Holzgreve H, Middeke M
Medizinische Poliklinik, University of Munich, Germany.
J Hum Hypertens. 1990 Dec;4 Suppl 5:11-8.
Even with antihypertensive therapy, the risks in hypertensive patients, especially the incidence of coronary events, cannot be lowered to that of the normotensive population. Therefore, the metabolic effects of long-term therapy on lipid metabolism and the efficacy of antihypertensive drugs to lower blood pressure were studied as possible explanations for this partial therapeutic failure. Hypertensive patients who participated in a long-term trial provided a unique opportunity to observe the effects of long-term treatment and of then discontinuing antihypertensive therapy. During treatment, increases in total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglycerides following hydrochlorothiazide, and increases of LDL-C and triglycerides and a decrease of high-density lipoprotein cholesterol (HDL-C) following atenolol were observed up to 42 months. After 5.2 +/- 1.4 years of randomised antihypertensive treatment, cessation of hydrochlorothiazide led to a decrease of total cholesterol from 6.40 to 5.98 mmol/l and of LDL-C from 4.33 to 3.89 mmol/l. After discontinuation of atenolol, LDL-C decreased from 4.20 to 3.89 mmol/l and triglycerides from 2.21 to 1.91 mmol/l, whereas HDL-C increased from 0.96 to 1.17 mmol/l (all differences significant). Thus the adverse effects of both agents persisted for more than five years and were reversible after medication was discontinued. In recent years titration to the lowest possible dose of antihypertensive agents has been suggested to avoid adverse metabolic alterations and subjective side effects.(ABSTRACT TRUNCATED AT 250 WORDS)
即使进行抗高血压治疗，高血压患者的风险，尤其是冠心病事件的发生率，也无法降至正常血压人群的水平。因此，研究了长期治疗对脂质代谢的代谢影响以及抗高血压药物降低血压的疗效，以解释这种部分治疗失败的可能原因。参与长期试验的高血压患者提供了一个独特的机会，来观察长期治疗以及随后停用抗高血压治疗的效果。在治疗期间，观察到服用氢氯噻嗪后总胆固醇、低密度脂蛋白胆固醇（LDL-C）和甘油三酯升高，服用阿替洛尔后LDL-C和甘油三酯升高，高密度脂蛋白胆固醇（HDL-C）降低，这种情况持续了42个月。经过5.2±1.4年的随机抗高血压治疗后，停用氢氯噻嗪导致总胆固醇从6.40 mmol/l降至5.98 mmol/l，LDL-C从4.33 mmol/l降至3.89 mmol/l。停用阿替洛尔后，LDL-C从4.20 mmol/l降至3.89 mmol/l，甘油三酯从2.21 mmol/l降至1.91 mmol/l，而HDL-C从0.96 mmol/l升至1.17 mmol/l（所有差异均有统计学意义）。因此，两种药物的不良反应持续了五年多，停药后是可逆的。近年来，有人建议将抗高血压药物滴定至尽可能低的剂量，以避免不良代谢改变和主观副作用。（摘要截短于250字）
