ช่วยแปลทีครับผม T^T
lower incidence of hypokalemia than with diuretics alone. In
fact, the concomitant use of potassium-sparing diuretics such
as triameterene, spironolactone, amiloride, or oral potassium
supplementation in patients taking these combinations is discouraged
in most because of the risk for hyperkalemia.45,80
Diuretics often are combined with direct-acting vasodilators
such as hydralazine and minoxidil because of the peripheral
edema that may develop when unopposed reflex activation of
the sympathetic nervous system by drugs in this class results
in increased renal sodiumreabsorption.66 Frequently a third
drug, a _-blocker or a central sympatholytic agent such as
clonidine, is added to blunt the reflex tachycardia consequent
to sympathetic activation.66
Combinations of calcium antagonists and ACEIs have been
studied extensively in randomized clinical trials. A fixed-dose
combination of amlodipine/benazepril, 10/20 mg, controlled
blood pressure in a greater percentage of patients with stage II
hypertension (61%) than did amlodipine alone at 10 mg
(43%); the incidence of peripheral edema in patients taking
the combination was half that of patients on amlodipine
monotherapy.81 In another study, patients with systolic hypertension
achieved better blood pressure reduction on amlodipine/
benazepril 5/20 mg than patients receiving either
amlodipine 10 mg or benazepril 40 mg.82 Low fixed-dose
amlodipine/benazepril also has been shown to improve arterial
distensibility and reduce left ventricular mass in hypertensive
patients more than higher doses of either drug given
as monotherapy.83 Even though DCAs such as amlodipine
given as monotherapy either have no effect or worsen urinary
protein excretion in patients with proteinuria,84,85 they do
not negate the reduction in proteinuria observed with ACEIs
when administered as part of an ACEI-DCA combination,86
probably because both systemic blood pressure and intraglomerular
pressure are reduced by the complementary action
of the 2 drugs on the afferent and efferent arteriole, respectively.
87 The NDCA drugs such as verapamil have either a
neutral or less-negative effect on proteinuria than the DCAs
and actually may improve urinary protein excretion when
given with an ACEI.88 The pre-capillary arteriolar and postcapillary
venular dilating effects of DCAs and ACEIs, respectively,
balance pressure across the capillary which results in a
reduction of the peripheral edema associated with DCA
monotherapy in some patients.89
The effects of combining ARBs with CCBs on renal function,
proteinuria, surrogate markers of cardiovascular disease
such as left ventricular mass or arterial distensibility, and
CCB-associated adverse effects have not been studied systematically
to date. Therefore, it is not surprising that fixed-dose
combinations of drugs representing these 2 classes are not
available. Also absent from the list of fixed-dose combinations
are drugs containing both an ACEI and an ARB. Interest
in conducting studies to obtain Food and Drug Administration
approval for such combinations likely will increase if
pilot trials of such combinations show a more marked reduction
in the rate of deterioration in renal function in diabetic
and hypertensive patients than is achieved with either ACEIs
or ARBs alone.
The addition of drugs to the patient’s therapeutic regimen
to achieve goal blood pressure other than those combinations
included in Figure 2 sometimes is necessary. In selected patients,
especially those with evidence of increased sympathetic
nervous system activity, _1-receptor antagonists and
sympatholytic agents including clonidine and reserpine may
be indicated. In the patient whose blood pressure still is
increased despite 3-drug therapy (defined as resistant hypertension
by JNC 71), the addition of low-dose spironolactone
should be considered. An additional mean blood pressure
reduction of 25/12 mm Hg was achieved in both African-
American and Caucasian resistant hypertensive patients taking
calcium antagonists, ACEIs, and diuretics 6 months after
adding spironolactone to this regimen in doses titrated up to
50 mg.90 The response to spironolactone was similar in those
patients with and without evidence of hyperaldosteronism.
ช่วยเหลือทีครับ แปลศัพท์ทางการแพทย์
lower incidence of hypokalemia than with diuretics alone. In
fact, the concomitant use of potassium-sparing diuretics such
as triameterene, spironolactone, amiloride, or oral potassium
supplementation in patients taking these combinations is discouraged
in most because of the risk for hyperkalemia.45,80
Diuretics often are combined with direct-acting vasodilators
such as hydralazine and minoxidil because of the peripheral
edema that may develop when unopposed reflex activation of
the sympathetic nervous system by drugs in this class results
in increased renal sodiumreabsorption.66 Frequently a third
drug, a _-blocker or a central sympatholytic agent such as
clonidine, is added to blunt the reflex tachycardia consequent
to sympathetic activation.66
Combinations of calcium antagonists and ACEIs have been
studied extensively in randomized clinical trials. A fixed-dose
combination of amlodipine/benazepril, 10/20 mg, controlled
blood pressure in a greater percentage of patients with stage II
hypertension (61%) than did amlodipine alone at 10 mg
(43%); the incidence of peripheral edema in patients taking
the combination was half that of patients on amlodipine
monotherapy.81 In another study, patients with systolic hypertension
achieved better blood pressure reduction on amlodipine/
benazepril 5/20 mg than patients receiving either
amlodipine 10 mg or benazepril 40 mg.82 Low fixed-dose
amlodipine/benazepril also has been shown to improve arterial
distensibility and reduce left ventricular mass in hypertensive
patients more than higher doses of either drug given
as monotherapy.83 Even though DCAs such as amlodipine
given as monotherapy either have no effect or worsen urinary
protein excretion in patients with proteinuria,84,85 they do
not negate the reduction in proteinuria observed with ACEIs
when administered as part of an ACEI-DCA combination,86
probably because both systemic blood pressure and intraglomerular
pressure are reduced by the complementary action
of the 2 drugs on the afferent and efferent arteriole, respectively.
87 The NDCA drugs such as verapamil have either a
neutral or less-negative effect on proteinuria than the DCAs
and actually may improve urinary protein excretion when
given with an ACEI.88 The pre-capillary arteriolar and postcapillary
venular dilating effects of DCAs and ACEIs, respectively,
balance pressure across the capillary which results in a
reduction of the peripheral edema associated with DCA
monotherapy in some patients.89
The effects of combining ARBs with CCBs on renal function,
proteinuria, surrogate markers of cardiovascular disease
such as left ventricular mass or arterial distensibility, and
CCB-associated adverse effects have not been studied systematically
to date. Therefore, it is not surprising that fixed-dose
combinations of drugs representing these 2 classes are not
available. Also absent from the list of fixed-dose combinations
are drugs containing both an ACEI and an ARB. Interest
in conducting studies to obtain Food and Drug Administration
approval for such combinations likely will increase if
pilot trials of such combinations show a more marked reduction
in the rate of deterioration in renal function in diabetic
and hypertensive patients than is achieved with either ACEIs
or ARBs alone.
The addition of drugs to the patient’s therapeutic regimen
to achieve goal blood pressure other than those combinations
included in Figure 2 sometimes is necessary. In selected patients,
especially those with evidence of increased sympathetic
nervous system activity, _1-receptor antagonists and
sympatholytic agents including clonidine and reserpine may
be indicated. In the patient whose blood pressure still is
increased despite 3-drug therapy (defined as resistant hypertension
by JNC 71), the addition of low-dose spironolactone
should be considered. An additional mean blood pressure
reduction of 25/12 mm Hg was achieved in both African-
American and Caucasian resistant hypertensive patients taking
calcium antagonists, ACEIs, and diuretics 6 months after
adding spironolactone to this regimen in doses titrated up to
50 mg.90 The response to spironolactone was similar in those
patients with and without evidence of hyperaldosteronism.