Fernandez P G, Snedden W, Vasdev S, Bolli P
Division of Clinical Pharmacology, Memorial Medical School, St. John's, Newfoundland.
Can J Cardiol. 1989 Mar;5(2):93-7.
An attempt was made to establish whether cardioselective beta-blockade could counteract the stimulation by hydrochlorothiazide of the renin-angiotensin and sympathetic nervous systems and to what extent such actions contributed to the antihypertensive effect of bevantolol. The hemodynamic and neurohumoral responses of 21 thiazide resistant hypertensives who had received sequential chronic therapy with hydrochlorothiazide, hydrochlorothiazide combined with bevantolol and bevantolol monotherapy were compared. In these patients, bevantolol had a negative chronotropic effect and appeared, when administered alone, to induce an overall lowering of sympathetic nervous system activity without inhibiting the reflex responses of peripheral vascular resistance to postural change or lowered heart rate. When bevantolol and hydrochlorothiazide were administered together, sympathetic activity appeared to be maintained, possibly as a reflex response to volume depletion but vascular resistance did not appear to be responsive to baroreceptor stimulation. Diminished vascular reactivity induced by the hydrochlorothiazide is suspected to be a contributory factor. Inhibition of thiazide stimulated renin release by bevantolol may contribute to the antihypertensive effect of the combined therapy.
本研究旨在确定心脏选择性β受体阻滞剂是否能对抗氢氯噻嗪对肾素 - 血管紧张素系统和交感神经系统的刺激作用，以及这种作用在何种程度上有助于贝凡洛尔的降压效果。比较了21例对噻嗪类药物耐药的高血压患者在接受氢氯噻嗪、氢氯噻嗪联合贝凡洛尔以及贝凡洛尔单药序贯长期治疗后的血流动力学和神经体液反应。在这些患者中，贝凡洛尔具有负性变时作用，单独使用时似乎可使交感神经系统活动总体降低，但不抑制外周血管阻力对体位变化或心率降低的反射反应。当贝凡洛尔与氢氯噻嗪合用时，交感神经活动似乎得以维持，这可能是对血容量减少的一种反射反应，但血管阻力似乎对压力感受器刺激无反应。怀疑氢氯噻嗪引起的血管反应性降低是一个促成因素。贝凡洛尔抑制噻嗪类药物刺激的肾素释放可能有助于联合治疗的降压效果。
