Sica Domenic A
Section of Clinical Pharmacology and Hypertension, Division of Nephrology, Medical College of Virginia of Virginia Commonwealth University, Richmond, VA 23298-0160, USA.
J Clin Hypertens (Greenwich). 2003 Jul-Aug;5(4):291-4, 297. doi: 10.1111/j.1524-6175.2003.02402.x.
Calcium channel blocker (CCB)-related edema is quite common in clinical practice and can effectively deter a clinician from continued prescription of these drugs. Its etiology relates to a decrease in arteriolar resistance that goes unmatched in the venous circulation. This disproportionate change in resistance increases hydrostatic pressures in the precapillary circulation and permits fluid shifts into the interstitial compartment. CCB-related edema is more common in women and relates to upright posture, age, and the choice and dose of the CCB. Once present it can be slow to resolve without intervention. A number of strategies exist to treat CCB-related edema, including switching CCB classes, reducing the dosage, and/or adding a known venodilator such as a nitrate, an angiotensin-converting enzyme inhibitor, or an angiotensin-receptor blocker to the treatment regimen. Angiotensin-converting enzyme inhibitors have been best studied in this regard. Diuretics may alter the edema state somewhat, but at the expense of further reducing plasma volume. Traditional measures such as limiting the amount of time that a patient is upright and/or considering use of graduated compression stockings are useful adjunctive therapies. Discontinuing the CCB and switching to an alternative antihypertensive therapy will resolve the edema.
钙通道阻滞剂（CCB）相关的水肿在临床实践中相当常见，会有效阻碍临床医生继续开具这些药物。其病因与小动脉阻力降低有关，而静脉循环中未出现相应变化。这种阻力的不均衡变化会增加毛细血管前循环中的流体静压，使液体转移至间质腔隙。CCB相关的水肿在女性中更为常见，与直立姿势、年龄以及CCB的选择和剂量有关。一旦出现，若不干预，水肿消退可能较慢。有多种治疗CCB相关水肿的策略，包括更换CCB类别、减少剂量，和/或在治疗方案中添加已知的静脉扩张剂，如硝酸盐、血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂。在这方面，血管紧张素转换酶抑制剂的研究最为充分。利尿剂可能会在一定程度上改变水肿状态，但代价是进一步降低血浆容量。传统措施，如限制患者直立时间和/或考虑使用分级压力弹力袜，是有用的辅助治疗方法。停用CCB并改用其他抗高血压疗法可消除水肿。
