Kaplan N M
Am J Med. 1986 May 23;80(5B):100-4. doi: 10.1016/0002-9343(86)90861-2.
As millions more patients with mild hypertension are being brought into active drug therapy, the need for effective medications that are safe for long-term use has increased. This is, in part, as a result of the adverse effect on coronary heart disease mortality observed in two of the major therapeutic trials, the Oslo Study and the Multiple Risk Factor Intervention Trial. In both of these, the diuretic-first, stepped-care approach was used. Administration of diuretics is frequently associated with such biochemical abnormalities as hypokalemia, hypercholesterolemia, and hyperglycemia. Thus, the wisdom of the routine use of a diuretic as the first choice of therapy is being questioned. Alternative drugs for initial therapy include beta blockers and selective alpha 1 blockers. With beta blockers, there is a tendency for serum triglycerides to increase and high-density lipoprotein cholesterol to decline, as well as a tendency for an undesirable reduction in cardiac output and an increase in peripheral resistance. Selective alpha 1 blockers, because they lower blood pressure in a hemodynamically more favorable manner and have a tendency to improve the lipid profile, are becoming increasingly attractive as initial therapy for mild hypertension and also as part of the combination needed for more severe disease. The favorable results noted with the new selective alpha 1 blocker terazosin strongly support its addition to the list of preferred drugs for initial therapy.
随着数百万轻度高血压患者开始接受积极的药物治疗，对长期使用安全的有效药物的需求增加了。部分原因是在两项主要治疗试验（奥斯陆研究和多重危险因素干预试验）中观察到对冠心病死亡率的不利影响。在这两项试验中，都采用了以利尿剂为先的阶梯式治疗方法。利尿剂的使用常常与低钾血症、高胆固醇血症和高血糖等生化异常有关。因此，常规使用利尿剂作为首选治疗方法的合理性受到质疑。初始治疗的替代药物包括β受体阻滞剂和选择性α1受体阻滞剂。使用β受体阻滞剂时，血清甘油三酯有升高趋势，高密度脂蛋白胆固醇有下降趋势，同时心输出量有不良减少趋势，外周阻力增加。选择性α1受体阻滞剂由于能以更有利于血流动力学的方式降低血压，并有改善血脂谱的趋势，作为轻度高血压的初始治疗以及更严重疾病所需联合治疗的一部分，正变得越来越有吸引力。新型选择性α1受体阻滞剂特拉唑嗪的良好结果有力地支持将其列入初始治疗的首选药物名单。
