Morgan T O
Department of Physiology, University of Melbourne, Parkville, Victoria, Australia.
J Cardiovasc Pharmacol. 1990;15 Suppl 5:S39-45.
Mortality resulting from coronary artery disease and sudden death has not been significantly reduced by the use of antihypertensive medications in patients with hypertension, despite evidence that hypertension is a major risk factor for myocardial infarction. One possible reason is that the drugs used may have adverse metabolic effects that negate the beneficial effect of lowering blood pressure. Diuretics and beta-blocking agents produce a wide range of biochemical or metabolic alterations-e.g., changes in plasma potassium and in lipoprotein profiles. In general, fewer or less marked alterations are associated with the use of angiotensin-converting enzyme inhibitors, alpha-adrenergic blockers, and slow calcium channel blocking drugs. The effects of these agents alone and in combination and their potential relationship with coronary adverse events are reviewed. Although the clinical relevance of these alterations has yet to be fully determined, it is rational to suggest that given or current knowledge, the antihypertensive agent selected for use should be an effective, well-tolerated drug with a minimum of adverse biochemical or metabolic effects.
尽管有证据表明高血压是心肌梗死的主要危险因素，但使用抗高血压药物并未显著降低高血压患者因冠状动脉疾病导致的死亡率和猝死率。一个可能的原因是，所使用的药物可能具有不良代谢效应，从而抵消了降低血压的有益作用。利尿剂和β受体阻滞剂会产生广泛的生化或代谢改变，例如血浆钾和脂蛋白谱的变化。一般来说，使用血管紧张素转换酶抑制剂、α肾上腺素能阻滞剂和慢钙通道阻滞剂时，相关改变较少或不太明显。本文综述了这些药物单独使用及联合使用的效果及其与冠状动脉不良事件的潜在关系。尽管这些改变的临床相关性尚未完全确定，但根据现有知识合理地建议，所选用的抗高血压药物应是一种有效、耐受性良好且具有最少不良生化或代谢效应的药物。
