Olsson G, Rydén L
Department of Medicine, Karolinska Institutet, Danderyd Hospital, Sweden.
Circulation. 1991 Dec;84(6 Suppl):VI33-7.
Coronary artery disease is the most serious complication of hypertension; therefore, the treatment of hypertension should be directed toward reducing the mortality from this disease. Since the majority of deaths occurring in post-myocardial infarction patients and hypertensive patients are sudden, the key objective is coronary artery disease treatment that will reduce the risk of sudden death. Several pharmacological interventions have been tested to determine whether they reduce the risk of sudden death. So far, only treatment with beta-adrenoceptor antagonists has been proven effective. Since most sudden cardiac deaths are due to ventricular fibrillation, an antifibrillatory effect on beta-adrenoceptor blockade has been invoked and demonstrated in clinical as well as animal experimental studies. Apart from an antifibrillatory effect, other effects of beta-blockade may also be involved. In the present review, different effects of beta-blockers that may contribute to the observed beneficial effects are discussed. The reduction in the risk of sudden death during active beta-adrenoceptor blockade reported in clinical studies is probably related to the summation of different effects, since cardiovascular drugs with a more limited mode of action (i.e., pure anti-ischemic effect or pure antiarrhythmic effect) have not shown similar impressive results.
冠状动脉疾病是高血压最严重的并发症；因此，高血压的治疗应致力于降低由此疾病导致的死亡率。由于心肌梗死后患者和高血压患者中发生的大多数死亡是突然发生的，关键目标是进行冠状动脉疾病治疗以降低猝死风险。已经对几种药物干预措施进行了测试，以确定它们是否能降低猝死风险。到目前为止，只有β-肾上腺素能受体拮抗剂治疗已被证明有效。由于大多数心源性猝死是由心室颤动引起的，β-肾上腺素能受体阻滞的抗纤颤作用已在临床以及动物实验研究中得到证实和体现。除了抗纤颤作用外，β-阻滞剂的其他作用可能也起作用。在本综述中，讨论了可能有助于观察到的有益效果的β-阻滞剂的不同作用。临床研究报道的在积极进行β-肾上腺素能受体阻滞期间猝死风险的降低可能与不同作用的总和有关，因为作用方式更有限的心血管药物（即单纯抗缺血作用或单纯抗心律失常作用）并未显示出类似令人印象深刻的结果。
