Widimský J
Klinika kardiologie IKEM, Praha.
Cas Lek Cesk. 1998 Feb 23;137(4):99-104.
The main problem of treatment of hypertension in this country as well as abroad is the fact that only less than one quarter of hypertensive patients are treated effectively and have thus normal blood pressure readings. More effective treatment of hypertension is thus one of the main tasks of health care systems in different countries. The objective of treatment of hypertension is to achieve a normal blood pressure. Evidence has been provided that diuretics and beta-blockers markedly reduce cerebrovascular and cardiovascular mortality, in particular in the elderly. ACE inhibitors are the drugs of choice in patients with heart failure or asymptomatic left ventricular dysfunction and in patients with diabetic nephropathy. Unsuitable for treatment of hypertension are short acting calcium channel blockers, in particular nifedipine. On the other hand, long-acting calcium channel blockers reduce the cerebrovascular mortality in elderly hypertensive patients. A number of questions still remain the subject of research: a) should diastolic pressure be reduced to values lower than 90 mm Hg; so far it is necessary only in hypertensive subjects with diabetes mellitus and in juvenile hypertensives; b) is the influence of new groups of antihypertensive drugs, in particular calcium channel blockers, similar, better or worse than that of diuretics and beta-blockers in the prevention of cardiovascular and cerebrovascular morbidity and mortality?; c) is it wise to recommend acetylsalicylic acid also to hypertensive patients without clinical signs of IHD or atherosclerotic affection of other vessels?; d) what is the value of combined antihypertensive and hypolipidaemic pharmacological treatment? Will this combination be not much more valuable in the prevention of IHD?; e) is the prognosis of hypertensive subjects with left ventricular hypertrophy better when ACE inhibitors are used as compared with other antihypertensive drugs?; f) do ACE inhibitors influence the prognosis of diabetic patients more favourably than beta-blockers?
在这个国家以及国外，高血压治疗的主要问题在于，只有不到四分之一的高血压患者得到有效治疗，从而使血压读数正常。因此，更有效地治疗高血压是不同国家医疗保健系统的主要任务之一。高血压治疗的目标是使血压正常。已有证据表明，利尿剂和β受体阻滞剂可显著降低脑血管和心血管死亡率，尤其是在老年人中。血管紧张素转换酶抑制剂是心力衰竭或无症状左心室功能不全患者以及糖尿病肾病患者的首选药物。短效钙通道阻滞剂，尤其是硝苯地平，不适合用于高血压治疗。另一方面，长效钙通道阻滞剂可降低老年高血压患者的脑血管死亡率。仍有一些问题是研究的主题：a）舒张压是否应降至低于90毫米汞柱的值；目前仅在患有糖尿病的高血压患者和青少年高血压患者中才有必要这样做；b）新型抗高血压药物组，尤其是钙通道阻滞剂，在预防心血管和脑血管发病及死亡方面的影响与利尿剂和β受体阻滞剂相比是相似、更好还是更差？c）对于没有缺血性心脏病临床体征或其他血管动脉粥样硬化病变迹象的高血压患者，推荐使用乙酰水杨酸是否明智？d）联合抗高血压和降血脂药物治疗的价值是什么？这种联合在预防缺血性心脏病方面是否更有价值？e）与其他抗高血压药物相比，使用血管紧张素转换酶抑制剂时，左心室肥厚的高血压患者的预后是否更好？f）血管紧张素转换酶抑制剂对糖尿病患者预后的影响是否比β受体阻滞剂更有利？
