Weinberger M H
Department of Medicine, Indiana University School of Medicine, Indianapolis 46202-5111.
Am J Med. 1991 May 17;90(5A):15S-20S. doi: 10.1016/0002-9343(91)90480-l.
Marked heterogeneity exists in the response of blood pressure to specific antihypertensive agents. In general, a single therapeutic agent can be expected to provide an adequate blood pressure response in 40% to 60% of hypertensive patients. The addition of a second agent usually extends the response rate to over 85%. The addition of a diuretic to nondiuretic regimens often produces an additive blood pressure-lowering effect. However, calcium channel entry blockers (CCBs) may be an exception, as diuretics do not appear to improve these agents' efficacy. CCBs have a dual mechanism for blood pressure reduction. In addition to their vasodilatory actions, they also promote diuresis and natriuresis. These features account for the striking efficacy of these agents when used as monotherapy in hypertensive patients. Studies have shown that dietary sodium restriction does not appear to improve the efficacy of CCBs, nor is a high-salt diet predictive of a better therapeutic outcome. Recent studies also indicate that the addition of a diuretic to a CCB does not produce a significant or consistent additive antihypertensive effect. Because CCBs do not produce the typical responses of the renin-angiotensin-aldosterone (RAA) system to sodium/volume depletion, their diuretic and natriuretic effects do not result in the same adverse metabolic consequences as experienced with traditional diuretic therapy.
血压对特定抗高血压药物的反应存在显著异质性。一般来说，单一治疗药物预计能使40%至60%的高血压患者血压得到充分控制。添加第二种药物通常会使有效率提高到85%以上。在非利尿剂治疗方案中添加利尿剂往往会产生额外的降压效果。然而，钙通道阻滞剂（CCB）可能是个例外，因为利尿剂似乎并不能提高这些药物的疗效。CCB具有双重降压机制。除了血管舒张作用外，它们还能促进利尿和排钠。这些特性解释了这些药物在高血压患者中作为单一疗法使用时显著的疗效。研究表明，饮食限钠似乎并不能提高CCB的疗效，高盐饮食也不能预测更好的治疗结果。最近的研究还表明，在CCB中添加利尿剂不会产生显著或一致的额外降压效果。由于CCB不会产生肾素-血管紧张素-醛固酮（RAA）系统对钠/容量耗竭的典型反应，它们的利尿和排钠作用不会导致与传统利尿剂治疗相同的不良代谢后果。
