Cruickshank J M
Department of Cardiology, Wythenshawe Hospital, Manchester, UK.
J Hypertens Suppl. 1992 Jun;10(3):S21-7.
In patients with asymptomatic high blood pressure, antihypertensive treatment is initiated for only one reason, to prevent the hypertensive sequelae of myocardial infarction, stroke and heart failure. MORBIDITY, MORTALITY AND SURROGATE ENDPOINTS: Only diuretics and beta-blockers have been shown to benefit hypertensive patients in terms of the hard endpoints morbidity and mortality. beta-Blockers and diuretics are cheaper than newer drugs and thus represent good value for money. It is not acceptable to use drug effects on plasma lipids or insulin resistance as measures of the effects on coronary heart disease, since dihydropyridine calcium antagonists improve these parameters while significantly increasing coronary heart disease events in the acute and chronic ischaemic situation. PATIENT PROFILING: Diuretics. Diuretics appear particularly suited to elderly hypertensives, especially those with isolated systolic hypertension, but they may increase cardiac events in younger and middle-aged diabetic and non-diabetic hypertensives. Angiotensin converting enzyme (ACE) inhibitors. ACE inhibitors are undoubtedly valuable in the presence of left ventricular dysfunction, and possibly in the diabetic in maintaining good renal function. beta-Blockers. beta-Blockers are particularly well suited to younger and middle-aged hypertensives at all blood pressure levels, especially white males; where ischaemia and/or stress is a factor, beta-blockers can significantly reduce the incidence of myocardial infarction and strokes. beta-Blockers benefit elderly hypertensives by preventing strokes and may prevent coronary heart disease if prescribed with a diuretic.
对于无症状高血压患者，启动降压治疗仅出于一个原因，即预防心肌梗死、中风和心力衰竭等高血压后遗症。发病率、死亡率及替代终点：仅利尿剂和β受体阻滞剂在硬终点发病率和死亡率方面已被证明对高血压患者有益。β受体阻滞剂和利尿剂比新药便宜，因此性价比高。将药物对血脂或胰岛素抵抗的作用用作对冠心病影响的衡量标准是不可接受的，因为二氢吡啶类钙拮抗剂虽能改善这些参数，但在急性和慢性缺血情况下会显著增加冠心病事件。患者特征分析：利尿剂。利尿剂似乎特别适合老年高血压患者，尤其是那些单纯收缩期高血压患者，但它们可能会增加年轻和中年糖尿病及非糖尿病高血压患者的心脏事件。血管紧张素转换酶（ACE）抑制剂。ACE抑制剂在存在左心室功能障碍时无疑很有价值，对糖尿病患者可能在维持良好肾功能方面也有价值。β受体阻滞剂。β受体阻滞剂特别适合所有血压水平的年轻和中年高血压患者，尤其是白人男性；在缺血和/或压力是一个因素的情况下，β受体阻滞剂可显著降低心肌梗死和中风的发生率。β受体阻滞剂通过预防中风使老年高血压患者受益，如果与利尿剂联合使用可能预防冠心病。
