Ting C T, Chen C H, Chang M S, Yin F C
Veterans General Hospital, Taichung, Taipei, Taiwan.
Hypertension. 1995 Sep;26(3):524-30. doi: 10.1161/01.hyp.26.3.524.
This article reviews our work on the effects of different classes of antihypertensive agents on the hemodynamic alterations in essential human hypertension. Short-term studies were done during cardiac catheterization in young normotensive subjects (mean age, 33 years; range, 19 to 40) and several different age-matched (range, 25 to 53 years) groups of patients with essential hypertension. Aortic impedance, resistance, wave reflections, and compliance were calculated from high-fidelity recordings of ascending aortic pressure and flow signals during baseline and after nitroprusside, propranolol followed by phentolamine, phentolamine, captopril, and nifedipine, respectively, at doses sufficient to normalize blood pressure in each hypertensive group. Propranolol exacerbated all the hemodynamic parameters; these effects were only partially overcome by phentolamine. Among the other agents only phentolamine did not completely normalize compliance, and only captopril did not completely normalize wave reflections. The long-term study was a randomized, double-blind comparison of fosinopril and atenolol in 79 normotensive subjects and 79 essential hypertensive patients. Baseline 24-hour ambulatory blood pressures and carotid artery tonometry to index wave reflections were performed in all subjects and in hypertensive patients after 8 weeks of therapy. Both fosinopril and atenolol normalized blood pressure and lowered the elevated augmentation index, but fosinopril had a significantly larger effect than atenolol. Both short- and long-term beta-blockade did not have as beneficial an effect as the other agents. Thus, the differing hemodynamic effects of the various classes of antihypertensive agents might be a consideration in the choice of therapy.
本文回顾了我们关于不同类别抗高血压药物对原发性高血压患者血流动力学改变影响的研究工作。在年轻血压正常受试者（平均年龄33岁；范围19至40岁）以及几组年龄匹配（范围25至53岁）的原发性高血压患者进行心导管检查期间开展了短期研究。分别在基线状态以及给予硝普钠、先使用普萘洛尔再使用酚妥拉明、酚妥拉明、卡托普利和硝苯地平后，根据升主动脉压力和血流信号的高保真记录计算主动脉阻抗、阻力、波反射和顺应性，所用剂量足以使各高血压组的血压恢复正常。普萘洛尔使所有血流动力学参数恶化；酚妥拉明仅部分克服了这些影响。在其他药物中，只有酚妥拉明未使顺应性完全恢复正常，只有卡托普利未使波反射完全恢复正常。长期研究是一项在79名血压正常受试者和79名原发性高血压患者中进行的福辛普利与阿替洛尔的随机双盲比较。在所有受试者以及高血压患者治疗8周后，测量了基线24小时动态血压以及用于评估波反射的颈动脉张力测定。福辛普利和阿替洛尔均使血压恢复正常并降低了升高的增强指数，但福辛普利的效果显著大于阿替洛尔。短期和长期使用β受体阻滞剂的效果均不如其他药物有益。因此，各类抗高血压药物不同的血流动力学效应可能是治疗选择时需要考虑的因素。
