Frohlich E D
Alton Ochsner Medical Foundation, New Orleans, LA 70121.
Heart Lung. 1989 Jul;18(4):370-6.
A new class of antihypertensive agents has emerged for clinical consideration in the initial treatment of hypertension. These calcium antagonists are rapidly absorbed and reduce arterial pressure very promptly by antagonizing the pathophysiologic hallmark of the disease: an increased vascular resistance. Moreover, in reducing arterial pressure by means of arteriolar dilation, these agents do so without expanding intravascular volume and without inordinately stimulating the heart through reflex mechanisms. Vascular resistance is reduced in each of the major target organs of the disease: the heart, brain, and kidney. Reduction of coronary vascular resistance should be of particular value in patients with increased myocardial oxygen demands (e.g., with coronary arterial disease or with ventricular hypertrophy). Reduction of renal vascular resistance should be especially valuable for patients with renal functional impairment as a result of hypertensive vascular disease or with associated renal parenchymal diseases. In this respect, these agents reduce renal vascular resistance while maintaining glomerular filtration rate and reducing renal filtration fraction; these changes should reduce glomerular hyperfiltration and may inhibit promotion of glomerulosclerosis. Diltiazem may be of particular value because it may produce these effects while increasing renal blood flow. Clearly these agents reverse cerebral constriction and might be expected to improve blood flow to the brain; however, further study is anticipated and necessary.
一类新型抗高血压药物已出现，可供临床考虑用于高血压的初始治疗。这些钙拮抗剂吸收迅速，通过拮抗该疾病的病理生理特征——血管阻力增加，能非常迅速地降低动脉血压。此外，通过小动脉扩张来降低动脉血压时，这些药物不会增加血管内容量，也不会通过反射机制过度刺激心脏。在该疾病的每个主要靶器官（心脏、大脑和肾脏）中，血管阻力都有所降低。对于心肌需氧量增加的患者（如患有冠状动脉疾病或心室肥大），降低冠状动脉血管阻力应具有特别的价值。对于因高血压血管疾病或相关肾实质疾病导致肾功能损害的患者，降低肾血管阻力应特别有价值。在这方面，这些药物在降低肾血管阻力的同时，能维持肾小球滤过率并降低肾滤过分数；这些变化应能减少肾小球超滤，并可能抑制肾小球硬化的进展。地尔硫䓬可能具有特别的价值，因为它在增加肾血流量的同时可能产生这些效果。显然，这些药物能逆转脑动脉收缩，有望改善脑血流量；然而，预计还需要进一步研究且这是必要的。
