Moan A, Os I, Hjermann I, Kjeldsen S E
Department of Internal Medicine, Ullevål Hospital, Oslo, Norway.
Cardiology. 1995;86(2):89-93. doi: 10.1159/000176845.
A recent meta-analysis of hypertension treatment trials demonstrated a marked reduction in the incidence of cerebrovascular disease, but a less pronounced reduction in coronary heart disease. Treatment consisted mainly of diuretics and beta-blockers, and this paper discusses the possible influences of their metabolic side effects on coronary risk factors compared with newer agents: angiotensin-converting enzyme (ACE) inhibitors, selective alpha 1-adrenoceptor inhibitors and calcium channel blockers. Several studies are underway to compare the effect of these compounds with diuretics and beta-blockers with respect to long-term cardiovascular morbidity and mortality. Until the results of these studies are available, young patients (i.e. < 60-65 years) at high risk of coronary heart disease, especially patients with the insulin resistance syndrome or diabetes mellitus, should in our opinion be treated with ACE-inhibitors, selective alpha 1-adrenoceptor inhibitors or calcium channel blockers.
最近一项对高血压治疗试验的荟萃分析表明，脑血管疾病的发病率显著降低，但冠心病的发病率降低幅度较小。治疗主要包括利尿剂和β受体阻滞剂，本文讨论了与新型药物（血管紧张素转换酶（ACE）抑制剂、选择性α1肾上腺素能受体抑制剂和钙通道阻滞剂）相比，它们的代谢副作用对冠心病危险因素的可能影响。正在进行多项研究，比较这些化合物与利尿剂和β受体阻滞剂在长期心血管发病率和死亡率方面的效果。在这些研究结果出来之前，我们认为，冠心病高危的年轻患者（即<60-65岁），尤其是患有胰岛素抵抗综合征或糖尿病的患者，应使用ACE抑制剂、选择性α1肾上腺素能受体抑制剂或钙通道阻滞剂进行治疗。
