Minami Junichi, Numabe Atsushi, Andoh Norikazu, Kobayashi Naohiko, Horinaka Shigeo, Ishimitsu Toshihiko, Matsuoka Hiroaki
Department of Hypertension and Cardiorenal Medicine, Dokkyo University School of Medicine, Mibu, Tochigi, Japan.
Br J Clin Pharmacol. 2004 May;57(5):632-9. doi: 10.1111/j.1365-2125.2003.02056.x.
Nifedipine is a short-acting calcium antagonist formulated into several different oral preparations, each of which may have different effects on haemodynamics and autonomic nervous function. We compared the effects of nifedipine controlled-release (CR) and nifedipine retard on 24-h blood pressure, heart rate, rate-pressure product, and power spectral measures of heart rate variability in patients with essential hypertension.
After 4 weeks of a drug-free period, 25 patients were randomized to receive either once-daily treatment with nifedipine CR (20-40 mg daily; 12 patients) or twice-daily treatment with nifedipine retard (20-40 mg daily; 13 patients) for 12 weeks. The ambulatory blood pressure, heart rate, and ECG R-R intervals were measured during a 24-h period using a portable recorder (TM-2425) at the end of the drug-free and the treatment periods. A power-spectral analysis of R-R intervals was performed to obtain the low-frequency (LF) and high-frequency (HF) components.
Nifedipine CR and nifedipine retard reduced 24-h blood pressure significantly by 15.9 +/- 3.2 (SE)/8.7 +/- 1.4 mmHg and by 10.9 +/- 2.8/9.4 +/- 1.7 mmHg, respectively, after the 12-week treatment. Nifedipine CR did not change the 24-h heart rate significantly, while nifedipine retard increased it significantly by 3.9 +/- 2.1 beats min(-1). Nifedipine CR produced a significant reduction in rate-pressure product throughout a 24-h period, while nifedipine retard did not change the rate-pressure product significantly. In addition, nifedipine retard significantly decreased the 24-h and daytime average values of the LF and HF components, while nifedipine CR affected the nighttime LF component alone and did not change the HF component throughout a 24-h period.
These results demonstrate that both nifedipine CR and nifedipine retard are effective as antihypertensive agents, but nifedipine CR has less influence on the autonomic nervous system and heart rate than nifedipine retard.
硝苯地平是一种短效钙拮抗剂，制成了几种不同的口服制剂，每种制剂对血流动力学和自主神经功能可能有不同影响。我们比较了硝苯地平控释片（CR）和硝苯地平缓释片对原发性高血压患者24小时血压、心率、心率血压乘积以及心率变异性功率谱测量的影响。
在4周的无药期后，25例患者被随机分为两组，12例患者接受硝苯地平CR每日一次治疗（每日20 - 40毫克），13例患者接受硝苯地平缓释片每日两次治疗（每日20 - 40毫克），疗程为12周。在无药期结束时和治疗期结束时，使用便携式记录仪（TM - 2425）在24小时内测量动态血压、心率和心电图R - R间期。对R - R间期进行功率谱分析以获得低频（LF）和高频（HF）成分。
经过12周治疗后，硝苯地平CR和硝苯地平缓释片分别使24小时血压显著降低15.9±3.2（SE）/8.7±1.4毫米汞柱和10.9±2.8/9.4±1.7毫米汞柱。硝苯地平CR对24小时心率无显著影响，而硝苯地平缓释片使其显著增加3.9±2.1次/分钟。硝苯地平CR在24小时内使心率血压乘积显著降低，而硝苯地平缓释片对心率血压乘积无显著影响。此外，硝苯地平缓释片显著降低了24小时和白天LF和HF成分的平均值，而硝苯地平CR仅影响夜间LF成分，在24小时内对HF成分无影响。
这些结果表明，硝苯地平CR和硝苯地平缓释片都是有效的抗高血压药物，但硝苯地平CR对自主神经系统和心率的影响比硝苯地平缓释片小。
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