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Abstract：
Hypertension is due to disturbance of the complex interplay between numerous known and unknown mechanisms that normally control blood pressure. Antihypertensive agents may, therefore, reduce blood pressure through widely different actions and, at the same time, elicit counterregulatory responses. This is a review of the long-term hemodynamic effects at rest as well as during exercise of nine relatively new antihypertensive compounds: a beta-blocker (epanolol), an alpha-receptor blocker (doxazosin), two double-acting compounds (dilevalol and carvedilol), three calcium antagonists (amlodipine, felodipine, and diltiazem), an angiotensin-converting enzyme inhibitor (lisinopril), a serotonin antagonist (ketanserin), and low-salt diet as a nonpharmacological treatment in 171 patients with mild to moderate essential hypertension. The results in the treatment groups are compared to the hemodynamic changes seen in 28 hypertensive patients left untreated for 10 years. The patient populations of the different groups were comparable. The invasive hemodynamic technique, including intraarterial blood pressure recording and measurements of cardiac output by Cardigreen, was the same in all studies. While blood pressure remained nearly unchanged in the untreated group, all antihypertensive compounds induced significant and sustained blood pressure reduction both at rest and during exercise. The modest reduction (3-5%) in blood pressure during a low-salt diet was also statistically significant. This review shows the multiplicity of the long-term hemodynamic changes, ranging from a reduction in cardiac output to peripheral vasodilatation, during chronic antihypertensive therapy. In untreated hypertensives, the cardiac output is reduced by 1-2% per year and total peripheral resistance is increased by 2-3% per year. The review also focuses on counterregulatory responses and modify the initial reduction in blood pressure after drug treatment for hypertension. It is concluded that proper understanding of the hemodynamic effects of antihypertensive agents is useful in the selection of the right treatment for specific groups of hypertensive patients.
摘要：
高血压是由于通常控制血压的许多已知和未知机制之间的复杂相互作用的干扰。抗高血压药可以，因此,通过广泛不同的行动降低血压，同时,引发反监管反应。这是对9种相对较新的抗高血压化合物（β-受体阻滞剂（epanolol））在休息和运动期间的长期血液动力学作用的回顾，α受体阻滞剂（多沙唑嗪），两种双作用化合物（二来戊醇和卡维地洛），三种钙拮抗剂（氨氯地平，非洛地平,和地尔硫卓)，血管紧张素转换酶抑制剂（赖诺普利），5-羟色胺拮抗剂（酮色林），和低盐饮食作为171例轻度至中度原发性高血压患者的非药物治疗。将治疗组的结果与28例未经治疗10年的高血压患者的血液动力学变化进行比较。不同组的患者群体具有可比性。侵入性血流动力学技术，包括Cardigreen的动脉内血压记录和心输出量测量，在所有研究中都是一样的。虽然未治疗组的血压几乎没有变化，所有抗高血压化合物在休息和运动时都能显著和持续地降低血压.低盐饮食期间血压的适度降低（3-5％）也具有统计学意义。这篇综述显示了长期血液动力学变化的多重性，从心输出量减少到外周血管扩张，在慢性降压治疗期间。在未经治疗的高血压患者中，心输出量每年减少1-2%,外周阻力每年增加2-3%.该综述还着重于反调节反应，并修改高血压药物治疗后血压的初始降低。结论正确认识降压药的血流动力学作用，有助于为特定人群的高血压患者选择正确的治疗方法。
