背景:全球,动脉高血压是最重要的可预防和可改变的心血管危险因素。除了生活方式的改变,最近的国际指南推荐单药,低剂量组合作为初始治疗策略。我们调查了这种方法在撒哈拉以南非洲农村地区是否可行。
方法:通过三组血压测量建立高血压的诊断,根据欧洲高血压协会的建议,由训练有素的人员进行,使用经过验证的,自动化,示波装置OMRONM7IT-HEM-7322-E.98例动脉高血压患者,每天一次,奥美沙坦单药组合,氨氯地平,氢氯噻嗪的处方剂量适当。指导患者的给药和潜在的副作用,并鼓励他们改变生活方式。调整治疗方案,如果需要,在4,8,12和16周后安排的每个门诊诊所。
结果:79名患者(年龄61[53-70]岁;中位数和四分位数范围)严格遵守治疗方案,而19个人(70[65-80]岁)退出。4周后血压<140/90mmHg44(56%),在62(78%)的8周后,在69(87%)的12周后,和16周后74(94%)的参与者。报告了优异的耐受性。
结论:这些结果提供了真实的证据,表明每天一次的高血压管理,奥美沙坦单药组合,氨氯地平,和氢氯噻嗪作为初始治疗在撒哈拉以南农村地区也是可行和有效的。作为可靠的一线治疗战略,也应在低收入和中等收入国家的农村和偏远地区提供单药组合。
BACKGROUND: Worldwide, arterial hypertension is the foremost preventable and modifiable cardiovascular risk factor. In addition to lifestyle changes, recent international guidelines recommend single-pill, low-dose combinations as initial treatment strategy. We investigated whether this approach is feasible in a rural sub-Saharan Africa setting.
METHODS: Diagnosis of hypertension was established over three sets of blood pressure measurements, performed according to the European Society of Hypertension recommendations by trained personnel, using a validated, automated, oscillometric device OMRON M7 IT-HEM-7322-E. In 98 individuals with arterial hypertension, a once-daily, single-pill combination of
olmesartan, amlodipine, and hydrochlorothiazide was prescribed at an appropriate dose. Patients were instructed on its administration and potential side effects and encouraged towards lifestyle modifications. The treatment regimen was adjusted, if needed, at each outpatient clinic scheduled after 4, 8, 12, and 16 weeks.
RESULTS: Seventy-nine patients (aged 61 [53-70] years; median and interquartile range) strictly adhered to the treatment schedule, while 19 individuals (70 [65-80] years) dropped out. Blood pressure was < 140/90 mmHg after 4 weeks in 44 (56%), after 8 weeks in 62 (78%), after 12 weeks in 69 (87%), and after 16 weeks in 74 (94%) participants. Excellent tolerance was reported.
CONCLUSIONS: These results provide real-life evidence that hypertension management with a once-daily, single-pill combination of
olmesartan, amlodipine, and hydrochlorothiazide as initial treatment is feasible and effective also in a rural sub-Saharan setting. Single-pill combinations should be made available also in rural and remote areas in low- and middle-income countries as a reliable first-line treatment strategy.