Zanchetti A
Istituto di Clinica Medica e Terapia Medica, Università di Milano, Italy.
Clin Exp Hypertens A. 1992;14(1-2):307-31. doi: 10.3109/10641969209036190.
The question whether some classes of antihypertensive drugs have an antiatherogenic action independent of the antihypertensive one has been investigated through a large series of experimental studies; on the other hand, clinical evidence is still rather scanty. Most experimental investigations have shown a significant antiatherogenic action of the antihypertensive compounds, but only when the drug is administered simultaneously with the atherogenic stimulus (mostly cholesterol feeding). When the drug is administered weeks or months after the beginning of atherosclerosis (as in the Watanabe heritable hyperlipemic rabbit), no antiatherogenic effect has been shown, with a single exception. Although the most numerous data available are on calcium antagonists, almost all antihypertensive classes tested have shown some favorable effect on some experimental model. The few clinical studies completed so far as on coronary patients; they have provided arteriographic evidence that various calcium-antagonists have little effect on well-developed lesions and display a beneficial action on new or early lesions only. Ultrasound studies are now underway to compare the effects of calcium-antagonists and diuretics on asymptomatic carotid atherosclerotic lesions in hypertensive patients.
通过一系列大量的实验研究，人们对某些种类的抗高血压药物是否具有独立于其降压作用之外的抗动脉粥样硬化作用这一问题进行了调查；另一方面，临床证据仍然相当匮乏。大多数实验研究表明，抗高血压化合物具有显著的抗动脉粥样硬化作用，但前提是该药物要与致动脉粥样硬化刺激因素（主要是喂食胆固醇）同时使用。当在动脉粥样硬化开始数周或数月后给药（如在渡边遗传性高脂血症兔中），除了一个例外情况外，未显示出抗动脉粥样硬化作用。尽管现有最多的数据是关于钙拮抗剂的，但几乎所有测试过的抗高血压药物类别都已显示出对某些实验模型有一些有利影响。目前为止完成的关于冠心病患者的临床研究很少；这些研究提供了血管造影证据，表明各种钙拮抗剂对已形成的病变几乎没有影响，仅对新的或早期病变显示出有益作用。目前正在进行超声研究，以比较钙拮抗剂和利尿剂对高血压患者无症状颈动脉粥样硬化病变的影响。
