Beleslin D B, Prostran M S, Jovanović-Mićić D
Institute for Pharmacology and Toxicology, Medical School, Belgrade.
Srp Arh Celok Lek. 1992 May-Jun;120(5-6):188-92.
The calcium antagonist, diltiazem is effective in the treatment of patients with various types of angina pectoris, as well as with essential and renovascular arterial hypertension. Sustained-release diltiazem in dose of 180 mg once daily is effective as sustained-release diltiazem in dose of 90 mg twice daily. Besides, in patients with stable angina pectoris and essential arterial hypertension the monotherapy with sustained-release diltiazem in dose of 180 mg is similarly effective as beta blockers and thiazide diuretics. However, monotherapy with sustained-release diltiazem is at least effective as monotherapy with sustained-release verapamil. Comparative clinical investigations showed that diltiazem is more effective than propranolol in decreasing ischemic attacks, whereas the risk of bradycardia is smaller. On the other hand, nifedipine (dihydropyridine calcium antagonist) is more effective than diltiazem in lowering ischemic electrocardiographic changes, incidence of attacks and improving working capability. The efficacy of diltiazem, nifedipine and verapamil is similar in the treatment of patients with spastic angina pectoris, whereas the least effective is propranolol. As far as the arterial hypertension is concerned, clinical investigations showed that the efficacy of diltiazem and nifedipine is similar. Side effects are relatively rare (1.8-9.6% patients) and depend on the dose (nausea, fatigue, dizziness, headache and itching).
钙拮抗剂地尔硫䓬对各类心绞痛患者以及原发性和肾血管性动脉高血压患者的治疗均有效。每日一次服用180毫克缓释地尔硫䓬与每日两次服用90毫克缓释地尔硫䓬的效果相同。此外，对于稳定型心绞痛和原发性动脉高血压患者，每日一次服用180毫克缓释地尔硫䓬进行单一疗法与β受体阻滞剂和噻嗪类利尿剂同样有效。然而，缓释地尔硫䓬单一疗法至少与缓释维拉帕米单一疗法效果相当。比较临床研究表明，地尔硫䓬在减少缺血发作方面比普萘洛尔更有效，而心动过缓的风险较小。另一方面，硝苯地平（二氢吡啶类钙拮抗剂）在降低缺血性心电图改变、发作发生率和提高工作能力方面比地尔硫䓬更有效。地尔硫䓬、硝苯地平和维拉帕米在治疗痉挛性心绞痛患者方面疗效相似，而普萘洛尔效果最差。就动脉高血压而言，临床研究表明地尔硫䓬和硝苯地平的疗效相似。副作用相对较少（1.8 - 9.6%的患者），且取决于剂量（恶心、疲劳、头晕、头痛和瘙痒）。
