利尿薬のこだわり その２
Cochrane
DatabaseのSystemic
Reviewによると、利尿薬はファーストラインの降圧薬がなんであろうと、セカンドラインで使うととても良い降圧効果を示したとあります。
Cochrane
DatabaseのSystemic
Reviewによると、利尿薬はファーストラインの降圧薬がなんであろうと、セカンドラインで使うととても良い降圧効果を示したとあります。ところで、例のHCTZ（Hydrochlorothiazide）の効果については議論がやっぱり出ているようです。もちろん、そんなに悪くないという議論が出ているわけです。利尿薬（HCTZ）をファーストラインで使っても大丈夫だろうと言う議論もあります。
ACCOMPLISHでは、ACE-Iと利尿薬よりもACE-IとCCB（カルシウム拮抗薬）の方がアウトカムが良いと出ています。いったい利尿薬はどう考えればいいか？まずは良い薬だと考えるべきです。そして今までの議論でもっとも重要なところが抜けていると思うべきです。つまり、食塩摂取量がいったいどうなっているか？ってことです。当然ですが、利尿薬は減塩をしている患者にはより良く効きます。そうでなければ効き方は減じます。これがもっとも重要な利尿薬のファクターなんです。これを抜きに議論しても埒があきません。
Vancouver, BC - Diuretics, when given as second-line therapy to treat hypertension, reduce blood pressure to about the same extent as when they are used as first-line treatment, a new review shows.
The results also indicate that the BP-lowering effect of diuretics depends on the dose used but is independent of the type of first-line agent used; the latter being an unexpected finding, say Jenny MH Chen (University of British Columbia, Vancouver) and colleagues in a report published October 7, 2009 in the Cochrane Database of Systematic Reviews.
Hydrochlorothiazide (HCTZ) was the diuretic used in 92% of the studies included in this review, and it has recently been the subject of some criticism. But Chen told heartwire she did not believe this to be warranted: "We believe that the recent criticism of HCTZ is misguided and not an accurate reflection of the evidence. Our review adds to the body of evidence demonstrating that HCTZ is indeed effective in lowering trough blood pressure; it can be given as a single daily pill and is an excellent drug choice for patients as the first or second drug."
Dr Franz Messerli (St Luke's Roosevelt Hospital, New York, NY), the lead author of a recent meta-analysis that concluded that HCTZ is a "paltry" antihypertensive at the usual doses prescribed (12.5-25 mg), told heartwire: "The meta-analysis of Chen et al is thorough and comprehensive, as one expects from this well-experienced team." But, he says, it is outcomes that are important, not merely lowering blood pressure, and there are no outcome data as yet for HCTZ 12.5 to 25 mg. "All outcome data with so-called 'thiazides' are based on chlorthalidone and indapamide."
The heart.orgから
ACCOMPLISHでは、ACE-Iと利尿薬よりもACE-IとCCB（カルシウム拮抗薬）の方がアウトカムが良いと出ています。いったい利尿薬はどう考えればいいか？まずは良い薬だと考えるべきです。そして今までの議論でもっとも重要なところが抜けていると思うべきです。つまり、食塩摂取量がいったいどうなっているか？ってことです。当然ですが、利尿薬は減塩をしている患者にはより良く効きます。そうでなければ効き方は減じます。これがもっとも重要な利尿薬のファクターなんです。これを抜きに議論しても埒があきません。
Vancouver, BC - Diuretics, when given as second-line therapy to treat hypertension, reduce blood pressure to about the same extent as when they are used as first-line treatment, a new review shows.
The results also indicate that the BP-lowering effect of diuretics depends on the dose used but is independent of the type of first-line agent used; the latter being an unexpected finding, say Jenny MH Chen (University of British Columbia, Vancouver) and colleagues in a report published October 7, 2009 in the Cochrane Database of Systematic Reviews.
Hydrochlorothiazide (HCTZ) was the diuretic used in 92% of the studies included in this review, and it has recently been the subject of some criticism. But Chen told heartwire she did not believe this to be warranted: "We believe that the recent criticism of HCTZ is misguided and not an accurate reflection of the evidence. Our review adds to the body of evidence demonstrating that HCTZ is indeed effective in lowering trough blood pressure; it can be given as a single daily pill and is an excellent drug choice for patients as the first or second drug."
Dr Franz Messerli (St Luke's Roosevelt Hospital, New York, NY), the lead author of a recent meta-analysis that concluded that HCTZ is a "paltry" antihypertensive at the usual doses prescribed (12.5-25 mg), told heartwire: "The meta-analysis of Chen et al is thorough and comprehensive, as one expects from this well-experienced team." But, he says, it is outcomes that are important, not merely lowering blood pressure, and there are no outcome data as yet for HCTZ 12.5 to 25 mg. "All outcome data with so-called 'thiazides' are based on chlorthalidone and indapamide."
The heart.orgから
Posted: 金 - 11月 6, 2009 at 07:17 午後 |
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Published On: 11月 06, 2009 07:23 午後
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Published On: 11月 06, 2009 07:23 午後