Zusman R M
Hypertension Division, Massachusetts General Hospital, Boston, MA 02114.
Am J Hypertens. 1989 Jun;2(6 Pt 2):200S-206S.
With the increasingly widespread recognition of the adverse side effects of traditional antihypertensive medications, alternative approaches to the treatment of uncomplicated hypertensive patients have been proposed. The use of vasodilator agents, calcium-channel blockers, angiotensin-converting enzyme (ACE) inhibitors, and alpha-adrenergic receptor blockers results in blood pressure reduction without adverse metabolic consequences. Furthermore, vasodilatory agents reverse the principal physiological abnormality of hypertensive patients, that is, they reverse the increased systemic vascular resistance that characterizes these patients and, in so doing, may alleviate abnormalities of systolic and diastolic left ventricular performance. In particular, a comparison of the effects of nifedipine and propranolol on left ventricular (LV) function in patients with moderately severe hypertension revealed significant differences in their effects on cardiac function. Although both drugs reduced blood pressure to an identical degree, nifedipine therapy was associated with a decrease in systemic vascular resistance, an increase in cardiac output, and improved parameters of left ventricular contractile and diastolic function as measured by quantitative radionuclide ventriculography. Vasodilator therapy should be considered for the initial treatment of patients with uncomplicated essential hypertension.
随着传统抗高血压药物副作用的认识日益广泛，已提出了治疗单纯性高血压患者的替代方法。使用血管扩张剂、钙通道阻滞剂、血管紧张素转换酶（ACE）抑制剂和α-肾上腺素能受体阻滞剂可降低血压，且无不良代谢后果。此外，血管扩张剂可逆转高血压患者的主要生理异常，即它们可逆转这些患者特征性的全身血管阻力增加，从而可能减轻左心室收缩和舒张功能异常。特别是，比较硝苯地平和普萘洛尔对中度严重高血压患者左心室（LV）功能的影响发现，它们对心脏功能的影响存在显著差异。虽然两种药物都将血压降低到相同程度，但硝苯地平治疗与全身血管阻力降低、心输出量增加以及通过定量放射性核素心室造影测量的左心室收缩和舒张功能参数改善有关。对于单纯性原发性高血压患者的初始治疗，应考虑血管扩张剂治疗。
