Tamargo J
Instituto de Farmacología, Facultad de Medicina, Universidad Complutense, Madrid.
Rev Esp Cardiol. 1990;43 Suppl 1:9-17.
Because hypertension is a major risk factor for cardiovascular disease it would be expected that therapeutic reduction of blood pressure would protect patients from coronary heart disease (CHD). Twelve long-term trials involving over 40,000 patients have been performed to study the effectiveness of diuretics and beta-blockers in controlling blood pressure and reducing cardiovascular morbidity and mortality. However, no other drugs have been tested. The Hypertension Detection and Follow-up Program, European Working Party in the Elderly and the Metoprolol Atherosclerosis Prevention in Hypertension trial were the only studies where a significant reduction in total, cardiac and cardiovascular mortality were observed. Moreover three large trials have demonstrated some reduction in CHD among male nonsmokers. This review examines all these trials as well as some of the reasons for this disappointing outcome. New trials using modern antihypertensive drugs should be performed to analyze whether they contribute directly to protection from coronary events and other cardiovascular complications.
由于高血压是心血管疾病的主要危险因素，因此可以预期通过治疗降低血压能够保护患者免受冠心病（CHD）的侵害。已经进行了12项涉及40000多名患者的长期试验，以研究利尿剂和β受体阻滞剂在控制血压以及降低心血管发病率和死亡率方面的有效性。然而，尚未对其他药物进行测试。高血压检测与随访计划、欧洲老年工作组研究以及高血压患者美托洛尔动脉粥样硬化预防试验是仅有的观察到总死亡率、心脏死亡率和心血管死亡率显著降低的研究。此外，三项大型试验表明，男性不吸烟者的冠心病发病率有所降低。本综述审视了所有这些试验以及导致这一令人失望结果的一些原因。应开展使用现代抗高血压药物的新试验，以分析它们是否能直接预防冠心病事件和其他心血管并发症。
