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降压药何时服用效果最好新解 精选

已有 5019 次阅读 2022-10-19 15:46 |个人分类:健康生活|系统分类:科普集锦

降压药何时服用效果最好新解

诸平

taking-a-blood-pressur.jpg

Credit: Unsplash/CC0 Public Domain

1 高血压概况

据世界卫生组织(WHO)网站报道,高血压(Hypertension)是一种严重的疾病,会显著增加患心脏、大脑、肾脏和其他疾病的风险。高血压是全世界过早死亡的主要原因。据估计,全世界有12.8亿30-79岁的成年人患有高血压,其中大多数(三分之二)生活在低收入和中等收入国家。据估计,有46%的高血压成年人并不知道自己患有高血压,只有不到一半的高血压成人(42%)得到诊断和治疗,而得到控制的高血压患者大约有五分之一(21%)。防治非传染性疾病的全球目标之一是在2010~2030年期间将高血压患病率降低33%

世界卫生组织(WHO)网站2021825日发布 的联合新闻报道,根据《柳叶刀》(The Lancet2021825日发表的由伦敦帝国理工学院(Imperial College London)和世界卫生组织(WHO)主持撰写的首份全球高血压流行趋势综合分析报告,在过去30年中,30-79岁高血压成年人人数从6.5亿人增加到12.8亿人。其中将近一半人不知道自己患有高血压。

高血压是全世界死亡和疾病的一大因素,会显著加剧罹患心脏、大脑和肾脏疾病的风险。只要在家里或医疗点测量血压,就很易检出高血压,并且通常可以使用低成本药物有效进行药物治疗。

全球各地医生和研究人员联手开展了这项研究,研究涵盖时间为1990-2019年。研究项目使用了184个国家1亿多名30-79岁人的血压测量和治疗数据。这些数据覆盖全球99%的人口,最全面反映了迄今全球高血压趋势。

通过分析这些海量数据,研究人员发现,从1990-2019年,全球高血压总流行率变化不大,但疾病负担已从富裕国家转至低收入和中等收入国家。富裕国家的高血压流行率下降,目前流行率往往位居最低之列,但在许多低收入或中等收入国家则呈上升趋势。

2019年,加拿大、秘鲁和瑞士是世界上高血压流行率最低的国家,而多米尼加共和国、牙买加和巴拉圭女性以及匈牙利、巴拉圭和波兰男性高血压流行率最高。

1990年以来,高血压者百分比变化不大,但高血压人数翻了一番,达到12.8亿人。这主要是由于人口增长和老龄化。2019年,10亿多高血压者(占全球高血压者总数的82%)生活在低收入和中等收入国家。

2  降压药何时服用效果最好?

对于降压药何时服用效果最好?通过网络可以进行搜索,相关介绍甚多,以血压有两个高峰期,即上午6~10时(8~9时)及下午4~8时(2~3时);一般建议在清早起床后第一次饮用水时将降血压药服用,这样可以在早晨高峰值的时候将血压稳定下来。但是不同的患者病情不同,首先要选用一天一次的降压药,然后是清晨7时左右一次服用。如是一天二次的,清晨7时和下午4-5时即可。临床上的降压药基本是长效的,但睡前服用也有一定的副作用,血压降低太快,对心、肾、脑负担太重。不过总原则应该是在医生指导下,根据病情,遵守医嘱,按时按量服药为宜。

3 爱丁堡大学的最新研究结果

据爱丁堡大学(University of Edinburgh20221018日报道,降压药在一天中的任何时候都有效:大型临床试验推翻了之前的研究(Blood pressure medication effective at any time of day: Large clinical trial overturns previous research)。一项大型临床试验发现,如果在早上或晚上服用降血压药物同样有效。

这推翻了之前的研究,即如果在晚上服用降压药物可能更有效(百度搜索结果:在早上服用降压药物可能更有效)

降血压药物是英国处方最广泛的药物之一,有700万至900万人服用降血压药物以降低患心脏病和循环系统疾病的风险。临床试验这项针对21000多名高血压患者的新随机对照试验发现,早晨或晚上服用降压药对心脏病发作、中风或循环系统疾病的预防没有影响。

试验参与者至少服用了一种药物来降低血压。一半人被要求在晚上服药,另一半人被要求在早上服药。在对这些受试者进行了五年的跟踪研究后,发现心脏病发作、中风或循环系统疾病的人数没有差异——早上组362人,晚上组390人。

这项研究由英国爱丁堡大学、邓迪大学(University of Dundee)、格拉斯哥大学(University of Glasgow)和牛津大学(University of Oxford)、伦敦帝国理工学院(Imperial College London)和伦敦玛丽女王大学(Queen Mary University of London)的团队进行。相关研究结果于20221011日已经在《柳叶刀》(The Lancet)杂志网站发表——Isla S MackenzieAmy Rogers, Neil R Poulter FMedSci, Bryan Williams FMedSci, Morris J Brown, David J Webb, Ian Ford, David A Rorie, Greg Guthrie, J W Kerr Grieve, Filippo Pigazzani, Peter M Rothwell FMedSci, Robin Young, Alex McConnachie, Allan D Struthers FMedSci, Chim C Lang, Thomas M MacDonald, TIME Study Group. Cardiovascular outcomes in adults with hypertension with evening versus morning dosing of usual antihypertensives in the UK (TIME study): a prospective, randomised, open-label, blinded-endpoint clinical trial. The Lancet (2022). DOI: 10.1016/S0140-6736(22)01786-X. Available online 11 October 2022. https://doi.org/10.1016/S0140-6736(22)01786-X

克里斯汀治疗学和临床药理学主席(Christison Chair of Therapeutics and Clinical Pharmacology)、该研究作者大卫·韦伯(David Webb)教授说:“该研究的主要信息是,没有最佳时间服用降压片以达到更好的效果,因此患者应该在最适合自己的时间服用。”

上述介绍,仅供参考。欲了解更多信息,敬请注意浏览原文或者相关报道

Evening dosing of blood pressure medication not better than morning dosing

Summary

Background

Studies have suggested that evening dosing with antihypertensive therapy might have better outcomes than morning dosing. The Treatment in Morning versus Evening (TIME) study aimed to investigate whether evening dosing of usual antihypertensive medication improves major cardiovascular outcomes compared with morning dosing in patients with hypertension.

Methods

The TIME study is a prospective, pragmatic, decentralised, parallel-group study in the UK, that recruited adults (aged ≥18 years) with hypertension and taking at least one antihypertensive medication. Eligible participants were randomly assigned (1:1), without restriction, stratification, or minimisation, to take all of their usual antihypertensive medications in either the morning (06:00–10:00 h) or in the evening (20:00–00:00 h). Participants were followed up for the composite primary endpoint of vascular death or hospitalisation for non-fatal myocardial infarction or non-fatal stroke. Endpoints were identified by participant report or record linkage to National Health Service datasets and were adjudicated by a committee masked to treatment allocation. The primary endpoint was assessed as the time to first occurrence of an event in the intention-to-treat population (ie, all participants randomly assigned to a treatment group). Safety was assessed in all participants who submitted at least one follow-up questionnaire. The study is registered with EudraCT (2011-001968-21) and ISRCTN (18157641), and is now complete.

Findings

Between Dec 17, 2011, and June 5, 2018, 24 610 individuals were screened and 21 104 were randomly assigned to evening (n=10 503) or morning (n=10 601) dosing groups. Mean age at study entry was 65·1 years (SD 9·3); 12 136 (57·5%) participants were men; 8968 (42·5%) were women; 19 101 (90·5%) were White; 98 (0·5%) were Black, African, Caribbean, or Black British (ethnicity was not reported by 1637 [7·8%] participants); and 2725 (13·0%) had a previous cardiovascular disease. By the end of study follow-up (March 31, 2021), median follow-up was 5·2 years (IQR 4·9–5·7), and 529 (5·0%) of 10 503 participants assigned to evening treatment and 318 (3·0%) of 10 601 assigned to morning treatment had withdrawn from all follow-up. A primary endpoint event occurred in 362 (3·4%) participants assigned to evening treatment (0·69 events [95% CI 0·62–0·76] per 100 patient-years) and 390 (3·7%) assigned to morning treatment (0·72 events [95% CI 0·65–0·79] per 100 patient-years; unadjusted hazard ratio 0·95 [95% CI 0·83–1·10]; p=0·53). No safety concerns were identified.

Interpretation

Evening dosing of usual antihypertensive medication was not different from morning dosing in terms of major cardiovascular outcomes. Patients can be advised that they can take their regular antihypertensive medications at a convenient time that minimises any undesirable effects.

Funding

British Heart Foundation.



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