Hansson L
Department of Medicine, University of Gothenburg, Ostra Hospital, Sweden.
J Hypertens Suppl. 1987 Aug;5(3):S61-7.
Following the early and important observations more than two decades ago, by Prichard and Gillam that beta-blockers had a useful antihypertensive effect, this class of compounds has become widely accepted in the treatment of elevated arterial pressure. Today there are numerous different compounds available within the beta-blocker class, with marked differences in their ancillary properties. Undoubtedly, the blockade of beta 1-adrenoceptors is the effect needed to achieve the reduction in blood pressure, and this selectivity also offers some advantages from a safety point of view. However, in some circumstances, ancillary properties such as beta 2-blockade may offer advantages, as can intrinsic sympathomimetic activity. The fact that beta-blockers have become first-line treatment for hypertension in many countries and that memoranda produced by the World Health Organization and the International Society of Hypertension jointly advocate beta-blockers as one alternative for basic therapy reflects the positive balance between efficacy and side effects seen with these agents. It is also an indication that positive long-term clinical experience has been accumulated with beta-blockers. Finally, secondary prevention against coronary heart disease is well documented for beta-blockers. For this reason there have been great hopes for many years that beta-blockers would also have a primary preventive effect against coronary heart disease when used in the treatment of hypertension. Indications are now accumulating that, at least in some subgroups of patients, beta-blockers may have such an effect. Thus, although newer classes of compounds appear to be extremely competitive, beta-blockers are likely to play an important role in the treatment of hypertension for many years to come.
二十多年前，普里查德和吉勒姆进行了早期且重要的观察，发现β受体阻滞剂具有有益的降压作用。自此，这类化合物在治疗动脉血压升高方面已被广泛接受。如今，β受体阻滞剂类别中有众多不同的化合物，它们的辅助特性存在显著差异。毫无疑问，阻断β1肾上腺素能受体是实现血压降低所需的作用，而且这种选择性从安全角度来看也具有一些优势。然而，在某些情况下，诸如β2阻断等辅助特性可能会带来益处，内在拟交感活性也是如此。β受体阻滞剂已成为许多国家高血压的一线治疗药物，世界卫生组织和国际高血压学会联合发布的备忘录倡导将β受体阻滞剂作为基础治疗的一种选择，这一事实反映了这些药物在疗效和副作用之间呈现出的积极平衡。这也表明β受体阻滞剂积累了积极的长期临床经验。最后，β受体阻滞剂对冠心病二级预防的作用已有充分记录。因此，多年来人们一直满怀期望，认为β受体阻滞剂在用于治疗高血压时对冠心病也会有一级预防作用。现在有越来越多的迹象表明，至少在某些患者亚组中，β受体阻滞剂可能具有这种作用。所以，尽管新型化合物类别似乎极具竞争力，但β受体阻滞剂在未来许多年的高血压治疗中可能仍将发挥重要作用。
