慢性肺部疾病合并高血压的治疗

       9  总结
        综上所述，合并高血压的慢性肺部疾病的患者在涉及降压治疗时确实存在很多顾虑，但是目前仍有许多降压药物可供选择。以下几类药物对肺功能几乎没有影响，有的甚至会有少许有利作用，如噻嗪类利尿剂、钙通道阻滞剂、选择性的α1受体拮抗剂以及5-羟色胺受体拮抗剂。血管紧张素II受体阻滞剂和ACEI也可以选用。较为不安全的药物是β肾上腺受体阻滞剂，应尽量避免使用；但是现在也有研究表明具有α受体阻滞作用的β受体阻滞剂并不诱发支气管痉挛，在其他药物都无效的情况下可以谨慎尝试使用。
参 考 文 献
〔1〕Ong K L, et al. Prevalence, awareness, treatment, and control of hypertension among United States adults 1999.2004[J]. Hypertension，2007，49:69-75.
〔2〕叶任高主编.内科学[M].第六版.北京：人民卫生出版社，2004.
〔3〕A V. CHOBANIAN, et al. Roccella, and the National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and evidence from new hypertension trials[J]. Hypertension，2003 ，42(6): 1206-52. 
〔4〕江明性主编.药理学[M].第四版，北京人民卫生出版社，1998.
〔5〕H, NS. Fluid and electrolyte considerations in diuretic therapy for hypertensive patients with chronic obstructive pulmonary disease[J]. Arch Intern Med, 1986,146:129-133.
〔6〕RHODEN, et al. Evidence of Na-K-Cl cotransport in airway smooth muscle[J]. Am J Physiol, 1995,268:L551-L557.
〔7〕R. A. DART, et al. Woolf.Treatment of Systemic Hypertension in Patients With Pulmonary Disease: COPD and Asthma[J]. Chest, 2003,123(1): 222-243. 
〔8〕M. CAZZOLA, et al.The Pharmacologic Treatment of Uncomplicated Arterial Hypertension in Patients With Airway Dysfunction[J]. Chest,2002, 121(1): 230 - 241. 
〔9〕B. E, et al. Effect of nifedipine on arterial hypoxemia occurring after methacholine challenge in asthma[J]. Thorax,1986, 41:468-472.
〔10〕M A Christopher, et al.Clinical relevance of the interaction of theophylline with diltiazem or nifedipine[J]. Chest, 1989,95: 309-313.
〔11〕A GASSNER, et al. Differential therapy with calcium antagonists in pulmonary hypertension secondary to COPD. Hemodynamic effects of nifedipine, diltiazem, and verapamil[J].Chest, 1990,98: 829-834. 
〔12〕S D, et al.Felodipine improves pulmonary hemodynamics in chronic obstructive pulmonary disease[J]. Chest,1993, 103(5): 1354-1361.
〔13〕N NAIR, et al. Safety of nifedipine in subjects with bronchial asthma and COPD[J]. Chest,1984,86:515-518.
〔14〕S D, et al. 1-Adrenoceptor function and autoradiographic distribution in human asthmatic lung[J].Br J Pharmacol,1989,97:701-708.
〔15〕BIERNACKI, et al.Doxazosin, a new alpha-1-antagonist drug, controls hypertension without causing airways obstruction in asthma and COPD[J]. J Hum Hypertens,1989,3:419-425.
〔16〕S SR, et al.Cardioselective {beta}-Blockers in Patients with Reactive Airway Disease: A Meta-Analysis [J].Ann Intern Med, 2002,137(9): 715-725.
〔17〕WINTER, et al.Detrimental Effects of b-Blockers in COPD[J].Chest, 2005,127:818-824.
〔18〕M. EGRED, et al.Under-use of beta-blockers in patients with ischaemic heart disease and concomitant chronic obstructive pulmonary disease[J].QJM, 2005,98(7): 493 - 497.
〔19〕R B GEORGE, et al.Comparison of the effects of labetalol and hydrochlorothiazide on the ventilatory function of hypertensive patients with asthma and propranolol sensitivity[J].Chest, 1985，88：815-818.
〔20〕W.H.INMAN,et al.Angiotensin converting enzyme inhibitors and asthma[J].BMJ,1994, 308(6928): 593-594.
〔21〕H KANAZAWA. et al Effects of captopril administration on pulmonary haemodynamics and tissue oxygenation during exercise in ACE gene subtypes in patients with COPD: a preliminary study[J].Thorax,2003,58:629-631.
〔22〕H KANAZAWA, et al.Association Between the Angiotensin-Converting Enzyme Gene Polymorphisms and Tissue Oxygenation During Exercise in Patients With COPD[J].Chest,2002,121:697-701.
〔23〕H LUNDE, et al.Dyspnoea, asthma, and bronchospasm in relation to treatment with angiotensin converting enzyme inhibitors[J]. BMJ, 1994，308(6920): 18-18. 
〔24〕M. MEYSMAN.Angiotensin II blockers in obstructive pulmonary disease: a randomised controlled trial[J].Eur Respir J September 1,2006,28:670.