Laragh J H
Cardiovascular Center, New York Hospital-Cornell Medical Center, NY 10021.
Health Psychol. 1988;7 Suppl:253-65. doi: 10.1037/h0090277.
Essential hypertension is a heterogeneous spectrum of pathophysiologic disturbances, not a single entity. Identification and characterization of two different vasoconstrictor mechanisms--one renin-mediated, the other sodium-volume mediated--has made it possible not only to apply antihypertensive drug therapy on a more rational basis but to screen out a significant number of cases of curable (high-renin) renovascular disease as well as many cases of curable (low-renin) primary aldosteronism. An array of five major drug types makes long-term monotherapy for essential hypertension an achievable goal. Converting enzyme inhibitors and beta-blockers counteract the renin-mediated vasoconstriction; diuretics, calcium-channel antagonists, and alpha-blockers oppose the low-renin sodium-volume-mediated form of vasoconstriction. This information brings us closer to the primary goal of modern therapy: to give each patient the fewest drugs in the smallest amounts and with the least frequency possible for the often lifetime commitment that antihypertensive therapy involves.
原发性高血压是一系列病理生理紊乱的异质性疾病谱，而非单一实体。两种不同的血管收缩机制——一种是肾素介导的，另一种是钠容量介导的——的识别和特征描述，不仅使基于更合理的基础应用抗高血压药物治疗成为可能，而且能够筛查出大量可治愈的（高肾素型）肾血管疾病病例以及许多可治愈的（低肾素型）原发性醛固酮增多症病例。五类主要药物使原发性高血压的长期单一药物治疗成为一个可实现的目标。转换酶抑制剂和β受体阻滞剂可对抗肾素介导的血管收缩；利尿剂、钙通道拮抗剂和α受体阻滞剂则对抗低肾素钠容量介导的血管收缩形式。这些信息使我们更接近现代治疗的主要目标：对于抗高血压治疗通常所需的终身治疗，尽可能以最少的药物剂量、最低的用药频率给予每位患者用药。
