB是非常理想的药物，中国的高血压患者应当尽量早使用CCB。

Norman Kaplan
美国心脏协会（AHA）终身成就奖得主
WHO/ISH指南委员会成员
美国德克萨斯大学西南医学中心教授

Dr. Norman Kaplan: Now that has been a philosophy but I think we realize there is no need for hurry. When people's blood pressures are reduced markedly, they often become weak, fatigued, and dizzy. If those symptoms can be prevented than it is more likely that patients will stay on therapy. So unless the patient is really in major distress at the moment, and with a very high pressure, then going slowly rather than more rapidly is probably the best way to manage those patients. If we lower the blood pressure slowly, patients will be more likely to remain symptomatic and not be bothered by the medication and, therefore, hopefully will be more willing to stay on the medication.

Kaplan博士：首先，大家都已经意识到，降压没有必要非常的快。当血压非常快速下降时，经常会有明显的副作用发生，如无力、疲惫、头晕等。但是，我们如果能够避免上述症状。患者就更容易坚持治疗，患者的依从性和顺应性就会很好。除非患者有严重的症状，同时血压又很高的时候，才需要快速降压，绝大多数情况下，和缓降压是管理血压的最佳方式。如果我们和缓地降低血压，患者就不会出现相关的副作用症状，用药也不会对他们造成困扰，成为负担，当然这样患者治疗的依从性就会更好

Suzanne Oparil
JNC 8指南委员会主席
美国高血压协会（ASH）前任主席
美国阿拉巴马大学伯明翰分校教授

Dr. Suzanne Oparil: Getting patients under rapid control is satisfying to the patient because in the US most patients have home blood pressure machines so they are monitoring their pressure and if they don't see a change in a few days they think that you are not a good doctor and the drug is not working. Very fast is very bad. We don't use for example, capsule nifedipine is not used anymore because it drops the pressure too fast and there have had problems with heart attacks and strokes with that. We prefer drugs that are true once a day, that act over a long period of time.

Oparil博士：往往患者本身非常喜欢快速控制血压，因为在美国，大多数患者家里都备有血压计，所以他们一直在监测血压。如果用药后血压降不下来，患者会主观地埋怨医生的水平不高，或者直接地认为降压药物不起作用。但事实上，降压非常快就是非常糟糕。举个例子来说，目前我们不用普通剂型的硝苯地平，就是因为它降压太快了，会引发心脏病发作和卒中等问题。我们更倾向于应用真正的每日只需服用一次、作用时间长的药物。

Henry R. Black
美国高血压协会（ASH）现任主席
美国纽约大学医学院教授

Dr. Henry R. Black: In the past there has been confusion, I think, between what we would call the urgent treatment of hypertension, or immediate treatment and the prompt treatment. We think from carefully analyzing recent clinical trials, that the rate that you lower blood pressure can make a big difference on outcomes. And I am not talking hours, certainly not minutes; I am not even talking days. I am talking about weeks and months. Start a drug, one drug if you wish, or one therapy if you wish, not switch to something else but rather to add. We know that drugs with their different mechanisms, on a platform of lifestyle modifications, will have the best outcomes. The VALUE study in particular, showed that if you didn't get blood pressure down within the first three months, that the stroke rate stayed high, you didn't catch up until the very end of that study.

Black博士：以往我们混淆了紧急降压和快速降压的概念。在仔细分析最新的临床试验数据之后，我们发现，降压速度不同时，患者的转归有巨大差异。这里我说的不是几分钟或几小时，也不是几天，而是在几周或几个月内使患者的血压达标。起始治疗应用单一药物，必要时也可以应用联合治疗。我们可以增加药物剂量，但是最好不要轻易换药。应用作用机制不同的抗高血压药物，在生活方式干预的基础上，能够取得最佳疗效。需要特别提到的是VALUE研究，结果显示，如果在试验的前3个月没有把血压降下来，那么卒中的发生率居高不下。直到试验结束时依然如此。