心肌缺血的优化控制：阿替洛尔与硝苯地平固定复方制剂对慢性稳定性心绞痛患者的益处。

Optimal control of myocardial ischaemia: the benefit of a fixed combination of atenolol and nifedipine in patients with chronic stable angina.

作者信息

el-Tamimi H, Davies G J

机构信息

Cardiovascular Research Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London.

出版信息

Br Heart J. 1992 Sep;68(3):291-5. doi: 10.1136/hrt.68.9.291.

DOI:10.1136/hrt.68.9.291

PMID:1389761

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1025073/

Abstract

OBJECTIVE

To study the effects on myocardial ischaemia of 50 mg of atenolol, 20 mg of slow release nifedipine, and their fixed combination given 12 hourly.

DESIGN

A treadmill exercise test and 24 hour ambulatory electrocardiographic monitoring were carried out after a period of five days off treatment (control) and at the end of three weeks of each treatment period.

PATIENTS

23 patients with stable angina pectoris, documented coronary artery disease, and a positive exercise test were randomised in a double blind, three way, cross over study.

RESULTS

Compared with the control, nifedipine significantly induced an increase in resting heart rate of (mean (SEM)) 14 (2) beats/min whereas atenolol and the combination significantly reduced it by 24 (2) and 20 (1) beats/min respectively. The number of exercise tests rendered negative after each intervention was five for nifedipine, nine for atenolol, and 11 for the combination. Compared with the control the time to the start of myocardial ischaemia (1 mm ST segment depression) during exercise significantly increased by 3.2 (0.6) min after nifedipine, by 4.6 (0.4) min after atenolol, and by 4.6 (0.5) min after the combination; rate-pressure product (beats/min. mm Hg) at 1 mm ST segment depression increased by 2824 (970) after nifedipine but fell by 4436 (900) and 4501 (719) after atenolol and the combination. The weekly frequency of angina was reduced from a mean of five while taking nifedipine, to three while taking atenolol, and to two while taking the combination. The total ischaemic time during ambulatory monitoring was significantly reduced from 69 (17) min during control to 37.5 (9.8) min during nifedipine, to 15.6 (5.5) min during atenolol, and to 6.5 (2.7) min during the combination.

CONCLUSION

The undesirable effect of a high basal heart rate induced by nifedipine was neutralised by its combination with atenolol. Whereas atenolol and the combination were equally efficacious in controlling exercise induced ischaemia, the combination was more effective in reducing total ischaemic burden.

摘要

目的

研究12小时服用一次50毫克阿替洛尔、20毫克缓释硝苯地平及其固定复方制剂对心肌缺血的影响。

设计

在停药5天（对照）后以及每个治疗期3周结束时，进行跑步机运动试验和24小时动态心电图监测。

患者

23例稳定型心绞痛患者，有冠状动脉疾病记录且运动试验阳性，被随机纳入一项双盲、三臂、交叉研究。

结果

与对照组相比，硝苯地平显著使静息心率增加（均值（标准误））14（2）次/分钟，而阿替洛尔和复方制剂分别显著降低静息心率24（2）次/分钟和20（1）次/分钟。每次干预后运动试验转为阴性的例数，硝苯地平组为5例，阿替洛尔组为9例，复方制剂组为11例。与对照组相比，运动期间心肌缺血（ST段压低1毫米）开始时间，硝苯地平组显著增加3.2（0.6）分钟，阿替洛尔组增加4.6（0.4）分钟，复方制剂组增加4.6（0.5）分钟；ST段压低1毫米时的心率 - 血压乘积（次/分钟·毫米汞柱），硝苯地平组增加2824（970），而阿替洛尔组和复方制剂组分别降低4436（900）和4501（719）。心绞痛的每周发作频率，服用硝苯地平时平均为5次，服用阿替洛尔时降至3次，服用复方制剂时降至2次。动态监测期间的总缺血时间，对照组为69（17）分钟，硝苯地平组显著降至37.5（9.8）分钟，阿替洛尔组降至15.6（5.5）分钟，复方制剂组降至6.5（2.7）分钟。