本研究將每日處方劑量(PDD)藉由定義日劑量(DDD)分為兩組，探討不同DDD比值的statins類用藥對於高血壓病人之目標血脂達成率與肝、腎功能的影響，並藉由觀察治療期間加入觀察藥品(BZD或non-BZD類安眠藥)的情形，探討statins的安全性。

以2007/01/01至2007/12/31期間首次開立statins類藥品之高血壓病人為對象。PDD≧DDD者，為高劑量組(atorvastatin≧20 mg、rosuvastatin≧10 mg、fluvastatin≧60 mg、pravastatin≧30 mg)；PDD＜DDD者，為低劑量組(atorvastatin＜20 mg、rosuvastatin＜10 mg、fluvastatin＜60 mg、pravastatin＜30 mg)。比較兩組的目標血脂(TC＜200 mg/dL、LDL-C＜130 mg/dL、TG<200 mg/dL + HDL-C>40 mg/dL、TG<200 mg/dL +TC/HDL-C<5)達成率與肝腎功能指標的影響。

以符合定義513筆資料進行分析。分析高、低劑量對於目標血脂達成率影響，當基礎TC≧238 mg/dL或LDL-C≧145 mg/dL時，使用高劑量(atorvastatin 20-40 mg、rosuvastatin 10 mg、fluvastatin 80 mg、pravastatin 40 mg)約有73-89 %可達到治療目標，當基礎TC≦207 mg/dL或LDL-C≦122 mg/dL時，使用低劑量(atorvastatin 2.5-10 mg、rosuvastatin 5 mg、fluvastatin 40 mg、pravastatin 20 mg)約有70-84%可達到治療目標，且低劑量亦可作為達到目標後的維持劑量參考。安全性評估上，atorvastatin在低劑量下雖呈現serum creatinine改善，但在高劑量下，則呈現serum creatinine增加的情形(3.21 ± 20.04% vs -2.64±6.70%, P=0.063)，故建議atorvastatin在高劑量治療下也應注意追蹤腎功能指標。atorvastatin (49.10±235.80% vs 6.47±45.22%, P=0.250)與rosuvastatin (10.02 ± 58.05% vs 4.35 ± 29.52%, P=0.487)，在高劑量下GPT呈現增加的情形，因此在高劑量治療時應追蹤肝功能指標。整體發現22個案(4.3%)在接受治療平均69.6±45.7天後加入BZD或non-BZD類安眠藥治療，且在併服的21位個案中，有48%在2個月內發生，90%在4個月內發生，在接受治療初期(尤其是4個月內)不論高低劑量治療皆應詢問病人睡眠的情形，注意精神方面可能的不良反應。

Hypertensive patients use initially on statins between January 1st, 2007 and December 31st, 2007. High-dosing regimen in PDD is more than or equal to DDD (atorvastatin ≧20 mg, rosuvastatin ≧10 mg, fluvastatin ≧60 mg, pravastatin ≧30 mg). Low-dosing regimen in PDD is less than DDD (atorvastatin < 20 mg, rosuvastatin < 10 mg, fluvastatin < 60 mg, pravastatin < 30 mg). The objectives of this study were to compare attainment rates of treatment goals (definition of the treatment goals are: TC < 200 mg/dL, LDL-C < 130 mg/dL, TG < 200 mg/dL + HDL-C > 40 mg/dL, TG < 200 mg/dL + TC / HDL-C < 5), serum creatinine, GPT levels in high-dosing regimen versus low-dosing regimen. 

There were 513 valid for this retrospective analysis. In comparison of the high-dosing regimen and the low-dosing regimen effects, when a baseline of TC≧238 mg/dL or LDL-C ≧145 mg/dL, were used for the high-dosing regimen (atorvastatin 20-40 mg, rosuvastatin 10 mg, fluvastatin 80 mg, pravastatin 40 mg), it estimated 73-89 % patients that achieve the treatment goal, and when a baseline of TC≦207 mg/dL or LDL-C≦122 mg/dL,were used for the low-dosing group (atorvastatin 2.5-10 mg, rosuvastatin 10 mg, fluvastatin 40 mg, pravastatin 20 mg), it estimated 70-84 % patients that achieve the treatment goal, and we suggest that low-dosing regimen can be used as reference for NHI maintenance doses. With the safety assessment, the serum creatinine levels shows an improvement in the low-dosing regimen of atorvastatin, on the contrary, the serum creatinine actually increases in the high-dosing regimen of atorvastatin (3.21 ± 20.04 % vs -2.64 ± 6.70 %, P=0.063). Thus, it is advisable to assess renal function when using high-dosing regimen of atorvastatin. The GPT also was elevated in the high-dosing regimen of atorvastatin (49.10 ± 235.80 % vs 6.47 ± 45.22 %, P=0.250) and rosuvastatin (10.02 ± 58.05 % vs 4.35 ± 29.52 %, P=0.487), thus it is also necessary to assess liver function among these patients when the treatment requires the high-dosing regimen of atorvastatin or rosuvastatin. In this study, we found 22 cases (4.3 % of the patients) were given BZD or non-BZD hypnotics treatment, 69.6 ± 45.7 days after initiation of their statins therapy. Further analysis of 21 of these cases, 48% occurs within 2 months and 90% occurs within 4 months. During the early stage, especially in the initial 4 months period, in both the high-dosing and the low-dosing regimen treatment group, pharmacist should assess the patient’s sleeping qualities with regarding to any psychiatric adverse reactions.