Mancia G, Seravalle G, Vailati S, Grassi G
Cattedra di Medicina Interna, Ospedale S. Gerardo, Monza, Italy.
J Hypertens Suppl. 1996 Nov;14(4):S33-8. doi: 10.1097/00004872-199606234-00007.
Several hypertension trials have shown that antihypertensive treatment can reduce the cardiovascular morbidity and mortality accompanying this condition. They have also shown, however, that the reduction does not entirely normalize the risk of hypertensive patients. STRATEGIES TO IMPROVE THE BENEFIT OF ANTIHYPERTENSIVE TREATMENT: Although some of the risk of the hypertensive patient may prove to be irreversible, pathophysiological and clinical evidence obtained in recent years suggests that some modifications to antihypertensive treatment strategies might increase the benefit. For example, greater use of drugs such as calcium antagonists and angiotensin converting enzyme (ACE) inhibitors as first-line agents might bring greater benefits, because some properties of these drugs which are additive to their blood pressure lowering effects, such as regression of cardiovascular structural changes, nephroprotection and delay of atherogenesis, may provide a degree of protection against target-organ damage. ONGOING CLINICAL TRIALS AND THE INTERNATIONAL NIFEDIPINE (GITS) GASTROINTESTINAL SYSTEM STUDY OF INTERVENTION AS A GOAL IN HYPERTENSIVE TREATMENT (INSIGHT): Several ongoing clinical trials are aimed at comparing the effects of calcium antagonists and ACE inhibitors versus beta-blockers and diuretics on cardiovascular morbidity and mortality. INSIGHT is particularly interesting because the effects of nifedipine GITS and a combined thiazide and potassium-sparing diuretic on cardiovascular morbidity and fatal events are being compared in patients with hypertension plus one or more additional risk factors, such as hypercholesterolemia, smoking, diabetes, left ventricular hypertrophy, etc. INSIGHT is therefore the first trial to address, in a prospective fashion, the prognostic influence of antihypertensive treatment in hypertensives with concomitant risk factors.
多项高血压试验表明，抗高血压治疗可降低伴随该病症的心血管疾病发病率和死亡率。然而，这些试验也表明，这种降低并不能使高血压患者的风险完全正常化。改善抗高血压治疗益处的策略：尽管高血压患者的某些风险可能被证明是不可逆转的，但近年来获得的病理生理学和临床证据表明，对抗高血压治疗策略进行一些调整可能会增加益处。例如，更多地使用钙拮抗剂和血管紧张素转换酶（ACE）抑制剂等药物作为一线药物可能会带来更大的益处，因为这些药物除了具有降压作用外，还具有一些其他特性，如心血管结构变化的逆转、肾脏保护和动脉粥样硬化的延缓，可能会提供一定程度的针对靶器官损害的保护。正在进行的临床试验和国际硝苯地平（控释片）胃肠道系统干预作为高血压治疗目标的研究（INSIGHT）：几项正在进行的临床试验旨在比较钙拮抗剂和ACE抑制剂与β受体阻滞剂和利尿剂对心血管疾病发病率和死亡率的影响。INSIGHT特别有趣，因为正在比较硝苯地平控释片与噻嗪类和保钾利尿剂联合使用对伴有一种或多种其他危险因素（如高胆固醇血症、吸烟、糖尿病、左心室肥厚等）的高血压患者心血管疾病发病率和致命事件的影响。因此，INSIGHT是第一个以前瞻性方式探讨抗高血压治疗对伴有危险因素的高血压患者预后影响的试验。
