Anderson S
Renal Division, Brigham and Women's Hospital, Boston, MA 02115.
J Hypertens Suppl. 1989 Sep;7(7):S39-42. doi: 10.1097/00004872-198909007-00008.
Systemic hypertension accelerates the progression of glomerular injury. Studies in experimental animals indicate that the beneficial effects of antihypertensive agents may relate to their intrarenal haemodynamic consequences, and specifically to their effects on the arteriolar resistances. Relative afferent arteriolar vasodilation allows transmission of systemic pressure into the glomerular capillary network; the resultant glomerular capillary hypertension is associated with progressive structural injury. Antihypertensive agents, such as angiotensin converting enzyme (ACE) inhibitors, relax the efferent arteriole, alleviate glomerular hypertension and protect the kidney from progressive injury. These agents are effective in numerous animal models, and preliminary clinical observations suggest that they may also be effective in humans. In contrast, vasodilator/diuretic regimens are effective in some animal models, but fail to reduce glomerular pressure or injury in others. Less is known about the potential renal protective effects of calcium channel blockers, with reported observations offering conflicting findings. Further experimental and clinical studies are needed to define the optimal antihypertensive therapy for patients at risk of glomerular injury.
系统性高血压会加速肾小球损伤的进展。对实验动物的研究表明，抗高血压药物的有益作用可能与其肾内血流动力学后果有关，特别是与其对小动脉阻力的影响有关。相对的入球小动脉血管舒张可使全身压力传递至肾小球毛细血管网络；由此产生的肾小球毛细血管高压与进行性结构损伤相关。抗高血压药物，如血管紧张素转换酶（ACE）抑制剂，可舒张出球小动脉，减轻肾小球高压，并保护肾脏免受进行性损伤。这些药物在众多动物模型中有效，初步临床观察表明它们在人类中可能也有效。相比之下，血管扩张剂/利尿剂方案在一些动物模型中有效，但在其他模型中未能降低肾小球压力或损伤。关于钙通道阻滞剂的潜在肾脏保护作用了解较少，报道的观察结果相互矛盾。需要进一步的实验和临床研究来确定对有肾小球损伤风险的患者的最佳抗高血压治疗方案。
