Gifford R W
Postgrad Med. 1977 Mar;61(3):153-5, 157-9, 162-3. doi: 10.1080/00325481.1977.11712159.
Managing hypertension effectively requires careful evaluation of the patient, in particular for the presence of target-organ damage and of other risk factors for atherosclerosis. Dietary management has proved to be unsatisfactory in most hypertensive patients, as patients resist dietary restrictions or any other changes in life-style. Drug treatment has been shown to significantly reduce morbidity and mortality in patients with diastolic blood pressures above 104 mm Hg. Evidence suggests that drug treatment is also effective in those with diastolic pressures between 90 and 104 mm Hg. Selection of drugs is still an empirical decision--treatment with an oral diuretic usually is effective for mild hypertension (diastolic pressures 90 to 115 mm Hg). A sympathetic depressant, often propranolol, may be added to the regimen next, and if this is ineffective, a vasodilator (usually hydralazine) is included. Common side effects of antihypertensive drugs are seldom serious but can be annoying. Patients should be forewarned about them, and about the effects of untreated hypertension in an effort to improve compliance.
有效控制高血压需要对患者进行仔细评估，尤其是要评估是否存在靶器官损害以及其他动脉粥样硬化风险因素。事实证明，大多数高血压患者的饮食管理并不理想，因为患者会抵制饮食限制或任何其他生活方式的改变。药物治疗已被证明能显著降低舒张压高于104毫米汞柱患者的发病率和死亡率。有证据表明，药物治疗对舒张压在90至104毫米汞柱之间的患者也有效。药物的选择仍然是一个经验性的决定——口服利尿剂治疗通常对轻度高血压（舒张压90至115毫米汞柱）有效。接下来可在治疗方案中添加一种交感神经抑制剂，通常是普萘洛尔，如果这无效，则加入一种血管扩张剂（通常是肼屈嗪）。抗高血压药物的常见副作用很少严重，但可能会令人烦恼。应预先告知患者这些副作用以及未治疗高血压的后果，以提高依从性。
