Kaplan N M
Department of Internal Medicine, University of Texas Health Science Center, Southwestern Medical School, Dallas 75235-9030.
Am Heart J. 1988 Jan;115(1 Pt 2):288-94. doi: 10.1016/0002-8703(88)90652-7.
Hypertensive patients who smoke have a high risk of developing premature cardiovascular disease. In addition to encouraging these patients to stop smoking, effective nondrug therapies include weight reduction, salt restriction, and alcohol limitation. For patients whose hypertension is severe or who have other health problems, antihypertensive drug therapy is also used. In the past, diuretics and beta-blockers have proved popular. However, these drugs have produced biochemical disturbances, such as diuretic-induced hypokalemia and both diuretic- and beta-blocker-induced alterations in blood lipids. The hazard of such drug-induced alterations may be greater in hypertensive patients, who may already suffer from hypercholesterolemia. Other drugs are available that can treat hypertension with no or beneficial influence on blood lipids. For smokers, the selective alpha 1-receptor inhibitors may be more attractive, since they also act to counteract the vasoconstriction produced by nicotine. In the future, inhibitors of hydroxymethylglutaryl coenzyme A reductase may offer potential for effective control of blood lipids in hypertensive patients who smoke.
吸烟的高血压患者发生心血管疾病过早的风险很高。除了鼓励这些患者戒烟外，有效的非药物治疗方法包括减轻体重、限制盐摄入和限制饮酒。对于高血压严重或有其他健康问题的患者，也会使用抗高血压药物治疗。过去，利尿剂和β受体阻滞剂很受欢迎。然而，这些药物会产生生化紊乱，如利尿剂引起的低钾血症以及利尿剂和β受体阻滞剂引起的血脂改变。在可能已经患有高胆固醇血症的高血压患者中，此类药物引起的改变所带来的危害可能更大。还有其他一些药物可用于治疗高血压，且对血脂没有影响或有有益影响。对于吸烟者来说，选择性α1受体抑制剂可能更具吸引力，因为它们还能对抗尼古丁产生的血管收缩作用。未来，羟甲基戊二酰辅酶A还原酶抑制剂可能为有效控制吸烟的高血压患者的血脂提供潜力。
