新型二氢吡啶类钙拮抗剂西尼地平对原发性高血压患者自主神经功能、动态血压及心率的影响。
Effects of cilnidipine, a novel dihydropyridine calcium antagonist, on autonomic function, ambulatory blood pressure and heart rate in patients with essential hypertension.
作者信息
Minami J, Kawano Y, Makino Y, Matsuoka H, Takishita S
机构信息
Division of Hypertension and Nephrology, National Cardiovascular, Center, Suita 565-0873, Osaka, Japan.
出版信息
Br J Clin Pharmacol. 2000 Dec;50(6):615-20. doi: 10.1046/j.1365-2125.2000.00299.x.
AIMS
The aim of the present study was to evaluate the effects of cilnidipine, a novel dihydropyridine calcium antagonist, on autonomic function, ambulatory blood pressure and heart rate in patients with essential hypertension.
METHODS
Ten inpatients with mild to moderate essential hypertension (four men and six women; age: 44-64 years) underwent a drug-free period for 7 days and a treatment period with cilnidipine 10 mg orally for another 7 days, in a randomized crossover study. On the sixth day of each period, they underwent autonomic function tests including a mental arithmetic test, a cold pressor test and a Valsalva manoeuvre. After these tests, 24 h ambulatory blood pressure, heart rate, and the electrocardiogram R-R intervals were monitored every 30 min. A power spectral analysis of R-R intervals was performed to obtain the low-and high-frequency components.
RESULTS
Cilnidipine significantly decreased the 24 h blood pressure by 6.5 +/- 1.7 mm Hg systolic (mean +/- s.e.mean; P < 0.01) and 5.0 +/- 1.1 mmHg diastolic (P < 0.01), whereas cilnidipine did not change heart rate or any indices of power spectral components. During the cold pressor test, the maximum change in systolic blood pressure and percentage changes in both systolic and diastolic blood pressures were significantly lower during the treatment period with cilnidipine than during the drug-free period. The baroreflex sensitivity measured from the overshoot phase of the Valsalva manoeuvre did not differ significantly between the two periods.
CONCLUSIONS
Cilnidipine is effective as a once-daily antihypertensive agent and causes little influence on heart rate and the autonomic nervous system in patients with mild to moderate essential hypertension. Moreover, it is suggested that cilnidipine has an additional clinical benefit in the inhibition of the pressor response induced by acute cold stress.
目的
本研究旨在评估新型二氢吡啶类钙拮抗剂西尼地平对原发性高血压患者自主神经功能、动态血压和心率的影响。
方法
在一项随机交叉研究中，10例轻度至中度原发性高血压住院患者（4例男性，6例女性；年龄：44 - 64岁）经历了7天的无药期，随后口服10 mg西尼地平进行为期7天的治疗期。在每个阶段的第6天，他们接受了自主神经功能测试，包括心算测试、冷加压测试和瓦尔萨尔瓦动作。这些测试后，每30分钟监测一次24小时动态血压、心率和心电图R - R间期。对R - R间期进行功率谱分析以获得低频和高频成分。
结果
西尼地平使24小时收缩压显著降低6.5±1.7 mmHg（均值±标准误均值；P < 0.01），舒张压降低5.0±1.1 mmHg（P < 0.01），而西尼地平未改变心率或功率谱成分的任何指标。在冷加压测试期间，西尼地平治疗期的收缩压最大变化以及收缩压和舒张压的百分比变化均显著低于无药期。从瓦尔萨尔瓦动作的过冲阶段测得的压力反射敏感性在两个阶段之间无显著差异。
结论
西尼地平作为每日一次的抗高血压药物有效，对轻度至中度原发性高血压患者的心率和自主神经系统影响较小。此外，提示西尼地平在抑制急性冷应激诱导的升压反应方面具有额外的临床益处。
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