Gubner R S
Can J Cardiol. 1990 Oct;6(8):367-72.
Some old icons of hypertension warrant questioning in view of new insights. Lowering of blood pressure is no criterion of efficacy in prevention of cardiovascular morbidity, mortality and sudden death. The drugs used in early studies - diuretics, vasodilators and reserpine - greatly improved mortality from malignant hypertension, apoplectic stroke and congestive heart failure, but had little or no effect in persons with milder degrees of elevated blood pressure, who constitute the vast majority of hypertensives. The failure of diuretics and vasodilators to influence cardiovascular disease favorably appears due not to their known adverse effects on risk factors, such as lipids, as some have held, but to a failure - in conjunction with some sympathetic blocking agents - to cause effective regression of left ventricular hypertrophy, the keystone of successful therapy. A study of 674 hypertensive persons surveyed in the United States and eastern Canada, personally examined during their visit to a Florida health resort, has shown striking changes in prescribing practice during the period surveyed (1985-88), notably with increased use of angiotensin converting enzyme (ACE) inhibitors and, to a lesser degree, increased use of calcium channel blockers. Both of these cause regression of left ventricular hypertrophy, and will hopefully show long term benefit in decreasing hypertension mortality. Left ventricular hypertrophy is detected most sensitively echocardiographically, and is worthwhile not only for estimation of prognosis, but also for guiding therapy. Left atrial hypertrophy is a mirror of left ventricular hypertrophy and may be detected echocardiographically and in the electrocardiogram.(ABSTRACT TRUNCATED AT 250 WORDS)
鉴于新的见解，一些高血压的旧有观念值得质疑。降低血压并非预防心血管疾病发病率、死亡率和猝死的疗效标准。早期研究中使用的药物——利尿剂、血管扩张剂和利血平——极大地改善了恶性高血压、中风和充血性心力衰竭的死亡率，但对血压轻度升高的人群（他们占高血压患者的绝大多数）几乎没有影响。利尿剂和血管扩张剂未能对心血管疾病产生有利影响，似乎并非如一些人所认为的那样，是由于它们对血脂等危险因素有已知的不良影响，而是由于它们与一些交感神经阻滞剂联合使用时，未能有效使左心室肥厚消退，而左心室肥厚消退是成功治疗的关键。一项对674名在美国和加拿大东部接受调查的高血压患者的研究显示，在调查期间（1985 - 1988年），他们在访问佛罗里达健康度假村时接受了个人检查，在此期间处方习惯发生了显著变化，特别是血管紧张素转换酶（ACE）抑制剂的使用增加，以及程度较轻的钙通道阻滞剂的使用增加。这两种药物都能使左心室肥厚消退，有望在降低高血压死亡率方面显示出长期益处。超声心动图最能敏感地检测到左心室肥厚，它不仅对评估预后有价值，而且对指导治疗也有价值。左心房肥厚是左心室肥厚的反映，可以通过超声心动图和心电图检测到。（摘要截取自250词）
