International nifedipine trial on antiatherosclerotic therapy (intact)

Summary A number of animal studies revealed an inhibition or retardation of the progression of atherosclerosis by calcium-antagonists. Encouraged by these studies, a multicenter trial on the progression of coronary artery disease (CAD) in man was initiated testing the antisclerotic effect of nifedipine against placebo in 426 patients with mild to moderate coronary disease over 3 years. All patients underwent coronary angiography before entering the trial and will be restudied after 3 years; changes of the coronary artery lumen size are quantitatively assessed by a computer-assisted system (CAAS). INTACT (International Trial on Antiatherosclerotic Coronary Therapy) is therefore the first randomized prospective study on the progression of CAD based on a quantitated anigraphic control of the coronary system.This report presents the design of this still-ongoing study as well as inclusion and exclusion criteria. The quantitative evaluation of the coronary angiograms and the mode of compliance test are described in detail. A number of baseline data as well as the preliminary results of the quantitative evaluation of the first coronary angiograms are presented.Beside the results on the effect of the calcium-antagonist nifedipine on the progression of CAD, INTACT might also supply information on the antiatherosclerotic potency of other drugs administered additionally (beta-blockers and nitrates) and of HDL-cholesterol.     

Comparison of acute haemodynamic effects of nifedipine and isosorbide dinitrate in patients with heart failure following acute myocardial infarction

The acute haemodynamic effects of nifedipine (10 mg sublingually) and isosorbide dinitrate (5 mg sublingually) were compared in 13 patients with heart failure due to acute myocardial infarction. Nifedipine induced a significant reduction in systolic (from 122 ± 5 to 107 ± 3 mm Hg: mean ± SEM; P < 0.002) and diastolic blood pressure (from 85 ± 3 to 75 ± 2 mm Hg; P < 0.01). Heart rate did not change significantly, nor did mean right atrial pressure. The mean pulmonary arterial pressure was lowered from 31 ± 2 to 27 ± 2 mm Hg (P < 0.005). The left ventricular filling pressure decreased from 24 ± 1 to 19 ± 1 mm Hg (P < 0.0001). A significant increase in cardiac index (from 2.33 ± 0.13 to 2.69 ± 0.15 l/min per m²; P < 0.001) and in stroke volume index (from 24 ± 2 to 28 ± 2 ml/beats per m²; P < 0.005) was registered. Systemic vascular resistance fell from 1742 ± 145 to 1308 ± 85 dynes/sec per cm⁻⁵ (P < 0.00005). After isosorbide dinitrate was administered a significant reduction in mean right atrial pressure (from 9.5 ± 1.6 to 5.1 ± 1.2 mm Hg; P < 0.0001), in mean pulmonary arterial pressure (from 32 ± 1 to 23 ± 1 mm Hg; P < 0.00001) and in left ventricular filling pressure (from 23 ± 1 to 16 ± 1 mm Hg; P < 0.0001) was seen. No significant change in systolic and diastolic blood pressure, heart rate, cardiac index, stroke volume index and systemic vascular resistance was registered. No side-effects were seen after nifedipine and isosorbide dinitrate were administered.     

Controversies concerning calcium antagonists

Summary The paper discusses the controversial attitude regarding the safety of calcium channel blockers (CCBs), especially of the dihydropyridine nifedipine, induced through several meta-analyses of studies with CCBs by Dr. Furberg et al.; as a result, a detrimental effect of CCBs, especially during acute myocardial infarction, has been claimed. Several independent re-analyses of the 16 studies, all performed in the 1980s and mainly using the short-acting nifedipine capsule, did not confirm Furberg's results and showed an insignificant mortality difference between patients on CCBs versus those on control. Nevertheless, new safety studies applying long-acting CCBs (half-lives of 1 or more days) combined with efficacy assessments are necessary, both in hypertension as well as coronary artery disease, to finally clear up this important question.     

Atenolol versus the fixed combination of atenolol and nifedipine in stable angina pectoris

One hundred and fourteen patients (94 male) with chronic stableangina who had a positive exercise test after 4 weeks on atenololalone were randomized to receive either atenolol alone or thefixed combination of atenolol and nifedipine slow release formulationfor 4 weeks in a double-blind cross-over manner. Exercise stresstesting (Bruce protocol) at the end of each treatment perioddemonstrated that the time to the onset of pain and occurrenceof 1 mm ST segment depression improved significantly (P <0.05 and P < 0.001 respectively) whilst on the fixed combinationcompared to atenolol alone. In order to achieve sufficient sensitivityin the analysis of the exercise times, novel statistical methodsbased on survival analysis were used. Maximum ST segment depressionwas 0.13 mm less (p < 0.04) while on the fixed combination.The incidence of withdrawals and adverse effects was similaron both treatments.     

硝苯地平缓释片联合依那普利治疗冠心病合并高血压患者的疗效及其对NO、CRP、HCY的影响

目的探讨硝苯地平缓释片联合依那普利治疗冠心病合并高血压患者的疗效及其对一氧化氮(NO)、C-反应蛋白(CRP)、同型半胱氨酸(HCY)的影响。方法将116例冠心病合并高血压患者随机分成观察组和对照组各68例。对照组给予口服硝苯地平缓释片;观察组给予硝苯地平缓释片联合依那普。比较2组患者治疗后的临床疗效和NO、CRP、HCY水平的变化,以及治疗过程中的不良反应发生情况。结果治疗后观察组患者的总有效率显著高于对照组(P0.05);2组患者的NO水平在治疗后均显著升高(P0.05),CRP和HCY水平均显著下降(P0.05),且观察组NO、CRP和HCY水平显著优于对照组(P0.05)。2组患者不良反应发生率无显著差异(P0.05)。结论硝苯地平缓释片联合依那普利治疗冠心病合并高血压疗效显著。     

替米沙坦联合硝苯地平缓释片治疗老年高血压患者的临床效果

目的 分析替米沙坦联合硝苯地平缓释片治疗老年高血压患者的临床效果.方法 选择2018年3月至2020年3月收治的104例老年高血压患者为研究对象,采用奇偶分组法将其分为对照组和观察组,每组52例.对照组采用硝苯地平缓释片治疗,观察组采用替米沙坦联合硝苯地平缓释片治疗.比较两组的治疗效果.结果 观察组的治疗总有效率显著高...     

Intestinal Infarction Due to Nifedipine Overdose

Abstract

The first case of intestinal infarction associated with nifedipine overdose is presented. This is also the first reported case of an overdose with an extended release nifedipine preparation. The formation of a large gastric concretion of nifedipine tablets may have enhanced its local vasodilatory effects thereby producing mesenteric hypoperfusion, ischemia, and infarction.     

硝苯地平对野百合碱所致大鼠肺动脉高压的影响

目的探讨硝苯地平 (Nif)对野百合碱 (MCT)诱发慢性炎性肺动脉高压的防治作用。方法 3 3只雄性Wistar大鼠随机分为正常对照组、肺动脉高压模型组、Nif治疗组 ,每组 11只。予MCT (5 0mg/kg)制做大鼠肺动脉高压模型后 ,分别给Nif组及模型组大鼠连续灌胃Nif(2 0mg/kg·d)和等量生理盐水 2 1d。采用改良右心导管术测定肺血流动力学参数 ;处死大鼠后 ,称量肺湿重 (wW )、右心室自由壁 (RV)和左心室加室间隔 (LV S)重 ,计算右心肥厚指数 (RV/LV S)。结果Nif能明显降低肺动脉高压模型大鼠的平均肺动脉压及RV/LV S(P <0 0 1) ,但对wW无明显影响 (P >0 0 5 )。结论长期使用Nif能有效防治MCT所致肺动脉高压 ,改善心功能。     

甲壳胺对硝苯地平片剂药代动力学和生物利用度的影响

 目的:测定甲壳胺对硝苯地平片剂药代动力学和生物利用度的影响?方法:采用气相色谱法研究了10名男性健康志愿者随机单剂量口服市售片和以甲壳胺为辅料的硝苯地平片剂后,药物在体内的经时过程并计算药代动力学参数?结果:以甲壳胺为辅料的片剂和市售片的t_1/2ka分别为0.41h 和0.77h,t_1/2ke分别为2.64h和2.63h,t_max分别为1.59h和2.03h,c_max分别为104.61μg·L^-1和57.36μg·L^-1,AUC分别为586.18μg·h·L^-1和342.27μg·h·L^-1,其相对生物利用度为151.8% ?结论:甲壳胺可显著提高硝苯地平的生物利用度,明显改善药物的吸收?