Maxwell M H
UCLA School of Medicine, Los Angeles, CA 90024.
Am J Hypertens. 1988 Oct;1(4 Pt 2):366S-371S.
Mild hypertension accounts for approximately 60% of the mortality associated with high blood pressure. In addition to hypertension, other major cardiovascular risk factors include left ventricular hypertrophy (LVH), dyslipoproteinemia, and glucose intolerance. Thus, the effects of agents used to treat hypertension on these risk factors are of considerable importance. Large therapeutic intervention trials have shown that while adequate treatment of mild hypertension significantly and consistently reduces all-cause mortality as well as the risk of stroke and congestive heart failure, an anticipated reduction in coronary heart disease (CHD) has not been demonstrated. It is possible adverse metabolic side effects (hypercholesterolemia, hyperglycemia, hypokalemia) of widely used agents, such as diuretics and beta-blockers may be partially offsetting the beneficial effects of blood pressure reduction, with the net result being a failure of these agents to reduce the risk of CHD. Angiotensin-converting enzyme inhibitors (ACEIs) and calcium channel blockers do not produce these adverse metabolic derangements. The use of antihypertensive agents that have favorable or neutral metabolic effects should further reduce the risk of cardiovascular morbidity and mortality attributable to high blood pressure, including CHD.
轻度高血压约占高血压相关死亡率的60%。除高血压外，其他主要心血管危险因素包括左心室肥厚（LVH）、血脂蛋白异常和糖耐量异常。因此，用于治疗高血压的药物对这些危险因素的影响具有相当重要的意义。大型治疗干预试验表明，虽然对轻度高血压进行充分治疗可显著且持续降低全因死亡率以及中风和充血性心力衰竭的风险，但尚未证实对冠心病（CHD）有预期的降低作用。有可能广泛使用的药物（如利尿剂和β受体阻滞剂）的不良代谢副作用（高胆固醇血症、高血糖、低钾血症）可能部分抵消了血压降低的有益作用，最终结果是这些药物未能降低冠心病风险。血管紧张素转换酶抑制剂（ACEI）和钙通道阻滞剂不会产生这些不良代谢紊乱。使用具有有利或中性代谢作用的抗高血压药物应能进一步降低高血压所致心血管疾病发病率和死亡率的风险，包括冠心病。
