Autonomic imbalance, hypertension, and cardiovascular risk
Autonomic imbalance, hypertension, and cardiovascular risk
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DOI：
10.1016/s0895-7061(00)00228-4
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发表时间：
2000-06-01
影响因子：
3.2
通讯作者：
Julius, S
中科院分区：
文献类型：
--
作者：
Brook, RD;Julius, S
从许多大型随机试验和20世纪90年代初发表的荟萃分析中可以清楚地看到，高血压的药物治疗在降低卒中风险方面具有完全的保护作用。不幸的是，血压治疗的心脏保护价值不太令人鼓舞。只有在老年人中使用低剂量利尿剂治疗3，心脏病发病率的降低才接近预期的降压获益。一般而言，高血压治疗不能令人满意地降低心脏病发病率和死亡率。4有几种理论试图解释这种明显的不一致，即我们有能力降低血压，但没有充分改善高血压相关的心血管风险。血压控制不佳本身可能是一个影响因素。国家健康和营养检查研究（NHANES）数据、5高血压预防、检测、评估和治疗联合国家委员会（JNC VI）的第六次报告6以及其他工业化国家（如加拿大）的类似出版物都强调了这一点。7我们未能充分控制血压不能用短暂的办公室引起的血压升高来解释，8而更可能是由于缺乏医生的积极性。9尽管有强有力的证据表明积极的治疗既安全又特别有效，糖尿病患者就是例证。[10]另一方面，血压药物本身也受到指责。大多数较老的药物-利尿剂和β受体阻滞剂-破坏并可能恶化许多心血管相关的代谢因素，特别是脂质
It is clear from many large randomized trials and from the metaanalyses published in the early 1990s1, 2 that medication treatment of hypertension can be fully protective in reducing stroke risk. Unfortunately, the cardioprotective value of blood pressure therapy is less encouraging. Only with the use of low-dose diuretic therapy in the elderly3 has the reduction in cardiac morbidity approached the expected derived benefit from blood pressure lowering. In general, hypertension treatment has been unable to satisfactorily reduce cardiac morbidity and mortality. 4Several theories have sought to explain this apparent incongruity between our ability to lower blood pressure yet not adequately improve hypertensionrelated cardiovascular risk. Suboptimal control of blood pressure itself may be a contributing factor. This is underscored by the National Health and Nutrition Examination Study (NHANES) data, 5 the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of high blood pressure (JNC VI), 6 and similar publications in other industrialized countries, such as in Canada. 7 Our failure to adequately control blood pressure cannot be explained by transient office-induced pressure elevations, 8 but is more likely due to a lack of physician aggressiveness. 9 This is despite strong evidence that aggressive therapy is both safe and can be particularly effective, as exemplified by patients with diabetes. 10 Alternatively, blood pressure medications themselves have been blamed. Most older drugs—diuretics and ß-blockers—disrupt and may worsen many cardiovascular-related metabolic factors, particularly lipids