阿布贾大学Dike B. Ojji团队近日取得一项新成果。他们比较了降低非洲黑人血压的双药治疗方法。 相关论文于2019年6月20日发表于国际顶尖学术期刊《新英格兰医学杂志》杂志上。

研究人员在撒哈拉以南非洲的六个国家进行了随机、单盲、三组试验，小组随机分配不受控制的高血压患者728名黑人(≥140/90毫米汞柱在患者没有接受治疗或服用抗高血压药物),每日服用5mg氨氯地平加12.5mg克氢氯噻嗪，5mg氨氯地平加4mg培哚普利，或4mg培哚普利加12.5mg氢氯噻嗪2个月。 然后将剂量加倍(分别为10毫克和25毫克、10毫克和8毫克、8毫克和25毫克)，再延长4个月。 主要终点是基线至6个月间24小时动态收缩压的变化。 患者的平均年龄为51岁，其中63%为女性。 在621名病人24小时血压监测基线和6个月,那些接受氨氯地平+氢氯噻嗪和那些接受氨氯地平+培哚普利24小时动态收缩压低于那些接受培哚普利+氢氯噻嗪(从基线,群体间的差异变化 3.14毫米汞柱;95%置信区间[CI]， 5.90 ~ 0.38;P = 0.03;以及3.00毫米汞柱;95% CI, 5.8 - 0.20;分别为P = 0.04)。 氨氯地平加氢氯噻嗪组与氨氯地平加培哚普利组之间的差异为0.14 mm Hg (95% CI, 2.90 ~ 2.61;P = 0.92)。 在这三组中，对诊室血压、动态舒张压、血压控制和反应率的差异也很明显。这些发现表明，在撒哈拉以南非洲的黑人患者中，氨氯地平加氢氯噻嗪或培哚普利在6个月时降压效果优于培哚普利加氢氯噻嗪。

据介绍，在非洲黑人患者中，高血压的患病率很高，这些患者通常需要两种或两种以上的药物来控制血压。然而，目前尚未确定这些患者用于血压控制的最有效的双药组合。

附：英文原文

Title: Comparison of Dual Therapies for Lowering Blood Pressure in Black Africans

Author: Dike B. Ojji, M.D., Ph.D., Bongani Mayosi, D.Phil., Veronica Francis, B.A., Motasim Badri, Ph.D., Victoria Cornelius, Ph.D., Wynand Smythe, Ph.D., Nicky Kramer, M.P.H., Felix Barasa, M.Med., Albertino Damasceno, Ph.D., Anastase Dzudie, Ph.D., Erika Jones, Ph.D., Charles Mondo, M.D., Ph.D., Okechukwu Ogah, M.D., Ph.D., Elijah Ogola, M.D., Mahmoud U. Sani, M.D., Ph.D., Gabriel L. Shedul, M.D., Grace Shedul, B.Pharm., Brian Rayner, M.D., Ph.D., Ikechi G. Okpechi, M.D., Ph.D., Karen Sliwa, M.D., Ph.D.

Issue&Volume: VOL. 380 NO. 25, 2019

Abstract: 

BACKGROUND
The prevalence of hypertension among black African patients is high, and these patients usually need two or more medications for blood-pressure control. However, the most effective two-drug combination that is currently available for blood-pressure control in these patients has not been established.

METHODS
In this randomized, single-blind, three-group trial conducted in six countries in sub-Saharan Africa, we randomly assigned 728 black patients with uncontrolled hypertension (≥140/90 mm Hg while the patient was not being treated or was taking only one antihypertensive drug) to receive a daily regimen of 5 mg of amlodipine plus 12.5 mg of hydrochlorothiazide, 5 mg of amlodipine plus 4 mg of perindopril, or 4 mg of perindopril plus 12.5 mg of hydrochlorothiazide for 2 months. Doses were then doubled (10 and 25 mg, 10 and 8 mg, and 8 and 25 mg, respectively) for an additional 4 months. The primary end point was the change in the 24-hour ambulatory systolic blood pressure between baseline and 6 months.

RESULTS
The mean age of the patients was 51 years, and 63% were women. Among the 621 patients who underwent 24-hour blood-pressure monitoring at baseline and at 6 months, those receiving amlodipine plus hydrochlorothiazide and those receiving amlodipine plus perindopril had a lower 24-hour ambulatory systolic blood pressure than those receiving perindopril plus hydrochlorothiazide (between-group difference in the change from baseline, −3.14 mm Hg; 95% confidence interval [CI], −5.90 to −0.38; P=0.03; and −3.00 mm Hg; 95% CI, −5.8 to −0.20; P=0.04, respectively). The difference between the group receiving amlodipine plus hydrochlorothiazide and the group receiving amlodipine plus perindopril was −0.14 mm Hg (95% CI, −2.90 to 2.61; P=0.92). Similar differential effects on office and ambulatory diastolic blood pressures, along with blood-pressure control and response rates, were apparent among the three groups.

CONCLUSIONS
These findings suggest that in black patients in sub-Saharan Africa, amlodipine plus either hydrochlorothiazide or perindopril was more effective than perindopril plus hydrochlorothiazide at lowering blood pressure at 6 months.

DOI: 10.1056/NEJMoa1901113

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1901113