Kaplan N M
Am J Med. 1987 Jan 5;82(1A):9-14. doi: 10.1016/0002-9343(87)90137-9.
Diuretics, adrenergic inhibitors, and vasodilators--the three major classes of drugs used in the treatment of hypertension--have an impact on coronary heart disease. All three types of treatment reduce blood pressure to about the same degree, but with considerable individual variability with respect to their impact (positive or negative) on coronary heart disease risk. Hypokalemia, increased cholesterol levels, and hyperglycemia are common side effects of diuretic therapy that may exert a negative impact on coronary heart disease risk. Of the adrenergic inhibitors, the central agonists reverse left ventricular hypertrophy, whereas the alpha blockers generally have no adverse effect on cholesterol levels and may block coronary alpha receptors, both of which would have a positive impact on coronary risk. Beta blockers, the other class of adrenergic inhibitors, produce effects that can both negatively impact (lower high-density lipoprotein cholesterol levels and increase triglyceride levels) and positively impact (prevent arrhythmias and reverse left ventricular hypertrophy) coronary heart disease risk. The various types of vasodilators affect coronary risk differently: direct vasodilators stimulate sympathetics (negative impact), and converting enzyme inhibitors reverse left ventricular hypertrophy (positive impact). The effects of diuretics, adrenergic inhibitors, and vasodilators on all of these parameters need to be considered in the choice of therapy, particularly for the majority of asymptomatic patients with mild hypertension who are at relatively low risk for coronary heart disease.
利尿剂、肾上腺素能抑制剂和血管扩张剂——治疗高血压的三大类药物——对冠心病有影响。这三种治疗方法降低血压的程度大致相同，但在它们对冠心病风险的影响（正面或负面）方面存在相当大的个体差异。低钾血症、胆固醇水平升高和高血糖是利尿剂治疗的常见副作用，可能对冠心病风险产生负面影响。在肾上腺素能抑制剂中，中枢激动剂可逆转左心室肥厚，而α受体阻滞剂通常对胆固醇水平无不良影响，且可能阻断冠状动脉α受体，这两者都会对冠心病风险产生积极影响。另一类肾上腺素能抑制剂β受体阻滞剂产生的效应既能对冠心病风险产生负面影响（降低高密度脂蛋白胆固醇水平并升高甘油三酯水平），也能产生正面影响（预防心律失常并逆转左心室肥厚）。不同类型的血管扩张剂对冠心病风险的影响不同：直接血管扩张剂刺激交感神经（负面影响），而转换酶抑制剂可逆转左心室肥厚（正面影响）。在选择治疗方法时，需要考虑利尿剂、肾上腺素能抑制剂和血管扩张剂对所有这些参数的影响，特别是对于大多数无症状的轻度高血压患者，他们患冠心病的风险相对较低。
