Gavras H
Department of Medicine, Boston University School of Medicine, MA 02118.
Hypertension. 1990 Nov;16(5):587-93. doi: 10.1161/01.hyp.16.5.587.
Elevated peripheral vascular resistance, which characterizes hypertension and congestive heart failure (the latter regardless of absolute blood pressure level) is maintained to a large extent by the combined effects of three major neurohormonal pressor mechanisms: the renin-angiotensin system, the sympathoadrenal system, and arginine vasopressin. Blockade of one of these mechanisms may lead to compensatory stimulation of the others, thus offsetting in part the hemodynamic benefits of a specific intervention. Combination therapy, designed to attack all three systems (with use of an angiotensin converting enzyme inhibitor, a sympathetic blocker such as clonidine, and an antagonist of the vasopressor action of vasopressin), may help in the treatment of such cases. To illustrate this strategy, two experimental studies, one case of malignant hypertension, and one case of congestive heart failure are presented.
外周血管阻力升高是高血压和充血性心力衰竭（后者无论绝对血压水平如何）的特征，在很大程度上是由三种主要神经激素升压机制的联合作用维持的：肾素-血管紧张素系统、交感肾上腺系统和精氨酸加压素。阻断其中一种机制可能会导致对其他机制的代偿性刺激，从而部分抵消特定干预措施的血流动力学益处。旨在攻击所有这三种系统的联合治疗（使用血管紧张素转换酶抑制剂、可乐定等交感神经阻滞剂以及加压素升压作用的拮抗剂）可能有助于治疗此类病例。为说明这一策略，本文介绍了两项实验研究、一例恶性高血压病例和一例充血性心力衰竭病例。
