Trvanie účinku, dôležitá vlastnosť antihypertenzívnych liekov


Autoři: Rainer Düsing
Působiště autorů: Medizinische Klinik und Poliklinik Bonn, Deutschland (Germany)
Vyšlo v časopise: Forum Diab 2013; 2(1): 10-17
Kategorie: Hlavná téma

Souhrn

Pri liečbe hypertenzie sú dostupné rôzne lieky. Tradične sú charakterizované spôsobom účinku, napr. diuretiká, ACE-inhibítory, antagonisti angiotenzínových receptorov, blokátory vápnikových kanálov. Ich prognostický efekt je podobný, napriek výrazne odlišným mechanizmom zníženia krvného tlaku. Viedlo to ku konsenzu, že samotné zníženie krvného tlaku pomocou antihypertenzívnej liečby je hlavným sprostredkovateľom kardiovaskulárnej ochrany. Trvanie účinku môže byť ďalším dôležitým aspektom, ktorý charakterizuje antihypertenzívny liek. Väčšina dostupných liekov, ktoré sa užívajú raz denne, dostatočne znižuje TK počas obdobia 24 hodín. Nonkompliancia k antihypertenzívnej liečbe môže značne predĺžiť interval dávkovania, keď je užitie lieku oneskorené alebo dokonca vynechané. V klinických štúdiách s elektronickým liekovým monitorovaním, približne bolo 10 % plánovaných dávok vynechaných v ktorýkoľvek deň a takmer polovica z týchto opomenutí bola súčasťou niekoľkých dní. Lieky s predĺženým intervalom dávkovania a súčasne s predĺženým účinkom vystupujú ako tolerantné lieky (forgiving drugs), ktoré napriek nepravidelnému užívaniu poskytujú terapeutické krytie. Prítomný prehľad sa zameriava na tento dôležitý aspekt antihypertenzívnej liečby a poukazuje na skutočnosť, že okrem tiazidového diuretika chlórtalidónu a blokátora vápnikového kanála amlodipínu, je takisto charakteristický predĺženou účinnosťou, teda toleranciou priamy inhibítor renínu aliskirén.

Kľúčové slová:
aliskirén – antihypertenzívne lieky – kompliancia – trvanie účinku – tolerancia


Zdroje

1. Chobanian AV, Bakris GL, Black HR et al (for the National High Blood Pressure Education Program Coordinating Committee). Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003; 42(6): 1206–1252.

2. Mancia G, De BG, Dominiczak A, Cifkova R et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25(6): 1105–1187.

3. Mancia G, Laurent S, Agabiti-Rosei E et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens 2009; 27(11): 2121–2158.

4. Oh BH, Mitchell J, Herron JR et al. Aliskiren, an oral renin inhibitor, provides dose-dependent efficacy and sustained 24-hour blood pressure control in patients with hypertension. J Am Coll Cardiol. 2007; 49(11): 1157–1163.

5. Düsing R. Diuretika, Pharmakologie und therapeutischer Einsatz. Medizinisch-pharmakologisches Kompendium. Wissenschaftliche Verlagsgesellschaft: Stuttgart 1986. ISBN 3–8047–0754–8.

6. Ernst M, Moser M. Use of diuretics in patients with hypertension. N Engl J Med 2009; 361(22): 2153–2164.

7. Weber MA. The role of the new ß-blockers in treating cardiovascular disease. Am J Hypertens 2005; 18(Suppl 6): 169S-176S.

8. Elliott WJ, Ram CV. Calcium channel blockers. J Clin Hypertens (Greenwich) 2011; 13(9): 687–689.

9. Frampton JE, Curran MP. Aliskiren: a review of its use in the management of hypertension. Drugs 2007; 67(12): 1767–1792.

10. Lindholm LH, Carlberg B, Samuelsson O. Should ß-blockers remain first choice in the treatment of primary hypertension? A meta-analysis. Lancet 2005; 366(9496): 1545–1553.

11. Reboldi G, Angeli F, Cavallini C et al. Comparison between angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on the risk of myocardial infarction, stroke and death: a meta-analysis. J Hypertens 2008; 26(7): 1282–2089.

12. MacMahon S, Neil B, Rodgers A et al. Commentary: The PROGRESS trial three years later: time for more action, less distraction. Br Med J 2004; 329(7472): 970–971.

13. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke Statistics-2013 update : A report from the American Heart Association. Circulation 2013; 127(1): e6-e245. Available from http: doi: 10.1161/CIR.0b013e31828124ad.

14. Wolf-Maier K, Cooper RS, Kramer H et al. Hypertension Treatment and Control in Five European Countries, Canada, and the United States. Hypertension 2004; 43(1): 10–17.

15. Vrijens B, Vincze G, Kristanto P et al. Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories. Br Med J 2008; 336(7653): 1114–1117.

16. Urquhart J. Patient non-compliance with drug regimens: measurement, clinical correlates, economic impact. Eur Heart J 1996; 17(Suppl A): 8–15.

17. Métry JM, Meyer UA (Eds.). Drug Regimen Compliance: Issues in Clinical Trials and Patient Management. Wiley: New York 1999. ISBN 0–471–97122–7.

18. Costa FV. Compliance with antihypertensive treatment. Clin Exp Hypertens 1996; 18(3–4): 463–472.

19. Düsing R, Lottermoser K, Mengden T. Compliance with drug therapy - new answers to an old question. Nephrol Dial Transplant 2001; 16(7): 1317–1321.

20. Sabate E. Adherence to long-term therapies: evidence for action. World Health Organization: Geneva 2003.

21. Qureshi NN, Hatcher J, Chaturvedi N et al. Hypertension Research Group. Effect of general practitioner education on adherence to antihypertensive drugs: cluster randomised controlled trial. Br Med J 2007; 335(7628): 1030–1038.

22. Düsing R, Handrock R, Klebs S et al. Impact of supportive measures on drug adherence in patients with essential hypertension treated with valsartan; the randomized, open-label, parallel group study VALIDATE. J Hypertens 2009; 27(4): 894–901.

23. Osterberg LG, Urquhart J, Blaschke TF. Understanding forgiveness: minding and mining the gaps between pharmacokinetics and therapeutics. Clin Pharmacol Ther 2010; 88(4): 457–459.

24. The Latin American Hypertension Study (LAMHYST) Group. Antihypertensive efficacy of amlodipine and losartan after two ‘missed’ doses in patients with mild to moderate essential hypertension. J Int Med Res 2007; 35(6): 762–772.

25. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288(23): 2981–2997.

26. The VALUE trial group. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet 2004; 363(9426): 2022–2031.

27. Weber MA, Julius S, Kjeldsen S et al. Blood pressure dependent and independent effects of antihypertensive treatment on clinical events in the VALUE trial. Lancet 2004; 363(9426): 2049–2051.

28. Riess W, Dubach UC, Burckhardt D et al. Pharmacokinetic studies with chlorthalidone (Hygroton) in man. Eur J Clin Pharmacol 1977(5); 12: 375–382.

29. Hypertension Detection and Follow-up Program Cooperative Group. Five-year findings of the hypertension detection and follow-up program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension. JAMA 1979; 242(23): 2562–2571.

30. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991; 265(24): 3255–3264.

31. Düsing R. Therapie der Hypertonie mit Diuretika: Wirksamkeit, Sicherheit und Verträglichkeit (Efficacy, safety and tolerability of diuretics in the treatment of hypertension). Internist 2011; 52(12): 1484–1491.

32. Neutel JM, Smith DH, Ram CV et al. Application of ambulatory blood pressure monitoring in differentiating between antihypertensive agents. Am J Med 1993; 94(2): 181–187.

33. Kostis JB. ß-blocker duration of action and implications for therapy. Am J Cardiol 1990; 66(16): 60G-62G.

34. Carlberg B, Samuelsson O, Lindholm LH. Atenolol in hypertension: is it a wise choice? Lancet 2004; 364 (9446): 1684–1689.

35. Lindholm LH, Carlberg B, Samuelsson O. Should ß-blockers remain first choice in the treatment of primary hypertension? A meta-analysis. Lancet 2005; 366(9496):1545–1553.

36. Düsing R, Brunel P, Baek I et al. Sustained blood pressure-lowering effect of aliskiren compared with telmisartan after a single missed dose. J Clin Hypertens (Greenwich) 2013; 15(1): 41–47.

37. Waeber B, Burnier M, Brunner HR. Compliance with antihypertensive therapy. Clin Exp Hypertens 1999; 21(5–6): 973–985.

38. Wood JM, Maibaum J, Rahuel J et al. Structure-based design of aliskiren, a novel orally effective renin inhibitor. Biochem Biophys Res Commun 2003; 308(4): 698–705.

39. The ALTITUDE Investigators. Cardiorenal End Points in a Trial of Aliskiren for Type 2 Diabetes. N Engl J Med 2012; 367(23): 2204–2213.

40. The VALIANT Investigators. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med 2003; 349(20): 1893–1906.

41. The ONTARGET Investigators. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008; 358(15): 1547–1559.

42. Makani H, Bangalore S, Desouza KA, Shah A, Messerli FH. Efficacy and safety of dual blockade of the renin-angiotensin system: meta-analysis of randomised trials. Br Med J 2013; 346: f360. Available from http: doi: 10.1136/bmj.f360.

43. Nussberger J, Wuerzner G, Jensen C et al. Angiotensin II suppression in humans by the orally active renin inhibitor Aliskiren (SPP100): comparison with enalapril. Hypertension 2002; 39(1): e1-e8. Available from http: doi:10.1161/hy0102.102293.

44. Vaidyanathan S, Jarugula V, Dieterich HA et al. Clinical pharmacokinetics and pharmacodynamics of aliskiren. Clin Pharmacokinet 2008; 47(8): 515–531.

45. Boschmann M, Nussberger J, Engeli S et al. Aliskiren penetrates adipose and skeletal muscle tissue and reduces renin-angiotensin system activity in obese hypertensive patients. J Hypertens 2012; 30(3): 561–566.

46. Oh BH, Mitchell J, Herron JR et al. Aliskiren, an oral renin inhibitor, provides dose-dependent efficacy and sustained 24-hour blood pressure control in patients with hypertension. J Am Coll Cardiol 2007; 49(11): 1157–1163.

47. Andersen K, Weinberger MH, Egan B et al. Comparative efficacy and safety of aliskiren, an oral direct renin inhibitor, and ramipril in hypertension: a 6-month, randomized, double-blind trial. J Hypertens 2008; 26(3): 589–599.

48. Palatini P, Jung W, Shlyakhto E et al. Maintenance of blood-pressure-lowering effect following a missed dose of aliskiren, irbesartan or ramipril: results of a randomized, double-blind study. J Hum Hypertens 2010; 24(2): 93–103.

49. Düsing R, Brunel P, Baek I et al. Sustained decrease in blood pressure following missed doses of aliskiren or telmisartan: the ASSERTIVE double-blind, randomized study. J Hypertens 2012; 30(5): 1029–1040.

50. Herron J, Mitchell J, Oh B. The novel renin inhibitor aliskiren is not associated with rebound effects on blood pressure or plasma renin activity following treatment withdrawal. J Clin Hypertens 2006; 5(Suppl A): A86-A87.

51. Williams B, Baschiera F, Lacy PS et al. Blood pressure and plasma renin activty responses to different strategies to inhibit the reninangiotensin-aldosterone system during exercise. J Renin Angiotensin Aldosterone Syst 2013; 14(1): 56–66.

Štítky
Diabetologie Endokrinologie Interní lékařství

Článek vyšel v časopise

Forum Diabetologicum

Číslo 1

2013 Číslo 1

Nejčtenější v tomto čísle

Tomuto tématu se dále věnují…


Přihlášení
Zapomenuté heslo

Nemáte účet?  Registrujte se

Zapomenuté heslo

Zadejte e-mailovou adresu se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se