Kaplan N M
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas 75235-8899.
Cleve Clin J Med. 1991 Sep-Oct;58(5):432-43. doi: 10.3949/ccjm.58.5.432.
Because most patients with mild to moderate hypertension will not suffer a cardiovascular event due to elevated blood pressure, the presence of other risk factors must be assessed. Many of these are alterable with nondrug therapies, which cost little and carry no risks if applied sensibly. Drug therapies have costs, discomforts, and risks and should be used only for those at high risk or those who fail to respond adequately to nondrug therapies. When drug therapy is necessary, start with low doses and aim for a slow reduction of blood pressure, avoiding hypoperfusion and reducing as many risk factors as possible. Alpha blockers, angiotensin-converting enzyme inhibitors, and calcium-channel blockers may avoid metabolic risks associated with high-dose diuretic and beta-blocker therapy. The establishment of therapeutic goals, individualized assessment of status, and a conservative approach to treatment are the basis for optimal management of patients with hypertension.
由于大多数轻至中度高血压患者不会因血压升高而发生心血管事件，因此必须评估其他危险因素。其中许多危险因素可以通过非药物疗法改变，这些疗法成本低廉，合理应用时无风险。药物疗法有成本、不适和风险，应仅用于高危人群或对非药物疗法反应不佳的人群。当需要药物治疗时，从低剂量开始，目标是缓慢降低血压，避免灌注不足，并尽可能减少多种危险因素。α受体阻滞剂、血管紧张素转换酶抑制剂和钙通道阻滞剂可避免与高剂量利尿剂和β受体阻滞剂治疗相关的代谢风险。确立治疗目标、个体化评估病情以及采取保守的治疗方法是高血压患者最佳管理的基础。
