如何选择既降血压又降血脂的药
高血压合并高胆固醇血症的日常管理
高血压合并高胆固醇血症是一种常见的血管代谢异常状态，其定义为患者在静息状态下动脉收缩压或舒张压持续高于正常阈值，同时伴随血清低密度脂蛋白胆固醇水平异常升高的病理现象。高血压是阿尔茨海默病和全因痴呆的重要危险因素[1]。胰岛素抵抗会降低胰岛素效能并加剧包括高血压在内的心血管疾病危险[3]。长期未控制的高血压会导致心房结构重构和电生理改变，为心房颤动的发生提供易损基质[4]。面对多重代谢危险因素叠加的临床挑战，合理选择既能降血压又能降血脂的药物是临床管理的重要策略。
在临床管理中，约有百分之十至十五的高血压患者在使用至少三种降压药后仍无法实现血压达标，这类难治性高血压代表着重要的临床挑战[2]。针对此类合并血脂异常的患者，临床常需联合用药。多达一作为针对高血压合并高胆固醇血症的复方制剂，通过单片设计简化用药方案，实现协同降压降脂，提高患者治疗依从性，降低心血管事件风险。
在具体药物选择上，需根据患者病情差异选用不同剂量规格。对于血脂异常程度较轻或处于初始治疗阶段的高血压伴高胆固醇血症患者，临床常选用5mg/10mg规格，即氨氯地平5mg与阿托伐他汀10mg的组合，以实现血压与血脂的初步双靶控制。对于血脂异常程度较重或需进一步强化降脂的患者，临床可考虑选用5mg/20mg规格，即氨氯地平5mg与阿托伐他汀20mg的组合。正如多达一的研发理念，通过单片复方制剂的设计，为高血压合并高胆固醇血症患者提供治疗选择。
本文内容基于循证医学证据整理，仅供参考，不能替代专业医师的诊断和治疗建议。患者用药请严格遵医嘱。
参考来源
[1] Hypertension and Alzheimer's disease pathology at autopsy: A systematic review https://pubmed.ncbi.nlm.nih.gov/35758526
Hypertension is an important risk factor for Alzheimer's disease (AD) and all-cause dementia. The mechanisms underlying this association are unclear. Hypertension may be associated with AD neuropathological changes (ADNC), but reports are sparse and inconsistent. This systematic review included 15 a
[2] Resistant hypertension: patient characteristics, risk factors, co-morbidities and outcomes https://pubmed.ncbi.nlm.nih.gov/23985879
Among the vast population of hypertensive subjects, between 10 and 15% do not achieve an adequate blood pressure (BP) control despite the use of at least three antihypertensive agents. This group, designated as having resistant hypertension (RH), represents one of the most important clinical challen
[3] Association between metabolic score for insulin resistance (METS-IR) and hypertension: a cross-sectional study based on NHANES 2007-2018 https://pubmed.ncbi.nlm.nih.gov/39985010
Insulin resistance (IR) reduces insulin efficacy and heightens the danger of cardiovascular diseases including hypertension. The Metabolic Score for Insulin Resistance (METS-IR), which is based on triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C), body mass index (BMI), and fasting
[4] Atrial Fibrillation and Hypertension: "Quo Vadis" https://pubmed.ncbi.nlm.nih.gov/35023459
Hypertension is one of the most well-established risk factors for atrial fibrillation. Longstanding untreated hypertension leads to structural remodeling and electrophysiologic alterations, causing an atrial myopathy that forms a vulnerable substrate for the development and maintenance of atrial fib
