Korner P I, Jennings G L, Esler M D, Broughton A
J Clin Hypertens. 1987 Jun;3(2):187-96.
In experimental studies on renovascular hypertension, we found that the amplifier properties of the hypertrophied heart and resistance vessels contributed considerably more to the maintenance of the elevated blood pressure (BP) during the chronic phase of the disorder than the basic underlying cause. This must also occur in chronic primary hypertension. Accordingly, we hypothesized that after reversal of hypertrophy by antihypertensive medication, the cause(s) of hypertension should be easier to detect during the redevelopment of hypertension once medication was stopped than in the chronic phase of the disorder. We have studied three groups of patients with moderate/severe hypertension in whom BP was controlled for 1 month; 1 year; 15 months to 5 years. The rate of subsequent redevelopment of hypertension between the series was inversely related to the duration of therapy, which was mostly with beta blockers and diuretics. The differences in the rate of redevelopment of hypertension between series 2 and 3 suggest that, with the drugs used, reversal of vascular hypertrophy is quicker than reversal of left ventricular hypertrophy (LVH). In series 3, we observed an inverse relationship between LV mass and duration of therapy. Redevelopment of hypertension was slowest after obtaining regression of both vascular hypertrophy and LVH. Preliminary findings suggest that sympathetic overactivity is present during the redevelopment phase in the majority of patients. Our findings have suggested a new therapeutic strategy, where the effectiveness of nonpharmacological methods of controlling BP is enhanced by first causing regression of cardiovascular hypertrophy by drug treatment followed by a non-drug phase of maintaining normal BP. We have found moderate regular exercise one of the most effective nonpharmacological antihypertensive methods and have now maintained five patients with moderate hypertension at normal BP for 1 year, following an initial period of drug treatment.
在肾血管性高血压的实验研究中，我们发现，在该疾病的慢性期，肥厚的心脏和阻力血管的放大特性对维持血压升高的作用，比其基本潜在病因的作用要大得多。这在慢性原发性高血压中肯定也会发生。因此，我们推测，通过抗高血压药物使肥厚逆转后，在停药后高血压再次发展过程中，比起疾病的慢性期，高血压的病因应该更容易被检测到。我们研究了三组中度/重度高血压患者，他们的血压分别被控制了1个月、1年、15个月至5年。后续各系列之间高血压再次发展的速率与治疗持续时间呈负相关，治疗主要使用β受体阻滞剂和利尿剂。系列2和系列3之间高血压再次发展速率的差异表明，使用这些药物时，血管肥厚的逆转比左心室肥厚（LVH）的逆转更快。在系列3中，我们观察到左心室质量与治疗持续时间之间呈负相关。在血管肥厚和左心室肥厚均消退后，高血压的再次发展最慢。初步研究结果表明，大多数患者在再次发展阶段存在交感神经过度活跃。我们的研究结果提出了一种新的治疗策略，即通过药物治疗首先使心血管肥厚消退，然后进入维持正常血压的非药物阶段，从而增强控制血压的非药物方法的有效性。我们发现适度的规律运动是最有效的非药物抗高血压方法之一，并且在经过初始阶段的药物治疗后，我们现已使五名中度高血压患者的血压维持正常达1年。
