Dzau V J
Am J Med. 1987 Jan 5;82(1A):36-43. doi: 10.1016/0002-9343(87)90142-2.
The primary hemodynamic hallmark of essential hypertension is elevated systemic vascular resistance that may be affected by increased sympathetic tone, activation of the renin-angiotensin system, or structural and cellular abnormalities (e.g., those involving calcium) of the blood vessel wall. The aim of therapy, therefore, is to reduce vascular tone through the use of a specific blocker of neurohormonal mechanisms or a nonspecific vasodilator. These agents are not equally effective in all patients. In comparing these drugs, the following issues are important: pathophysiology, patient demography, mechanism of drug action, long-term efficacy, and metabolic effects. Several studies have suggested that there is a response to angiotensin converting enzyme inhibitors in young and middle-aged patients, whereas in elderly patients there may be more of a response to calcium channel blockers. Alpha 1-adrenergic blockers, however, appear to be effective in all age groups. Calcium channel blockers and alpha 1-adrenergic blockers generally are more effective in black patients than are angiotensin converting enzyme inhibitors. Neither of these agents adversely affects serum potassium, glucose, or plasma lipid levels. In fact, data suggest that alpha 1-adrenergic blockers may reduce low-density lipoprotein cholesterol and triglyceride levels and increase high-density lipoprotein cholesterol levels. Unlike alpha-adrenergic blockers and angiotensin converting enzyme inhibitors, calcium channel blockers may produce a negative inotropic effect and improved cardiac diastolic relaxation. In addition to all of these factors, it is important that the agent selected as initial antihypertensive therapy be efficacious, have a favorable side-effects profile, and have no adverse influences on other risk factors.
原发性高血压的主要血流动力学特征是全身血管阻力升高，这可能受交感神经张力增加、肾素 - 血管紧张素系统激活或血管壁结构及细胞异常（如涉及钙的异常）影响。因此，治疗的目的是通过使用神经激素机制的特异性阻滞剂或非特异性血管扩张剂来降低血管张力。这些药物对所有患者的疗效并不相同。在比较这些药物时，以下问题很重要：病理生理学、患者人口统计学、药物作用机制、长期疗效和代谢效应。多项研究表明，年轻和中年患者对血管紧张素转换酶抑制剂有反应，而老年患者可能对钙通道阻滞剂反应更大。然而，α1肾上腺素能阻滞剂似乎在所有年龄组中都有效。钙通道阻滞剂和α1肾上腺素能阻滞剂在黑人患者中通常比血管紧张素转换酶抑制剂更有效。这些药物均不会对血清钾、葡萄糖或血脂水平产生不利影响。事实上，数据表明α1肾上腺素能阻滞剂可能降低低密度脂蛋白胆固醇和甘油三酯水平，并提高高密度脂蛋白胆固醇水平。与α肾上腺素能阻滞剂和血管紧张素转换酶抑制剂不同，钙通道阻滞剂可能产生负性肌力作用并改善心脏舒张期松弛。除了所有这些因素外，选择作为初始抗高血压治疗的药物必须有效、具有良好的副作用谱且对其他危险因素无不利影响，这一点很重要。
