Wilson M D, Weart C W
Philadelphia College of Pharmacy and Science, PA.
Ann Pharmacother. 1994 May;28(5):617-25. doi: 10.1177/106002809402800512.
To review the existing data on the use of diuretics or beta-blockers as first-line therapy for the treatment of mild to moderate hypertension, and to examine the issues surrounding the impact of these classes as well as the angiotensin-converting enzyme (ACE) inhibitors, calcium-channel blockers (CCBs), alpha-blockers, and alpha-beta-blockers on cardiovascular risk factors and cardiovascular morbidity and mortality.
A MEDLINE search of applicable articles on antihypertensive therapies and their impact on morbidity and mortality. In addition, a MEDLINE search of relevant articles regarding cardiovascular risk factors and the influence of the various antihypertensive therapies on these parameters.
The literature was evaluated with regard to outcome. Trials examining the impact of antihypertensive pharmacotherapy, primarily with diuretics and beta-blockers, have shown them to decrease the incidence of stroke by 33-50 percent. However, their effect on coronary heart disease has been disappointing, showing only a 14 +/- 5 (mean +/- SD) percent decrease. Examination of numerous clinical trials assessing the impact of the various antihypertensive therapies on cardiovascular risk factors, including blood pressure, plasma lipids, diabetic control/insulin sensitivity, and left ventricular hypertrophy was done. The classes included beta-blockers, diuretics, alpha-blockers, ACE inhibitors, and CCBs; the results show a diversity of effect. Diuretics and beta-blockers tend to worsen cardiovascular risk status, whereas the alpha-blockers, ACE inhibitors, and CCBs all show a beneficial effect.
Diuretics and beta-blockers can effectively reduce cerebrovascular morbidity and mortality, but have a limited effect on reducing cardiovascular disease, especially myocardial infarction. This may be explained, at least in part, by the negative, or lack of positive, effect on individual patients' overall cardiovascular risk status.
回顾关于使用利尿剂或β受体阻滞剂作为治疗轻至中度高血压一线疗法的现有数据，并探讨这些类别以及血管紧张素转换酶（ACE）抑制剂、钙通道阻滞剂（CCB）、α受体阻滞剂和α-β受体阻滞剂对心血管危险因素以及心血管发病率和死亡率影响的相关问题。
对关于抗高血压疗法及其对发病率和死亡率影响的适用文章进行医学文献数据库（MEDLINE）检索。此外，对关于心血管危险因素以及各种抗高血压疗法对这些参数影响的相关文章进行医学文献数据库检索。
根据结果对文献进行评估。主要使用利尿剂和β受体阻滞剂的抗高血压药物治疗影响的试验表明，它们可使中风发病率降低33%至50%。然而，它们对冠心病的影响却令人失望，仅显示出14±5（均值±标准差）%的降低。对评估各种抗高血压疗法对心血管危险因素（包括血压、血脂、糖尿病控制/胰岛素敏感性和左心室肥厚）影响的众多临床试验进行了审查。这些类别包括β受体阻滞剂、利尿剂、α受体阻滞剂、ACE抑制剂和CCB；结果显示出不同的效果。利尿剂和β受体阻滞剂往往会使心血管风险状况恶化，而α受体阻滞剂、ACE抑制剂和CCB均显示出有益效果。
利尿剂和β受体阻滞剂可有效降低脑血管发病率和死亡率，但对降低心血管疾病尤其是心肌梗死的效果有限。这至少部分可以通过对个体患者整体心血管风险状况产生负面或缺乏正面影响来解释。
