Trenkwalder P
Department of Medicine, University of Munich, Starnberg Hospital, Germany.
Blood Press Suppl. 2000;1:27-30.
Patients with hypertension do not comprise a homogeneous group, and the majority present with a variety of concomitant and associated conditions. Antihypertensive therapies should therefore be effective and well tolerated in a wide range of patients and should, ideally, ameliorate the negative target-organ effects of hypertension, such as atherosclerosis, cardiovascular remodelling and renal impairment. Evidence is accumulating that the new angiotensin II type 1 receptor blocker, candesartan cilexetil, lowers blood pressure effectively and is well tolerated in a variety of patient groups, including women and the elderly. In patients with severe hypertension, a treatment schedule based on candesartan cilexetil, with the addition of diuretic and calcium antagonist therapy as needed, has been found to control blood pressure successfully. Candesartan cilexetil does not affect glucose tolerance or lipid profiles in patients with diabetes mellitus, and it is not associated with any of the side effects of other antihypertensive agents that would make it unsuitable for use in patients with pulmonary disease. Initial clinical studies have indicated that candesartan cilexetil is well tolerated and effective in patients with heart failure. Furthermore, the available evidence shows that treatment with candesartan cilexetil can reverse the negative effects of hypertension on left ventricular hypertrophy and microalbuminuria. It therefore appears that the pronounced efficacy and placebo-like tolerability of candesartan cilexetil, as demonstrated in large clinical trials of patients with mild to moderate hypertension, can be extended to a wide range of specific patient groups.
高血压患者并非一个同质群体，大多数患者还伴有多种并发和相关病症。因此，抗高血压疗法应在广泛的患者群体中有效且耐受性良好，并且理想情况下，应改善高血压对靶器官的负面影响，如动脉粥样硬化、心血管重塑和肾功能损害。越来越多的证据表明，新型血管紧张素II 1型受体阻滞剂坎地沙坦酯能有效降低血压，并且在包括女性和老年人在内的各种患者群体中耐受性良好。在重度高血压患者中，已发现基于坎地沙坦酯的治疗方案，必要时加用利尿剂和钙拮抗剂治疗，能够成功控制血压。坎地沙坦酯不影响糖尿病患者的糖耐量或血脂水平，并且它与其他抗高血压药物的任何副作用均无关联，这些副作用会使其不适用于肺部疾病患者。初步临床研究表明，坎地沙坦酯在心力衰竭患者中耐受性良好且有效。此外，现有证据表明，坎地沙坦酯治疗可逆转高血压对左心室肥厚和微量白蛋白尿的负面影响。因此，正如在轻度至中度高血压患者的大型临床试验中所证明的那样，坎地沙坦酯显著的疗效和类似安慰剂的耐受性似乎可以扩展到广泛的特定患者群体。
