Department of Pharmacology and INSERM U 970, Hôpital Européen Georges Pompidou, Paris-Descartes University, Assistance Publique - Hôpitaux de Paris, 56 rue Leblanc, 75015, Paris, France.
Pharmacol Res. 2017 Oct;124:116-125. doi: 10.1016/j.phrs.2017.07.026. Epub 2017 Aug 2.
Successful treatment of hypertension is possible with limited side effects given the availability of multiple antihypertensive drug classes. This review describes the various pharmacological classes of antihypertensive drugs, under two major aspects: their mechanisms of action and side effects. The mechanism of action is analysed through a pharmacological approach, i.e. the molecular receptor targets, the various sites along the arterial system, and the extra-arterial sites of action, in order to better understand in which type of hypertension a given pharmacological class of antihypertensive drug is most indicated. In addition, side effects are described and explained through their pharmacological mechanisms, in order to better understand their mechanism of occurrence and in which patients drugs are contra-indicated. This review does not address the effectiveness of monotherapies in large randomized clinical trials and combination therapies, since these are the matters of other articles of the present issue. Five major pharmacological classes of antihypertensive drugs are detailed here: beta-blockers, diuretics, angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists, and calcium channel blockers. Four additional pharmacological classes are described in a shorter manner: renin inhibitors, alpha-adrenergic receptor blockers, centrally acting agents, and direct acting vasodilators.
在有多种降压药类的情况下,通过限制副作用,可以实现高血压的成功治疗。本综述描述了各种降压药的药理学类别,主要从两个方面进行分析:它们的作用机制和副作用。通过药理学方法分析作用机制,即分子受体靶点、动脉系统的各个部位和动脉外作用部位,以便更好地了解特定的降压药类在何种类型的高血压中最适用。此外,通过药理学机制描述和解释副作用,以便更好地了解其发生机制以及哪些患者禁用这些药物。本综述不涉及大型随机临床试验中单药治疗和联合治疗的有效性,因为这些是本期其他文章的主题。本文详细介绍了五大类降压药:β受体阻滞剂、利尿剂、血管紧张素转换酶抑制剂、血管紧张素 II 受体拮抗剂和钙通道阻滞剂。另外四类药物以较短的篇幅进行了描述:肾素抑制剂、α肾上腺素能受体阻滞剂、中枢作用药物和直接作用的血管扩张剂。