Wierzbicki A S
Department of Chemical Pathology, St Thomas' Hospital, London, UK.
J Hum Hypertens. 2002 Nov;16(11):753-60. doi: 10.1038/sj.jhh.1001483.
Modern management of cardiovascular risk depends on assessment of cardiovascular risk factors. Hypertension and hyperlipidaemia are synergistic risk factors for cardiovascular events. Both show a degree of cross-correlation through sharing mechanisms of pathogenesis including insulin resistance and endothelial dysfunction. This article reviews the common pathways leading to dyslipidaemia and hypertension and the effects diet and lipid-lowering drug therapies have had on correcting blood pressure in patients with essential hypertension. Both statins and fibrates have shown a capability to lower blood pressure by up to 8/5 and 15/10 mmHg respectively, in some small-scale clinical trials and have effects on arterial wall structure and hence pulse wave velocity. This blood pressure action may account for some of the clinical effects of lipid-lowering drugs on cardiovascular risk. Thus, lipid lowering may provide an additional method of correcting hypertension in some high-risk patients. However, data from large-scale intervention trials are either absent or ambiguous. Definitive large-scale trials to investigate the antihypertensive effects of lipid-lowering drugs are required, although end point studies examining the interaction of lipid-lowering and antihypertensive drugs to determine optimum combinations are already under way.
心血管风险的现代管理依赖于对心血管危险因素的评估。高血压和高脂血症是心血管事件的协同危险因素。二者通过共享包括胰岛素抵抗和内皮功能障碍在内的发病机制，呈现出一定程度的相互关联。本文综述了导致血脂异常和高血压的共同途径，以及饮食和降脂药物治疗对原发性高血压患者血压校正的影响。在一些小规模临床试验中，他汀类药物和贝特类药物分别显示出能够使血压降低多达8/5 mmHg和15/10 mmHg的能力，并且对动脉壁结构以及脉搏波速度有影响。这种血压作用可能解释了降脂药物对心血管风险的一些临床效果。因此，降脂可能为一些高危患者提供一种校正高血压的额外方法。然而，大规模干预试验的数据要么缺乏，要么不明确。尽管已经在进行终点研究以检验降脂药物和降压药物的相互作用以确定最佳组合，但仍需要进行明确的大规模试验来研究降脂药物的降压作用。
