Widimský J
Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague-Krc, Czech Republic.
Expert Opin Pharmacother. 2000 Mar;1(3):515-35. doi: 10.1517/14656566.1.3.515.
Fixed verapamil SR/trandolapril combinations 180/1 mg and 180/2 mg (Tarka, Knoll AG) have a significantly superior antihypertensive effect compared to equal dosages of either agent alone. Verapamil SR/trandolapril 180/2 mg combination produces the best dose-response ratio of different dose combinations of these two drugs. Combination therapy has the most pronounced effect on blunting the early morning rise in blood pressure. Thus, verapamil SR/trandolapril combination therapy may be an appropriate treatment option in patients with moderate essential hypertension, particularly in those who have a tendency toward the early morning rise in blood pressure. The adverse effect profile of the fixed combination of verapamil SR/trandolapril includes the typical side effects of its monocompounds. The fixed combination of verapamil SR/trandolapril is also effective and safe in the treatment of hypertension in the elderly. The fixed low-dose combination therapy with verapamil SR/trandolapril 180/2 mg is a suitable treatment option for patients with moderate essential hypertension and Type 2 diabetes mellitus, because it improves parameters of carbohydrate metabolism and uricaemia and does not alter the lipid profile. The insulin-sensitising effect of angiotensin converting enzyme (ACE) inhibitor monotherapy with its theoretical risk of hypoglycaemia is completely neutralised in the combination with verapamil SR. Comparative studies have shown that the low-dose combination of verapamil SR/trandolapril may be a suitable alternative to combinations containing a thiazide diuretic or a beta-blocking agent for the long-term management of hypertensive patients for whom combination therapy is indicated. The combination of an ACE inhibitor with a non-dihydropyridine calcium channel blocker reduces proteinuria to a greater extent than either agent alone. A combination of an ACE inhibitor and a calcium channel blocker may provide additional benefit in inducing the regression of left ventricular hypertrophy. Combination therapy leads to a significant increase in left ventricular ejection fraction, improvement of wall motion index and increases exercise duration time in patients with coronary heart disease and left heart failure. It also improves the ratio of exercise to rest rate-pressure product and decreases the number of angina attacks. These findings support the hypothesis that the combination of verapamil and trandolapril might be useful in patients with attenuated left ventricular function and angina pectoris. Thus, Tarka is an effective and well-tolerated antihypertensive agent with a good safety profile and positive metabolic effects.
维拉帕米缓释片/群多普利固定复方制剂180/1毫克和180/2毫克（Tarka，诺尔公司）与单独使用同等剂量的任何一种药物相比，具有显著更强的降压效果。维拉帕米缓释片/群多普利180/2毫克复方制剂在这两种药物的不同剂量组合中产生最佳的剂量反应比。联合治疗对抑制清晨血压升高的作用最为显著。因此，维拉帕米缓释片/群多普利联合治疗可能是中度原发性高血压患者的合适治疗选择，尤其是那些有清晨血压升高倾向的患者。维拉帕米缓释片/群多普利固定复方制剂的不良反应谱包括其单一组分的典型副作用。维拉帕米缓释片/群多普利固定复方制剂在老年高血压患者的治疗中也有效且安全。维拉帕米缓释片/群多普利180/2毫克的固定低剂量联合治疗是中度原发性高血压和2型糖尿病患者的合适治疗选择，因为它改善了碳水化合物代谢和血尿酸参数，且不改变血脂谱。血管紧张素转换酶（ACE）抑制剂单药治疗的胰岛素增敏作用及其理论上的低血糖风险在与维拉帕米缓释片联合使用时被完全抵消。比较研究表明，维拉帕米缓释片/群多普利低剂量联合制剂可能是含噻嗪类利尿剂或β受体阻滞剂联合制剂的合适替代药物，用于对联合治疗有适应证的高血压患者的长期管理。ACE抑制剂与非二氢吡啶类钙通道阻滞剂联合使用比单独使用任何一种药物能更大程度地降低蛋白尿。ACE抑制剂和钙通道阻滞剂联合使用在促使左心室肥厚消退方面可能提供额外益处。联合治疗可使冠心病和左心衰竭患者的左心室射血分数显著增加、室壁运动指数改善，并延长运动持续时间。它还改善了运动与静息时心率-血压乘积的比值，并减少心绞痛发作次数。这些发现支持这样的假设，即维拉帕米和群多普利联合使用可能对左心室功能减弱和心绞痛患者有用。因此，Tarka是一种有效且耐受性良好的抗高血压药物，具有良好的安全性和积极的代谢作用。
