Black H R
Department of Preventive Medicine, Rush-Presbyterian-St. Luke's Medical Center, Rush Medical College, Chicago, Illinois 60612, USA.
Am J Med. 1996 Sep 30;101(3A):47S-52S. doi: 10.1016/s0002-9343(96)00267-7.
Safe and effective antihypertensive therapy became available in the 1950s with the introduction of thiazide diuretics. Prior to that time, we did have agents that lowered blood pressure but they often needed to be given parenterally and were too poorly tolerated to be used for the treatment of any but those with life-threatening elevations of blood pressure. When thiazide diuretics-first chlorothiazide and then hydrochlorothiazide-became available, it was possible to lower blood pressure in most hypertensives and assess whether that reduction would lead to a reduction in cardiovascular morbidity and mortality. The results of 17 large trials have now made it clear that antihypertensive therapy with regimens based on diuretics and beta blockers reduces cardiovascular events and saves lives. When first introduced, thiazide diuretics were prescribed at doses we now know are excessively high (100-200 mg of hydrochlorothiazide/day), and we have learned that much lower doses, even as little as 12.5 mg of hydrochlorothiazide, are effective. These lower doses will reduce blood pressure and do so with considerably less in the way of metabolic effects. This article will trace the development of antihypertensive therapy and review how data from clinical trials have influenced the recommendations of the Joint National Committees on the Detection, Evaluation and Treatment of Hypertension.
20世纪50年代，随着噻嗪类利尿剂的问世，安全有效的抗高血压治疗方法得以出现。在此之前，我们确实有一些能降低血压的药物，但这些药物通常需要肠胃外给药，而且耐受性太差，除了用于治疗血压严重升高危及生命的患者外，无法用于其他患者。当噻嗪类利尿剂——先是氯噻嗪，然后是氢氯噻嗪——出现后，大多数高血压患者的血压得以降低，并且可以评估这种血压降低是否会导致心血管发病率和死亡率的降低。17项大型试验的结果现已表明，基于利尿剂和β受体阻滞剂的抗高血压治疗方案可减少心血管事件并挽救生命。最初引入噻嗪类利尿剂时，所开的剂量我们现在知道过高（氢氯噻嗪每日100 - 200毫克），而且我们已经了解到，低得多的剂量，甚至低至氢氯噻嗪12.5毫克，也是有效的。这些较低剂量能降低血压，且代谢作用要小得多。本文将追溯抗高血压治疗的发展历程，并回顾临床试验数据如何影响全国高血压检测、评估与治疗联合委员会的建议。
