Prichard B N
Department of Clinical Pharmacology, University College and Middlesex School of Medicine, London, England.
J Cardiovasc Pharmacol. 1987;10 Suppl 11:S6-17.
There are several first choices for mild and moderate hypertension. The selection of a drug may of course be influenced by concomitant pathology, with positive indications for particular drugs: for coexistent angina, a beta-receptor blocking drug or a calcium antagonist; for fluid retention, a diuretic; or for contraindications, e.g., asthma, a beta-adrenoceptor blocking drug. There are therefore several possible first choices: beta-adrenoceptor blocking drugs, a combined alpha/vasodilator beta-adrenoceptor blocking drug, the vasodilators (i.e., drugs acting primarily to reduce peripheral resistance), the calcium antagonists, alpha 1-blocking drugs, and, more recently, the possibility of angiotensin converting enzyme inhibitors. Diuretics are also possible first choice agents, although not quite so frequently as once was the case. The majority of cases of hypertension can usually be controlled by one drug, even if not the first agent chosen. More severe cases may require drugs from two of the three major groups: beta-blocking drugs, vasodilators, and diuretics are often required, and, in some cases, drugs from each group. Drugs such as methyldopa, clonidine, and the adrenergic neuron inhibitory drugs are now more used as reserve agents.
轻度和中度高血压有几种首选药物。药物的选择当然可能会受到伴随病症的影响，某些药物有明确的适用指征：对于并存心绞痛的情况，可选用β受体阻滞剂或钙拮抗剂；对于有液体潴留的情况，可选用利尿剂；或者对于有禁忌证的情况，例如哮喘患者，禁用β肾上腺素能受体阻滞剂。因此有几种可能的首选药物：β肾上腺素能受体阻滞剂、α/血管扩张剂联合β肾上腺素能受体阻滞剂、血管扩张剂（即主要作用是降低外周阻力的药物）、钙拮抗剂、α1阻滞剂，以及最近出现的血管紧张素转换酶抑制剂。利尿剂也可能是首选药物，尽管不像过去那样频繁。大多数高血压病例通常用一种药物就能控制，即使不是首选药物。更严重的病例可能需要三大类药物中的两种：通常需要β受体阻滞剂、血管扩张剂和利尿剂，在某些情况下，每类药物都需要使用。诸如甲基多巴、可乐定和肾上腺素能神经元抑制药物等现在更多地用作备用药物。
