Cleland J G
Department of Cardiology, University of Hull, Castle Hill Hospital, Kingston-upon-Hull, UK.
Cardiology. 1999;92 Suppl 1:10-9; discussion 20-1. doi: 10.1159/000047289.
Patients with hypertension are at increased risk of developing heart failure (HF), but the mechanisms by which hypertension leads to HF have not been clarified [although left ventricular hypertrophy (LVH) is clearly a predictor of an increased risk of HF]. Similarly, although antihypertensive therapy has been shown to reduce the risk of HF in hypertensive patients, it is not known how this benefit is produced and, currently, there is no clear evidence that any class of antihypertensive agent is more effective than any other in this respect. On theoretical grounds, beta-blockers would be expected to be ideal agents for the prevention of HF in hypertensive patients. In addition to control of blood pressure and regression of LVH, they have clear benefits on morbidity and mortality after myocardial infarction (MI), which probably plays a major role in the development of HF in hypertensive patients, and on the prognosis of HF itself. A reduction in long-term mortality after MI has been demonstrated only for non-selective beta-blockers. Carvedilol, a non-selective beta-blocker which also has other ancillary properties including alpha-1-receptor blockade and antioxidant effects and a favourable metabolic profile, may be an appropriate choice for the prevention of HF in hypertensive patients. This is reinforced by the salutary benefits of carvedilol for the reduction in the morbidity and mortality of HF itself.
高血压患者发生心力衰竭（HF）的风险增加，但高血压导致HF的机制尚未阐明[尽管左心室肥厚（LVH）显然是HF风险增加的一个预测因素]。同样，尽管降压治疗已被证明可降低高血压患者发生HF的风险，但尚不清楚这种益处是如何产生的，而且目前尚无明确证据表明在这方面任何一类降压药比其他降压药更有效。从理论上讲，β受体阻滞剂有望成为预防高血压患者发生HF的理想药物。除了控制血压和使LVH消退外，它们对心肌梗死（MI）后的发病率和死亡率有明显益处，MI可能在高血压患者发生HF中起主要作用，而且对HF本身的预后也有好处。仅非选择性β受体阻滞剂已被证明可降低MI后的长期死亡率。卡维地洛是一种非选择性β受体阻滞剂，还具有其他辅助特性，包括α-1受体阻滞和抗氧化作用以及良好的代谢特征，可能是预防高血压患者发生HF的合适选择。卡维地洛对降低HF本身的发病率和死亡率的有益作用进一步强化了这一点。
