Galzerano Domenico, Capogrosso Cristina, Di Michele Sara, Bobbio Emanuele, Paparello Paola, Gaudio Carlo
Department of Cardiology, San Gennaro Hospital, Naples, Italy.
Vasc Health Risk Manag. 2010 Aug 9;6:479-94. doi: 10.2147/vhrm.s7969.
Antihypertensive therapy can lower the risk of cardiovascular morbidity and mortality. Yet, partly because of inadequate dosing, wrong pharmacological choices, and poor patient adherence, hypertension control remains suboptimal in the majority of hypertensive patients. Achieving greater blood pressure control requires a multifaceted approach that raises awareness of hypertension, uses effective therapies, and improves adherence. Particular classes of antihypertensive therapy have beneficial actions beyond blood pressure and studies have evaluated differences in cardiovascular protection among classes. The LIFE and HOPE studies showed between-class differences that may be due to effects other than blood pressure-lowering. In the ONTARGET study, telmisartan and ramipril provided similar cardiovascular protection but adherence was higher with telmisartan, which was better tolerated. This difference in compliance is likely to be important for long-term therapy. The selection of an agent for cardiovascular protection should depend on an appreciation of its composite properties, including any beneficial effects on tolerability and increased patient adherence, as these are likely to be advantageous for the long-term management of hypertension. This review examines the evidence that the effects beyond blood pressure provided by some antihypertensive agents can also lower the risk of cardiovascular, cerebrovascular, and renal events in patients with hypertension.
抗高血压治疗可降低心血管疾病的发病率和死亡率。然而，部分由于剂量不足、药物选择错误以及患者依从性差，大多数高血压患者的血压控制仍不理想。实现更好的血压控制需要采取多方面的方法，包括提高对高血压的认识、采用有效的治疗方法以及提高依从性。特定类别的抗高血压治疗除了能降低血压外，还有其他有益作用，并且已有研究评估了不同类别药物在心血管保护方面的差异。LIFE和HOPE研究显示了不同类别药物之间的差异，这可能是由降压以外的其他作用导致的。在ONTARGET研究中，替米沙坦和雷米普利提供了相似的心血管保护作用，但替米沙坦的依从性更高，耐受性也更好。这种依从性的差异对于长期治疗可能很重要。选择用于心血管保护的药物应基于对其综合特性的认识，包括对耐受性和提高患者依从性的任何有益作用，因为这些可能有利于高血压的长期管理。这篇综述探讨了一些抗高血压药物除降压作用外，还能降低高血压患者发生心血管、脑血管和肾脏事件风险的证据。
