Iannetti M, Vallebona A, Caponnetto S
Dipartimento di Medicina Interna, Università degli Studi di Genova.
Minerva Cardioangiol. 1991 Oct;39(10):367-74.
From the analysis of the epidemiological observational studies, among which one of the most famous is the Framingham study that has lasted for more than 30 years, it is evident that the risk of cardiac events and strokes is closely related to the levels of arterial systolic and diastolic blood pressure. Nevertheless, the link between hypertension and cardiovascular risk has very often been discussed, due to the results of therapeutic intervention trials, which have proved satisfactory for cardiovascular risk reduction but disappointing results for coronary disease reduction risk. Possible explanations for these poor results of antihypertensive therapy on coronary disease are different and very numerous. According to many Authors, the blood pressure was not reduced to the programmed levels in all trials and the drug used (diuretics, beta-blockers) possibly had negative effects on the lipid profile. Therefore, waiting data for new trials, will perhaps produce better results in the future taking into consideration all risks of our patient, monitoring a rigorous and steady blood pressure reduction and selecting drugs like calcium-channel blockers and ACE-inhibitors which contain characteristics similar to those ideal for the modern antihypertensive agent.
从流行病学观察性研究的分析来看，其中最著名的是持续了30多年的弗明汉姆研究，很明显心脏事件和中风的风险与动脉收缩压和舒张压水平密切相关。然而，由于治疗干预试验的结果，高血压与心血管风险之间的联系经常被讨论，这些试验已证明在降低心血管风险方面令人满意，但在降低冠心病风险方面结果令人失望。抗高血压治疗对冠心病产生这些不佳结果的可能解释多种多样。许多作者认为，并非所有试验中的血压都降至了设定水平，而且所使用的药物（利尿剂、β受体阻滞剂）可能对血脂谱有负面影响。因此，在等待新试验的数据时，未来或许会考虑到我们患者的所有风险，严格且稳定地监测血压降低情况，并选择像钙通道阻滞剂和ACE抑制剂这类具有类似于现代抗高血压药物理想特性的药物，从而产生更好的结果。
