钙离子拮抗剂和血管紧张素转换酶抑制剂对老年高血压病人左室肥厚的影响

目的 :评估钙离子拮抗剂和血管紧张素转换酶抑制剂 (ACEI)对老年高血压病人左室肥厚的疗效。方法 :6 6例接受钙离子拮抗剂和 /或 ACEI治疗 ,6 4～ 84岁的老年高血压病人被分为钙离子拮抗剂组、ACEI组和联合用药组 ,比较这三组病人治疗后左室肥厚的变化。结果 :左室肥厚在钙离子拮抗剂组 (n=2 6 ,P=0 .0 2 7)、ACEI组 (n=19,P=0 .0 0 2 )和联合用药组 (n=2 1,P<0 .0 0 1)均有明显消退。ACEI组效果明显好于钙离子拮抗剂组 (P<0 .0 1) ,其它组之间的疗效无显著差异。结论 :钙离子拮抗剂和 ACEI对消退老年高血压病人的左室肥厚均有较好的疗效 ,ACEI更佳     

血管紧张素转换酶抑制剂治疗高血压

血管紧张素转换酶抑制剂是抗高血压药,其降压作用与抑制组织中存在的血管紧张素转换酶有关。它在身体不同部位可产生不同的血流动力学效果,如可增加原发性高血压病人的肾血流量和肾小球滤过率,增加正常人骨骼肌和皮肤的外周阻力等。有关该类药的药代动力学及对高血压的治疗文中亦做了介绍。 (吴晶摘)     

血管紧张素转换酶抑制剂加钙离子拮抗剂致严重低血压2例

例1，男，71岁。因反复胸闷、心悸20余年，活动后气促、呼吸困难4天入院。患者原有高血压病史30余年，常反复出现胸闷、心悸并时有发作性夜间呼吸困难。血压控制在145～165／85～100mmHg，于去年10月入我院治疗，查体：BP160／90mmHg，P100次／min，心率100次／min。ECG示：窦律，左室肥大，ST段：V4～6下移0．05～0．1mV。心脏彩超检查示：主动脉瓣钙化；二尖瓣钙化并轻度关闭不全；左     

钙离子拮抗剂和血管紧张素Ⅱ受体阻断剂对高血压患者动脉僵硬度影响的Meta分析

目的 系统评价钙离子拮抗剂(CCB)和血管紧张素Ⅱ受体阻断剂(ARB)对高血压患者血管功能的作用差异.方法 按循证医学的要求,制定相应的纳入、排除标准及其检索策略.通过PubMed、Embase、Ovid EMBReviews、中国期刊全文数据库、中文科技期刊全文数据库、万方数据库检索相关的临床对照研究,检索各数据库从建库至2012年1月;纳入CCB和ARB治疗原发性高血压的随机对照试验.采用RevMan5.0软件进行统计分析.比较CCB和ARB对高血压患者脉搏波传导速度、收缩压、舒张压、脉压等指标的影响.结果 共纳入6个随机对照试验,共计411例患者.Meta分析结果显示,ARB在改善动脉僵硬度方面优于CCB(均数差为183.33,95％ CI为79.32 ～ 287.33),差异有统计学意义.但是在降低收缩压(均数差为-2.66,95％ CI为-3.35 ～-1.96)和舒张压(均数差为-5.43,95％ CI为-8.8 ～-2.07)方面较CCB弱.结论 ARB在改善高血压患者动脉僵硬度方面优于CCB,该作用与其降压作用无关.但仍需要大样本多中心的随机对照临床试验来进一步证实.     

血管紧张素转换酶抑制剂对高血压胰岛素抗性的影响

采用血管紧张素转换酶抑制剂（卡托普利、依那普利、赖诺普利）治疗原发性高血压患者30例。剂量分别为12．5～37．5，5～15，10～30mg／　d，疗程4周，血压从治疗前171／106mmHg降到143／88mmHg。治疗后的血胰岛素水平、血胰岛素／葡萄糖比值均较治疗前明显降低（P＜0．05），显示有明显的改善胰岛素抗性效应。     

血管紧张素转换酶抑制剂对心血管作用的差异

实验发现血管紧张素转换酶抑制剂结构的差异可以带来不同的生理作用，除了对肾素－血管紧张素系统的影响外。它的非肾素依赖作用不容忽视，本文综述了近年来常见的血管紧张素转移酶抑制剂对心血管以上两方面作用差异的研究新发现。     

血管紧张素转换酶抑制剂治疗高血压病人的疗效与血管紧张素转换酶基因多态性的关系

目的 探讨具有不同血管紧张素转换酶基因插入／缺矢基因型（Angiotension-converting enzyme gene I/D genotype,ACE I/D genotype)的高血压病人对血管紧张素转换酶抑制剂（Angiotension-converting enzyme inhibitor,ACEI)治疗的反应性。方法 根据ACE I／D基因多态性,将高血压病人分为Ⅱ组（20例）,ID组（20例,及DD组（18例）,共58例。使用西拉普利2．5mg Q.D,两周后无效增至5mgQ.D共4周,观察降压疗效。结果 Ⅱ组显效2例,有效12例,总有效率70％,ID组显效8例,有效8例,总有效率80％,DD组显效13例,有效4例,总有效率94％。ACEI对DD组疗效最好（P＜0．01）,降压幅度最大,ID组次之,Ⅱ组较差。结论 ACE I／D基因多态性可做为高血压病人选用ACEI时的参考指标之一。     

血管紧张素转换酶抑制剂治疗高血压的远期随访

循证医学研究证实,高血压患者经降压药治疗后心血管致残率和病死率均有降低,对生活质量亦无不良作用,甚至还会改善生活质量,但各类降压药给患者带来的益处报道不一。现将长期(平均6年)应用血管紧张素转换酶抑制剂(ACEI)为一线降压药治疗的原发性高血压病人的随访结果,并与同期未用ACEI类药物的原发性高血压病人作对照,报告如下:     

血管紧张素转换酶抑制剂对自发性高血压大鼠的高血压及高血压性血管改变的作用

血管紧张素转换酶抑制剂 (ＡＣＥＩ)是当前世界上研究开发、应用和销售最广的一类心血管药物。目前已开发了 75种以上的ＡＣＥＩ,但仅 16种左右应用于临床。ＡＣＥＩ的药理作用[1 ,2 ] :1 降压作用 :所有ＡＣＥＩ均有明显的降压效应。 2 降低外周血管阻力。 3 扩张冠状动脉 ,改善心功能。 4 改善肾血流和增加肾小球滤过率。 5 代谢作用。ＡＣＥＩ可降低血胆固醇和甘油三酯浓度 ,增加高密度脂蛋白 ,增强胰岛素 ,降低血糖及醛固酮的滞钾作用。一、ＡＣＥＩ对高血压的影响　ＡＣＥＩ的降压作用已得到广泛证实。ＡＣＥＩ可以使各种类型的人类…     

A computerized intervention to decrease the use of calcium channel blockers in hypertension

Objective

To determine whether a computer-assisted reminder would alter prescribing habits for the treatment of hypertension in accordance with current clinical guidelines in a general internal medicine clinic.

Design

A randomized trial.

Setting

The General Internal Medicine Clinic of the Veterans Affairs Puget Sound Health Care System, Seattle Division.

Patients/Participants

Clinic providers were randomized to a control group (n=35) or intervention group (n=36). We targeted the providers of patients being treated for hypertension with calcium channel blockers, a class of drug not recommended for initial therapy.

Intervention

An automated computer query identified eligible patients and their providers. A guideline reminder was placed in the charts of patients of intervention providers; the charts of patients of control providers received no reminder.

Measurements and main results

During the 5-month study period, 346 patients were seen by the 36 primary care providers (staff physicians, nurse practitioners, residents, and fellows) in the intervention group, and 373 patients were seen by the 35 providers in the control group. Intervention providers changed 39 patients (11.3%) to other medications during the study period, compared with 1 patient (<1.0%) of control providers (p<.0001). For patients whose therapy was unchanged, providers noted angina in 23.1%, indications other than those for hypertension in 9.5%, intolerable adverse effects with first-line therapy in 13.9%, and inadequte control with first-line therapy in 13.9%. Of those patients without provider-indicated contraindications, 23.6% were switched from calcium channel blockers to first-line agents during the intervention period.

Conclusions

The use of a computerized, clinic-based intervention increased compliance with guidelines in the treatment of primary hypertension in general, and decreased the use of calcium channel blockers for the treatment of hypertension in particular.     

不同钙通道阻滞剂联合叶酸治疗老年轻中度H型高血压的临床研究

目的 评价不同钙通道阻滞剂联合叶酸对老年轻中度高同型半胱氨酸（Hey,H型）高血压患者的疗效。方法 采用随机、单盲、平行对照方法,纳入2011年6月至2014月6月在河北省沧州中西医结合医院心血管病科门诊或住院治疗的原发性H型高血压Ⅰ～Ⅱ级患者90例,其中男42例,女48例,年龄（66.9±3.5）岁。将入选患者随机分为苯磺酸氨氯地平组,苯磺酸左氨氯地平组和非洛地平缓释片组,每组30例,均联合叶酸连续口服药物4周。按时监测血压,并予试验开始前、治疗4周时进行血浆Hcy、一氧化氮（NO）、内皮素?1（ET-1）、超氧化物歧化酶（SOD）、丙二醛（MDA）测定。结果 3种钙通道阻滞剂联合叶酸均可降低老年轻中度H型高血压患者的血压和血浆Hcy水平,且苯磺酸氨氯地平组降低收缩压的幅度和血浆Hcy水平大于其他两组,差异具有统计学意义（P＜0.05）。苯磺酸氨氯地平组,治疗后较治疗前血浆NO和SOD水平升高,ET-1和MDA水平降低,差异具有统计学意义（P＜0.05）。结论 钙通道阻滞剂联合叶酸可用于降低老年轻中度H型高血压患者的血压和血浆Hcy水平,且以苯磺酸氨氯地平联合叶酸为优。     

The efficacy and safety of arotinolol combined with a different calcium channel blocker in the treatment of Chinese patients with essential hypertension: a one-year follow-up study

Background: Combined treatment of a calcium antagonist and α/β-adrenoreceptor blocker is expected to offer some advantages in the management of hypertension; however, their antihypertensive efficacy and safety remain relatively under-explored.

Methods: The current study addresses the 24-h antihypertensive efficacy and safety of arotinolol combined with a different calcium channel blocker. One-hundred fifty-two patients were randomly divided into three groups: nifedipine, amlodipine and felodipine group. In each group, the antihypertensive treatment dose was 30?mg/d, 5?mg/d, 5?mg/d long acting nifedipine, amlodipine, felodipine plus 20?mg/d arotinolol, respectively. Blood pressure was measured in ABPM devices and mercury manometer.

Results: The result showed that the effective rate of one year antihypertensive treatment of arotinolol combined with nifedipine was 51 of 53, significantly effective (p?p?>?0.05) in controlled rate of morning peak blood pressure between treatment of arotinolol combined with amlodipine and arotinolol combined with nifedipine, but there was a significant difference (p?Conclusions: The therapy approached of arotinolol combined with nifedipine or amlodipine could be effective and well-tolerated, and they can be used as the better chosen antihypertensive drug.     

Efficacy and safety of calcium channel blockers in hypertensive patients with concomitant left ventricular dysfunction.

The use of calcium channel blockers (CCBs) in the treatment of hypertension and concomitant left ventricular dysfunction is reviewed. Some CCBs, particularly second-generation dihydropyridine agents such as felodipine, isradipine, nicardipine, nimodipine, and nitrendipine, have properties that enhance their usefulness in these patients. All CCBs have a similar mechanism of action. Differences in their selective action at various tissue sites determine which are most appropriate for patients with concomitant hypertension and left ventricular dysfunction. Most CCBs do not produce reflex stimulation of the heart or induce intravascular expansion. While all CCBs produce arteriolar dilation, all local beds and regional circulations in target organs are not affected equally. Most CCBs can decrease cardiac mass, and second-generation CCBs tend to have little or no negative inotropic effects at therapeutic dosages. In addition, they increase blood flow and reduce myocardial oxygen requirements. Because of differences in functional and electrophysiologic effects, specific CCBs may not be appropriate for all patients. Since second-generation dihydropyridine CCBs lack clinically relevant negative inotropic effects, and have been shown to improve exercise tolerance and coronary artery perfusion, they are appropriate for hypertensive patients with left ventricular dysfunction, angina, and coronary heart disease. Second-generation CCBs tend to lack cardiodepressant side effects and are less likely to react with digoxin than are first-generation CCBs.     

钙拮抗剂与血管紧张素转换酶抑制剂对高血压靶器官的影响

目的探讨用钙拮抗剂（ＣａＡ）和血管紧张素转换酶抑制剂（ＡＣＥＩ）长期治疗对高血压病靶器官的影响。方法对３８６例高血压病Ｉ期或Ｉ期患者服用ＣａＡ或ＡＣＥＩ平均５．１±０．６年，按服药情况分为ＣａＡ组、ＡＣＥＩ组、对照组（间断服药）。结果长期服用ＣａＡ或ＡＣＥＩ不仅能使血压持续稳定在较低水平，而且随着血压的下降，左室肥厚逆转、心脏舒张功能改善、尿蛋白排泄量下降（Ｐ＜０．００１）、眼底病变好转（Ｐ＜０．０１），且无脑卒中发生（Ｐ＜０．０５～０．０１）；而对照组上述各项指标均较ＣａＡ组和ＡＣＥＩ组有加重趋势，其加重程度和观察时间呈正相关（Ｐ＜０．０１）。结论长期ＣａＡ或Ａ－ＣＥＩ治疗对高血压病患者的预后有益。     

Concomitant use of nitrates,calcium channel blockers,and beta blockers for optimal antianginal therapy

Despite the introduction of new mechanical techniques for revascularization, pharmacologic therapy continues to be the mainstay of antianginal therapy. The conventional antianginal medications, which include nitrates, beta blockers, and calcium channel blockers, act to correct the imbalance between myocardial supply and demand by increasing coronary blood flow, reducing myocardial oxygen requirements, or both. All three are appropriate for the management of angina caused by a fixed coronary obstruction, but nitrates and calcium channel blockers, which not only reduce demand but also increase supply, are preferred in cases of angina believed to involve a significant increase in vasomotor tone. Because of the different yet complementary mechanisms of action of the three classes of anti-ischemic drags, use of these agents in combination is a rational approach to the treatment of angina unresponsive to monotherapy. Such combinations have been shown to enhance the therapeutic response achieved with single-agent therapy. In addition, the pharmacologic action of one of the components of the combination regimen may serve to offset side effects typically associated with the other.     

Hepatotoxicity of ethanol: protective effect of calcium channel blockers in isolated hepatocytes

Abstract: This study examines the effects of three calcium channel blockers (verapamil, nifedipine and diltiazem) on isolated rat hepatocytes exposed to ethanol. In the first part of our study, hepatocytes were incubated with increasing concentrations of ethanol (100, 300, 500, 1000 mM) for varying times. Alanine aminotransferase (ALT), aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) release were measured to evaluate the cytotoxic effects of ethanol. The concentration of 300 mM and time of incubation of 45 min were chosen for cytoprotection experiments in which calcium channel blockers, at two different concentrations, were added to the medium 30 min prior to the addition of ethanol. ALT, AST and LDH release as well as lipid peroxidation and cellular reduced gluthatione (GSH) were measured. Nifedipine and verapamil (25 μM) reduced ALT, AST and LDH activities. The highest dose of diltiazem (50 μM) was more effective than the lowest one (25 μM). Ethanol caused a significant depletion of cellular GSH content as well as a moderate enhancement of lipid peroxidation. While none of the three calcium channel blockers was able to restore the decrease in GSH levels, diltiazem (25 μM) and nifedipine (50 μM) showed the greatest effect, significantly reducing lipid peroxidation.     

Long-term treatment of hypertension with the calcium channel blocker diltiazem

A group of 48 patients with essential mild to moderate hypertension were treated with the calcium-channel blocker diltiazem (90-270 mg/day) for one year. Adequate blood pressure control was achieved in all patients. No tolerance developed during the one-year treatment period. The drug is almost free from side effects. Very few patients develop fluid retention, which can be controlled by adding a diuretic.     

The rs1458038 variant near FGF5 is associated with poor response to calcium channel blockers among Filipinos

Genetic variation is known to affect response to calcium channel blockers (CCBs) among different populations. This study aimed to determine the genetic variations associated with poor response to this class of antihypertensive drugs among Filipinos.One hundred eighty one hypertensive participants on CCBs therapy were included in an unmatched case-control study. Genomic deoxyribonucleic acid were extracted and genotyped for selected genetic variants. Regression analysis was used to determine the association of genetic and clinical variables with poor response to medication.The variant rs1458038 near fibroblast growth factor 5 gene showed significant association with poor blood pressure-lowering response based on additive effect (CT genotype: adjusted OR 3.41, P = .001; TT genotype: adjusted OR 6.72, P < .001).These findings suggest that blood pressure response to calcium channels blockers among Filipinos with hypertension is associated with gene variant rs1458038 near fibroblast growth factor 5 gene. Further studies are recommended to validate such relationship of the variant to the CCB response.     

Dihydropyridine calcium channel blockers and cardiovascular outcomes in elderly patients: a population-based study

BACKGROUND:

Dihydropyridine calcium channel blockers are widely used for the treatment of hypertension and angina. Despite safety concerns associated with short-acting agents, increasing evidence supports the safety of long-acting dihydropyridines. Although amlodipine is the best studied of these, there are few studies comparing it with nifedipine.

OBJECTIVE:

To examine the association between hospitalization for acute coronary syndromes and treatment with amlodipine or extended-release nifedipine in patients 65 years of age and older. The primary objective was a composite of hospital admission for angina or acute myocardial infarction.

METHODS:

The present population-based, retrospective cohort study used linked health care databases from Ontario. Propensity scores were used to identify highly similar patients started on amlodipine or extended-release nifedipine between April 1997 and March 2002. Time-to-event analysis was conducted using Cox proportional hazards models.

RESULTS:

The analysis included 24,190 patients (44% male; mean age 75 years) treated with amlodipine or extended-release nifedipine (n=12,095 each). The number of patients reaching the primary end point was 362 (3%) and 294 (2.4%) in the amlodipine and nifedipine groups, respectively. The groups were similar in a large number of demographic and clinical characteristics. No significant differences were observed among users of extended-release nifedipine (adjusted hazard ratio 0.91, 95% CI 0.74 to 1.13) relative to amlodipine.

CONCLUSIONS:

These findings suggest that amlodipine and extended-release nifedipine are not associated with differential rates of acute coronary events in older patients.