二位老年病患因服用第二代抗精神病藥物Quetiapine引起續發性高血壓

Quetiapine Related Secondary Hypertension in Two Old Patients

王家麒(Gia-Chi Wang) ； 吳立偉(Li-Wei Wu) ； 高東煒(Tung-Wei Kao) ； 張耀文(Yaw-Wen Chang)

《中華職業醫學雜誌》 21卷1期 (2014/01) Pp. 43-49

摘要

高血壓是老年人常見的健康問題之一。而引起高血壓的原因可初步分成原發性和續發性。續發性高血壓，是指高血壓有潛在病因，若能找到潛藏的病因，其高血壓的情況往往是可矯正的。根據研究及文獻指出，有許多種藥物及生活中的物質都會造成續發性高血壓。一般在臨床上常見之引起高血壓副作用的藥物如非類固醇類抗發炎藥物、口服避孕藥等。本篇個案報告的案例即是2位因服用第二代抗精神病藥物Quetiapine而導致續發性高血壓的老年病患，在試驗性將該藥物處方刪除後，高血壓控制不良的情形均獲得改善。對於一位臨床醫師，要辨認出「藥物誘發型高血壓」，最重要的關鍵是詳細的病史詢問及病人用藥的核對。若懷疑是藥物引起之續發性高血壓，可以試驗性的停止該藥物，看高血壓的情況是否改善。若是在臨床實務上無法停止該項藥物的使用，則可以減量該項藥物或是尋求效果類似的替代性藥物來取代停藥。另外一點值得注意的是，不同的病人服用某種可能會造成高血壓副作用的藥物，其血壓昇高的程度也往往不同。

關鍵字

續發性高血壓 ； 藥物 ； 第二代（非傳統型）抗精神病藥物 ； 藥物誘發型高血壓

並列摘要

Hypertension is one of common health issues in elderly. The causes of hypertension can be either primary or secondary. Patients with secondary hypertension have some underlying mechanisms that elevate their blood pressure. If we can find out the mechanism of secondary hypertension, it will be mostly correctable. According to the recent researches, a variety of prescription or over the counter medicines as well as other exogenous substances may induce secondary hypertension. Nonsteroidal anti-inflammatory drugs (NSAIDs) and oral contraceptives (OCTs) are familiar examples. In this article, we can see two old patients have secondary hypertension due to the prescription of second-generation antipsychotics (Quetiapine). In these two cases, the problem of secondary hypertension is settled because of withdrawal of Quetiapine. The key points for a clinical doctor to figure out ”drug-induced hypertension” are detailed and meticulous medical history. The identification and subsequent withdrawal of the offending drug may alleviate treatment resistance. However, withdrawal of the responsible agent is not always possible; in such cases, dose reduction and/or search for alternate treatment may substantially improve or even control blood pressure levels. Another very important aspect relates to the great variability of the effects of administered drugs on blood pressure. The administration of offending drugs can result in excessive blood pressure elevation in some individuals, while most individuals will experience little or no increases of blood pressure.

並列關鍵字

secondary hypertension ； drug ； Quetiapine ； drug-induced hypertension ； second-generation antipsychotics