糖尿病合並ST段抬高性心肌梗死的降壓藥物選擇

2010年《中國高血壓防治指南》推薦所有沒有禁忌證的患者均口服β受體阻滯劑和ACEI類藥物。伴嚴重高血壓或心肌梗死後心絞痛，可應用靜脈短效的β1受體阻滯劑。CCB一般不宜使用。對於此類患者可選擇具有血管舒張作用的β受體阻滯劑和ACEI類藥，並且嚴密監測血壓變化。

以上是對於糖尿病合並冠心病的原發性高血壓患者如何選擇降壓藥物及製定合理的降壓方案的一個總結，對於合並繼發性高血壓患者因病因不同降壓治療具有特異性，本文不再講述。綜上所述，對於糖尿病合並冠心病的高血壓患者，ACEI/ARB類藥物的基線地位基本明確;BB類藥物必要時應該應用，但盡量使用具有血管舒張作用的BB類藥物;CCB類藥物對血糖無影響，可用於除外合並ST段抬高性心肌梗死的冠心病患者;對於利尿劑的選擇目前還存在許多爭議，特別是關於氯噻酮相對於氫氯噻嗪的優越性仍是目前爭論的焦點，我國目前主要使用氫氯噻嗪，盡管很多研究表明氯噻酮優於氫氯噻嗪，但由於我國應用此類藥物的患者相對較少，所以對我國患者的有效性及優越性還需進一步證實。

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