Zusman R M
Hypertension Division, Massachusetts General Hospital, Boston 02114.
Hypertension. 1989 May;13(5 Suppl):I154-7. doi: 10.1161/01.hyp.13.5_suppl.i154.
The best antihypertensive regimen for use in patients with mild-to-moderate hypertension has not been determined. When nonpharmacological treatment of hypertension fails, initial drug treatment with diuretic drugs, sympatholytic agents (including beta-adrenergic receptor blockers), or vasodilators will result in satisfactory blood pressure control. However, each of these therapies has effects that are independent of their antihypertensive activity and that should be considered before a selection is made for initial therapy. The adverse effects of diuretic agents and beta-adrenergic receptor-blocking drugs on plasma lipid profiles may diminish the beneficial effects of blood pressure reduction. On the other hand, the hypocholesterolemic effect of alpha-adrenergic receptor antagonists, the potential cardioprotective effect of angiotensin converting enzyme inhibitors, and the salutary effects of calcium channel blockers on left ventricular function are responses that would support the use of vasodilatory therapy. Vasodilating antihypertensive drugs may be more beneficial than "standard" therapy and should be considered for the initial treatment of newly diagnosed hypertensive patients.
轻度至中度高血压患者的最佳抗高血压治疗方案尚未确定。当高血压的非药物治疗失败时，使用利尿剂、抗交感神经药（包括β-肾上腺素能受体阻滞剂）或血管扩张剂进行初始药物治疗将使血压得到满意控制。然而，这些治疗方法中的每一种都有独立于其抗高血压活性的作用，在选择初始治疗方法之前应予以考虑。利尿剂和β-肾上腺素能受体阻断药对血浆脂质谱的不良影响可能会削弱血压降低的有益作用。另一方面，α-肾上腺素能受体拮抗剂的降胆固醇作用、血管紧张素转换酶抑制剂的潜在心脏保护作用以及钙通道阻滞剂对左心室功能的有益作用，这些反应都支持使用血管舒张疗法。血管舒张性抗高血压药物可能比“标准”疗法更有益，对于新诊断的高血压患者的初始治疗应予以考虑。
