Digiesi V, Lenuzza M, Digiesi G
Clinica Medica III, Dipartimento di Medicina Interna, Università degli Studi, Azienda Ospedaliera Careggi di Firenze.
Ann Ital Med Int. 2001 Apr-Jun;16(2):93-100.
The purpose of this review is to examine the indications and contraindications of antioxidant therapy in arterial hypertension. It has been suggested that oxidative stress plays a role in hypertension, increasing pressure values and leading to complications. Oxidative stress, at present, appears as one of several metabolic abnormalities described in essential hypertension. It is still uncertain whether this abnormality is primary or secondary; in any case, measurement of the main oxidant and antioxidant activities in plasma and blood cells may be useful in order to recognize and monitor oxidative stress. Antioxidant therapy could be useful to counteract the effects of oxidative stress on blood vessels, arterial pressure and low-density lipoproteins. Although antioxidant therapy with drugs or physiological substances in hypertensive subjects has been examined in some clinical trials, these experimental observations do not appear sufficient to draw definitive conclusions because long-term randomized, controlled studies do not exist. At present, it seems appropriate to propose some dietary recommendations which, apart from their antioxidant properties, are useful and do not have untoward effects. The safest approach to treat or to prevent oxidative stress consists of a diet that includes foods with a high antioxidant content (i.e. vitamins C and E and flavonoids). This diet consists fundamentally of fruits, vegetables and grains. Moreover it seems useful to use antihypertensive drugs that are able to decrease oxidative stress. The addition of physiologic antioxidant substances should be considered only in hypertensive subjects with a marked increase in oxidant or decrease in antioxidant factors. Indeed reactive oxygen species play a pivotal role in many physiological reactions, and their excessive inhibition could be dangerous. Further controlled, randomized long-term trials with antioxidants in hypertension are necessary to establish the efficacy and tolerability of antioxidants in the adjuvant therapy of hypertension.
本综述的目的是探讨抗氧化治疗在动脉高血压中的适应证和禁忌证。有人提出氧化应激在高血压中起作用，会升高血压值并导致并发症。目前，氧化应激似乎是原发性高血压中描述的几种代谢异常之一。这种异常是原发性还是继发性仍不确定；无论如何，测量血浆和血细胞中的主要氧化剂和抗氧化剂活性可能有助于识别和监测氧化应激。抗氧化治疗可能有助于抵消氧化应激对血管、动脉血压和低密度脂蛋白的影响。虽然在一些临床试验中已经对高血压患者使用药物或生理物质进行抗氧化治疗进行了研究，但这些实验观察结果似乎不足以得出明确结论，因为缺乏长期随机对照研究。目前，提出一些饮食建议似乎是合适的，这些建议除了具有抗氧化特性外，还有益且无不良影响。治疗或预防氧化应激最安全的方法是饮食中包含抗氧化剂含量高的食物（即维生素C、维生素E和类黄酮）。这种饮食主要由水果、蔬菜和谷物组成。此外，使用能够降低氧化应激的抗高血压药物似乎也很有用。仅在氧化剂明显增加或抗氧化因子减少的高血压患者中考虑添加生理抗氧化物质。事实上，活性氧在许多生理反应中起关键作用，过度抑制它们可能是危险的。有必要进一步进行关于高血压患者抗氧化剂的对照、随机长期试验，以确定抗氧化剂在高血压辅助治疗中的疗效和耐受性。
