Klaus D
Internal Medicine Clinic, Dortmund City Hospital, Germany.
J Cardiovasc Pharmacol. 1992;20 Suppl 6:S5-14.
Calcium antagonists are of particular importance in the treatment of hypertension because they influence the free cytoplasmic calcium concentration and thereby many pressor mechanisms in the smooth muscle cell. A fall in the peripheral resistance is the main hemodynamic effect, and this is more marked with the second-generation calcium antagonists because they are more vasoselective than the first calcium-channel blockers. Particularly important is their lack of effect on lipid and glucose metabolism, as well as the absence of serious side effects. It has not yet been possible to confirm that the antiatherogenic effect found in some animal models also occurs in humans. Calcium antagonists are effective, safe, and well-tolerated antihypertensive agents that can be combined with all other antihypertensives with the exception of the combination of verapamil and a beta-blocker. They are easy to dose for individualized "stepped" therapy. They have a particular role in hypertensive patients with cardiac effects secondary to hypertension, coronary artery disease, obstructive bronchial diseases, diabetes, renal disease, and peripheral arterial occlusive disease.
钙拮抗剂在高血压治疗中具有特别重要的意义，因为它们会影响细胞质游离钙浓度，从而影响平滑肌细胞中的多种升压机制。外周阻力降低是主要的血流动力学效应，第二代钙拮抗剂的这种作用更为显著，因为它们比第一代钙通道阻滞剂具有更高的血管选择性。特别重要的是它们对脂质和葡萄糖代谢没有影响，也没有严重的副作用。目前尚无法证实某些动物模型中发现的抗动脉粥样硬化作用在人类中也会出现。钙拮抗剂是有效、安全且耐受性良好的抗高血压药物，除维拉帕米与β受体阻滞剂联合使用外，可与所有其他抗高血压药物联合使用。它们易于调整剂量以进行个体化的“阶梯式”治疗。它们在患有高血压继发心脏效应、冠状动脉疾病、阻塞性支气管疾病、糖尿病、肾脏疾病和外周动脉闭塞性疾病的高血压患者中具有特殊作用。
