◆Drug Recommendations Challenged 可以用饮食控制达到治疗目的时，大多数人不会选择吃药；可以用一种药治好病时，大多数人不会选择吃两种药；更何况"药"还会有危害"幸福"的副作用。 Professor Graham A McGregor, MD (St George's Hospital Medical School, London, UK), challenged the JNC 7 recommendation that antihypertensive therapy should be started with diuretics. He noted that simply restricting salt intake (one of the committee's recommendations) doubles the efficacy of an ACE inhibitor or an angiotensin receptor blocker (ARB), and he suggested that with this in mind, most physicians would opt for an ARB and then add a thiazide-type diuretic. While admitting that eventually most patients will probably end up on both drugs, he nevertheless believes that if they restrict salt, many patients can be controlled on an ACE inhibitor and an ARB and it would be illogical to add a diuretic. He also believes that the rate of impotence caused by first-line therapy with diuretics is unacceptable. Dr. Chobanian responded by making 2 points: first, a low salt diet is very difficult to follow, and second, if an individual develops impotence on any agent, there is no reason not to switch to another drug, considering how many "wonderful" drugs are available. Several delegates suggested that larger numbers of patients would respond to monotherapy if they were simply tried on different drugs. It was feared that when clinicians see the guidelines, they will start the patients on a diuretic and then add another drug, whereas many patients could be adequately controlled on monotherapy, simply by switching to a different drug. Another concern with diuretics was the possible side effects with lifelong treatment. Dr. Chobanian confirmed that JNC 7 does not advocate substitution of any particular class of drug (eg, diuretics) across the board to find one with a better effect over another. The emphasis from the practical standpoint is to combine therapy to get blood pressure levels down and keep them down, he said. He pointed out that wherever side effects occurred, those drugs should not be used. 编辑 郑麓薇