β肾上腺素能受体阻滞剂用于高血压治疗共识中国.doc

B肾上腺素能受体阻滞剂用于高血压治疗共识•中国()Beta adrenergic receptor blockers are used for high blood pressure therapyChina's expert consensusPublished in recent years, 1 arge~scale clinical trials such as the ASCOT study and LIFE, and the Swedish scholars Lindholm and meta-analysis published in 2005 [1], the beta adrenergic receptor blockers, beta blockers) on blood pressure, and the treatment results of 1ong-term use of glucose and lipid metabolism・ In June 2006 Britain，s national institute for heal th and cl ini cal excel 1ence (NICE) and the institute of hypertension (BHS) jointly issued the updated version of the journal of adult hypertension treatment guidelines (hereinafter referred to as the guidelines), put forward the "beta blockers are no longer preferred as a routine initial therapy for most patients with high blood pressure drugs" [2], and beta blockers as the fourth 1 ine of antihypertensive drugs, which caused a different response in academia・ Given the beta blockers now is widely used in clinical treatment of high blood pressure, and in the treatment of coronary heart disease, heart failure occupies very important position, the domestic many experts for Britain's revision of the guidelines on beta blockers gave high attention, and through extensive discussions reached the fol lowing agreement・T. the rationality of the application of beta-blocker from the pathogenesis of hypertensionOveractivation of sympathetic nervous system is one of the important mechanisms leading to elevated blood pressure in patients with primary hypertension [3-5]・ The results showed that the increase of the activity of the central sympathetic activity, the increase of the cardiac and renal norepinephrine release, the in crease of muscle sympathetic nerve tension, and the decrease of the reuptake of norepinephrine in the nerve endings・ The activation of sympathetic nervous system first promotes the release of renin by increasing the renal vascular resistance, which further activates the renin-angiotensin system (RAS)・ To promote the secretion of antidiuretic hormone and lead to water retention; It increases the tension of the blood vessel wall and the permeability of sodium, and increases the sensitivity of blood vessels to the contractile vessel material, thus increasing the peripheral vascular resistance・ The positive change of the heart is caused by the change of the heart, resulting in the increase of cardiac output.Beta blockers can not only against the excessive activation of the sympathetic nervous system and play a role of decompression, but also by reducing the sympathetic nervous tension and prevention of cardiac toxicity effect of catecholamine, inhibit excessive neural hormone and the activation of the RAS and give play to the role of comprehensive cardiovascular protection, including improve myocardial remodeling, reduce arrhythmia, ventricular fibrillation threshold, the prevention of sudden death, etc・ Therefore, beta-blockers have a solid theoretical basis for the treatment of hypertensiori.Second, the question about beta blockers used to treat high blood pressure1. 2006 English adult hypertension treatment guidelines on beta blockersIn 2006 the British guidelines made clear that beta blockers were no longer the preferred antihypertensive drugs for most hypertensive patients・ The guidelines recommend that, in the initial drug treatment for hypertension in 55 patients, the preferred calcium channel blocker (CCB) or thiazide diuretic treatment, and for patients under the age of 55, the preferred ACE inhibitors (ACEI); If the monotherapy is not satisfactory, the second step should be CCB + ACEI or diuretic + ACE I. The third step is to combine ACEI, CCB and diuretic drugs in combination. If combined treatment of three drugs is still out of control, consider a fourth step, which ineludes increasing the dose of diuretics, replacing other diuretics, beta-blockers, or alpha-blockers [2]. At the same time, the British guide health economic model analyses of the working party, 5 kinds of drug price - effect analysis in terms of clinical outcomes did not show statistically significant, but the beta blockers affect stroke events compared with other antihypertensive drugs in obvious disadvantage・ Therefore, beta blockers are not recommended as the initial treatment for hypertension. However, the UK guidelines also noted that beta-blockers should be considered in patients with high blood pressure, the presence of a contraindication in ACEI/ARB applications, and those with significantly increased sympathetic nervous system activity or pregnancy. The guidelines also note that the majority of previous beta blockers came from atlol, while other beta blockers have little research on hypertension.So will get conclusion from atenolol promotion to all the beta blockers, un certa in ties still exist, therefore, need to design a good other beta blockers in the treatment of hypertension research, is applied to update curre。