Sánchez M, Sobrino J, Ribera L, Adrián M J, Torres M, Coca A
Emergency Department, Hospital Clínic, Barcelona, Spain.
J Cardiovasc Pharmacol. 1999 Mar;33(3):479-84. doi: 10.1097/00005344-199903000-00019.
We compared antihypertensive efficacy and safety of a single administration of equipotent doses of lacidipine versus nifedipine in the hypertensive urgencies. Twenty-nine asymptomatic essential hypertensive patients (nine men, 20 women) with a mean age of 55.03+/-11.19 years and baseline diastolic blood pressure (DBP) of > or =120 mm Hg after resting 30 min, not taking antihypertensive drugs for the last 24 h, were randomized in a single-blind fashion to receive lacidipine, 4 mg (LCD, 15 patients) or short-acting nifedipine, 20 mg (NFD, 14 patients) in a single dose. Blood pressure (BP) and heart rate (HR) were taken every 30 min during the first 8 h and every 2 h until 24 h of follow-up. Baseline BP values were similar in the two groups (LCD, 222.5+/-32.8/124.6+/-8.4 mm Hg vs. NFD, 215.9+/-20.6/128+/-7.7 mm Hg; p = NS). Both drugs promoted a significant reduction of systolic blood pressure (SBP; 169.6+/-27.8 vs. 170.6+/-25.3 mm Hg) and diastolic blood pressure (DBP; 104.1+/-16 vs. 102.9+/-12.4 mm Hg) after 8 h. However, either SBP (165+/-27.3 vs. 190.6+/-18.2 mm Hg; p = 0.008) and DBP (99.9+/-12.3 vs. 117.2+/-11.4 mm Hg; p = 0.001) were significantly higher in the NFD group after 24-h dosing. Eleven patients in the LCD group had a decrease in BP >25% of the baseline value both 8 and 24 h after the dose. Although 10 patients showed the same response in the NFD group 8 h after the dose, only four patients maintained these values at 24 h. One patient treated with NFD had a transient cerebrovascular ischemic attack. No adverse effects were observed in the LCD group. We conclude that the long-acting calcium antagonist lacidipine was more effective than the short-acting nifedipine in both controlling BP and maintaining this BP reduction over 8 h in essential hypertensive patients with acute asymptomatic BP increase.
我们比较了在高血压急症中单次给予等效剂量拉西地平与硝苯地平的降压疗效和安全性。29例无症状原发性高血压患者（9例男性，20例女性），平均年龄55.03±11.19岁，静息30分钟后基线舒张压（DBP）≥120mmHg，在过去24小时内未服用降压药物，以单盲方式随机分为两组，分别单次服用4mg拉西地平（LCD组，15例患者）或20mg短效硝苯地平（NFD组，14例患者）。在随访的前8小时内每30分钟测量一次血压（BP）和心率（HR），之后每2小时测量一次直至24小时。两组的基线血压值相似（LCD组，222.5±32.8/124.6±8.4mmHg vs. NFD组，215.9±20.6/128±7.7mmHg；p=无显著性差异）。两种药物在8小时后均使收缩压（SBP）和舒张压（DBP）显著降低（SBP：169.6±27.8 vs. 170.6±25.3mmHg；DBP：104.1±16 vs. 102.9±12.4mmHg）。然而，在给药24小时后，NFD组的SBP（165±27.3 vs. 190.6±18.2mmHg；p=0.008）和DBP（99.9±12.3 vs. 117.2±11.4mmHg；p=0.001）均显著高于LCD组。LCD组有11例患者在给药后8小时和24小时血压下降超过基线值的25%。虽然NFD组有10例患者在给药后8小时出现相同反应，但在24小时时只有4例患者维持这些值。1例接受NFD治疗的患者发生短暂性脑血管缺血发作。LCD组未观察到不良反应。我们得出结论，在急性无症状血压升高的原发性高血压患者中，长效钙拮抗剂拉西地平在控制血压和维持8小时血压降低方面比短效硝苯地平更有效。
