Opie L H
S Afr Med J. 1980 Dec 27;58(26):1025-9.
The therapy of hypertension with heart failure is a classic illustration of the value of agents reducing the afterload, being a specialized example of the general principle of the modern treatment of heart failure by vasodilator therapy. Agents such as diuretics and vasodilators are used in the therapy of heart failure in general and also in the therapy of hypertensive heart failure. However, drugs such as digoxin, which primarily and directly increase the inotropic state of the heart, should not be used without careful consideration, because the basic problem is not the defective inotropic state of the myocardium, but the increased afterload. In hypertensive emergencies, the real danger is over-rapid reduction of the blood pressure with cerebral underperfusion and cerebrovascular accidents. Hence, in acute hypertensive heart failure or hypertensive encephalopathy, smooth reduction of blood pressure is essential and oral agents are often effective. In those unusual patients in whom urgent intravenous therapy is required, monitored infusions are used, but never single intravenous injections which can have effects that cannot be controlled.
高血压合并心力衰竭的治疗是使用降低后负荷药物价值的经典例证，它是通过血管扩张剂治疗心力衰竭这一现代治疗总则的一个特殊例子。利尿剂和血管扩张剂等药物一般用于心力衰竭的治疗，也用于高血压性心力衰竭的治疗。然而，像地高辛这类主要直接增强心肌收缩力的药物，在没有仔细考虑的情况下不应使用，因为根本问题不是心肌收缩力不足，而是后负荷增加。在高血压急症中，真正的危险是血压过度快速下降伴脑灌注不足和脑血管意外。因此，在急性高血压性心力衰竭或高血压脑病中，平稳降低血压至关重要，口服药物通常有效。在那些需要紧急静脉治疗的特殊患者中，采用监测下的静脉输注，但绝不要使用单次静脉注射，因为单次静脉注射可能产生无法控制的效果。
