Grimm R H, Flack J M
Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55455.
Am J Med. 1989 Aug 16;87(2A):62S-65S. doi: 10.1016/0002-9343(89)90116-2.
The major risk factors for coronary heart disease remain high blood pressure, cigarette smoking, and abnormal serum lipid levels, including total cholesterol but more specifically elevated low-density lipoprotein cholesterol and reduced high-density lipoprotein cholesterol levels. Observations made from large-scale trials almost a decade ago suggested that commonly used antihypertensive agents, such as thiazide diuretics and beta-blockers, may adversely influence serum lipid levels. Over time, we realized that these lipid alterations persist long term and are of sufficient magnitude to potentially account for important differences in coronary heart disease risk reduction among various antihypertensive drug regimens. Considering recent National Cholesterol Education Program and Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure recommendations concerning lipid and blood pressure treatment, it is prudent and timely to rethink our approach to antihypertensive therapy in patients with abnormal serum lipid levels. Therefore, when lipids are a concern, appropriate dietary treatments should be advised and antihypertensive therapy that has a beneficial or neutral impact on serum lipid levels should be considered.
冠心病的主要危险因素仍然是高血压、吸烟和血清脂质水平异常，包括总胆固醇，但更具体地说是低密度脂蛋白胆固醇升高和高密度脂蛋白胆固醇水平降低。近十年前大规模试验的观察结果表明，常用的抗高血压药物，如噻嗪类利尿剂和β受体阻滞剂，可能会对血清脂质水平产生不利影响。随着时间的推移，我们意识到这些脂质改变会长期持续，其程度足以潜在地解释各种抗高血压药物治疗方案在降低冠心病风险方面的重要差异。考虑到最近国家胆固醇教育计划和全国高血压检测、评估与治疗联合委员会关于脂质和血压治疗的建议，重新思考我们对血清脂质水平异常患者的抗高血压治疗方法是谨慎且及时的。因此，当脂质成为关注点时，应建议采取适当的饮食治疗，并应考虑对血清脂质水平有有益或中性影响的抗高血压治疗。
