Leitschuh M, Chobanian A
Med Clin North Am. 1987 Sep;71(5):827-41. doi: 10.1016/s0025-7125(16)30811-2.
Hypertension can directly damage blood vessels, and leads to renal failure, intracranial bleeds, and lacunar infarctions. Of equal importance is the effect of hypertension on the development of atherosclerosis. Specific changes in both the microvasculature and macrovasculature vary depending on the degree and rapidity of blood pressure elevation. Changes in the intima and media can lead to significant narrowing of vessels and ischemia in various tissues. In addition, changes in small-resistance vessels contribute to changes in peripheral-vasculature resistance and thus affect blood pressure regulation. Treatment of moderate to severe elevation in blood pressure clearly results in a decrease in the incidence of stroke. However, evidence that treating mild hypertension reduces coronary events is less convincing. Antihypertensive therapy may result in partial regression of vascular changes, especially fibrinoid necrosis seen in malignant hypertension, but more work needs to be done to clearly define the roles of specific drugs in preventing or regressing hypertensive vascular disease.
高血压可直接损害血管，导致肾衰竭、颅内出血和腔隙性脑梗死。同样重要的是高血压对动脉粥样硬化发展的影响。微血管和大血管的具体变化取决于血压升高的程度和速度。内膜和中膜的变化可导致血管显著狭窄和各组织缺血。此外，小阻力血管的变化会导致外周血管阻力改变，从而影响血压调节。治疗中度至重度血压升高显然会降低中风的发生率。然而，治疗轻度高血压可减少冠状动脉事件的证据并不那么令人信服。抗高血压治疗可能会使血管变化部分消退，尤其是在恶性高血压中见到的纤维蛋白样坏死，但需要做更多工作来明确定义特定药物在预防或消退高血压血管疾病中的作用。
