Frohlich E D
Alton Ochsner Medical Foundation, New Orleans, Louisiana 70121.
J Cardiovasc Pharmacol. 1989;13 Suppl 1:S11-7.
Hypertension is a multifactorial disease that is manifested hemodynamically by an increased total peripheral resistance that is more or less uniformly distributed throughout the organ circulations, especially in its target organs, the brain, heart, and kidney. The vasoconstriction involves venules as well as arterioles. The increased afterload that is imposed upon the left ventricle results in the development of concentric hypertrophy. This may be complicated by a preload component early in hypertension or in patients who are volume-dependent (e.g., obesity, blacks). Eventually, if not treated, dysrhythmias, sudden death, or cardiac failure may supervene. The kidney becomes affected by progressive failure in function related to hemodynamic impairment secondary to afferent, as well as efferent, arteriolar constriction, which increases glomerular hydrostatic pressure. If at all possible, antihypertensive therapy should not be associated with intravascular volume expansion or reflex cardiac stimulation. Calcium antagonists reduce arterial pressure through a fall in vascular resistance without expanding volume or inordinately stimulating the heart. Left ventricular afterload is diminished with associated decrease of left ventricular mass. Moreover, renal blood flow increases while filtration fraction and glomerular hydrostatic pressure diminishes. Thus, these agents approach the ideal in reversing the pathophysiological complications of the disease.
高血压是一种多因素疾病，其血流动力学表现为总外周阻力增加，这种增加或多或少均匀地分布于全身各器官循环，尤其是在其靶器官——脑、心脏和肾脏。血管收缩涉及小静脉以及小动脉。左心室所承受的后负荷增加会导致向心性肥厚。在高血压早期或对于容量依赖性患者（如肥胖者、黑人），这可能会因前负荷因素而变得复杂。最终，如果不进行治疗，可能会出现心律失常、猝死或心力衰竭。肾脏会因入球小动脉和出球小动脉收缩继发的血流动力学损害导致功能逐渐衰竭而受到影响，这会增加肾小球静水压力。只要有可能，抗高血压治疗不应与血管内容量扩张或反射性心脏刺激相关联。钙拮抗剂通过降低血管阻力来降低动脉血压，而不会使血容量增加或过度刺激心脏。左心室后负荷降低，同时左心室质量也会减少。此外，肾血流量增加，而滤过分数和肾小球静水压力降低。因此，这些药物在逆转该疾病的病理生理并发症方面接近理想状态。
