Talbot S, Smith A J
Br Heart J. 1975 Oct;37(10):1059-63. doi: 10.1136/hrt.37.10.1059.
Symptoms due to orthostatic and exertional hypotension occurred in 23-4 per cent of 448 hypertensive patients treated with guanethidine, debrisoquine, or bethanidine. Symptoms were significantly more frequent in patients treated with guanethidine than in those treated with bethanidine or debrisoquine. Women rather than men and patients with radiological evidence of cardiomegaly, electrocardiographic evidence of left ventricular hypertrophy, or ST/T wave changes, developed these symptoms significantly more often than other patients. A raised blood urea was found more frequently in patients with postural hypotensive symptoms. Characteristically guanethidine produced early morning postural hypotensive symptoms, wheras hypotensive symptoms caused by bethanidine and debrisoquine occurred at other times of the day and particularly one to two hours after tablet ingestion. Debrisoquine and guanethidine had a significantly greater negative chronotropic effect than bethanidine. It is suggested that negative chronotropic effects of these drugs may potentiate hypotensive symptoms in patients with cardiovascular, renal, or cerebrovascular disease. It should be possible to minimize symptoms of postural hypotension by attention to predisposing factors and selection of treatment accordingly.
在448例接受胍乙啶、异喹胍或苄乙胍治疗的高血压患者中，23.4%出现了体位性和运动性低血压症状。接受胍乙啶治疗的患者出现症状的频率明显高于接受苄乙胍或异喹胍治疗的患者。女性比男性更易出现这些症状，有心脏扩大影像学证据、左心室肥厚心电图证据或ST/T波改变的患者出现这些症状的频率也明显高于其他患者。有体位性低血压症状的患者血尿素升高更为常见。胍乙啶的典型表现是清晨出现体位性低血压症状，而异喹胍和苄乙胍引起的低血压症状出现在一天中的其他时间，尤其是服药后一到两小时。异喹胍和胍乙啶的负性变时作用明显大于苄乙胍。提示这些药物的负性变时作用可能会增强心血管、肾脏或脑血管疾病患者的低血压症状。通过关注易感因素并相应选择治疗方法，应该可以将体位性低血压症状降至最低。
