Moser M
Am J Med. 1986 May 23;80(5B):1-11. doi: 10.1016/0002-9343(86)90845-4.
Remarkable progress has been made during the past 30 years in the management of hypertension, a disease that affects approximately one out of every four adults in the United States. In the 1960s, at least half of the individuals with hypertension were unaware of their disease, and the blood pressures of fewer than 20 percent were controlled at normotensive levels. In contrast, in the 1980s, only a small percentage, perhaps as few as 10 or 15 percent of hypertensive patients, are unaware of their disease and, in many parts of the country, more than 60 percent are being treated to goal blood pressure levels. More effective treatment of hypertension is probably a major reason for the 45 percent decrease in stroke mortality rates in the last 12 years alone and for the dramatic decrease in the number of hypertensive patients in whom renal failure or congestive heart failure develops. In addition, at least a portion of the 25 to 30 percent decrease in coronary mortality rates can probably be attributed to better management of patients with hypertension. The availability of antihypertensive drugs in the 1950s (rauwolfia preparations, veratrum derivatives, thiocyanates, hydralazine, and the ganglion blockers) and the discovery of more effective agents in the period from the 1960s to the present have dramatically improved the prognosis of hypertensive patients. Thiazide diuretics, centrally acting sympatholytic agents, beta-adrenergic inhibitors, and, more recently, selective alpha-adrenergic inhibitors, converting-enzyme inhibitors, and calcium entry blockers are examples of these medications. All of these agents have some side effects, with varying patient acceptability. The search continues for newer drugs that are well tolerated, that lower blood pressure by reducing peripheral resistance, and that produce few metabolic changes. A detailed review of the physiologic effects of antihypertensive medications, as well as a critique of the clinical trials and some of the problems noted in the pharmacologic management of hypertension, is presented.
在过去30年里，高血压的治疗取得了显著进展。在美国，每四个成年人中就有一人受高血压影响。在20世纪60年代，至少一半的高血压患者不知道自己患病，血压得到控制并维持在正常水平的患者不到20%。相比之下，在20世纪80年代，只有一小部分高血压患者（可能只有10%或15%）不知道自己患病，而且在该国许多地区，超过60%的患者血压得到控制。仅在过去12年中，高血压治疗效果的提高可能是中风死亡率下降45%的主要原因，也是高血压并发肾衰竭或充血性心力衰竭患者数量大幅减少的主要原因。此外，冠心病死亡率下降25%至30%，至少部分原因可能是高血压患者得到了更好的治疗。20世纪50年代出现的抗高血压药物（萝芙木制剂、藜芦衍生物、硫氰酸盐、肼屈嗪和神经节阻滞剂）以及20世纪60年代至今发现的更有效的药物，显著改善了高血压患者的预后。噻嗪类利尿剂、中枢性抗交感神经药、β肾上腺素能抑制剂，以及最近的选择性α肾上腺素能抑制剂、血管紧张素转换酶抑制剂和钙通道阻滞剂都是这类药物的例子。所有这些药物都有一些副作用，患者的接受程度各不相同。人们仍在寻找耐受性良好、通过降低外周阻力来降低血压且几乎不引起代谢变化的新型药物。本文详细综述了抗高血压药物的生理作用，以及对临床试验的评论和高血压药物治疗中发现的一些问题。
