Inoue I, Matsuura H, Fujii T, Ishida T, Ozono R, Kainouchi M, Tsuchioka Y, Kajiyama G
First Department of Internal Medicine, Hiroshima University School of Medicine, Japan.
Clin Ther. 1992 Jan-Feb;14(1):22-9.
A combination of nifedipine (40 mg twice daily) plus carteolol (10 mg twice daily) was compared with nifedipine monotherapy in ten patients with essential hypertension. Ambulatory blood pressure (BP) monitoring over 24 hours and treadmill exercise testing were performed before treatment with nifedipine (but after the placebo period), after four weeks of nifedipine treatment, and after four weeks of nifedipine+carteolol combination therapy. At the end of nifedipine monotherapy, 24-hour average ambulatory BP, minimum ambulatory BP during sleep, maximum ambulatory BP, and casual BP all decreased significantly (P less than 0.01). However, the standard deviation (SD) of the ambulatory BP was not affected. The change in systolic BP response to treadmill exercise increased. After a four-week period of nifedipine+carteolol combination therapy, average ambulatory BP and maximum ambulatory BP were further decreased (P less than 0.01). The SD of the ambulatory BP and the change in BP response to exercise were significantly decreased (P less than 0.01), but the minimum ambulatory BP was not affected. These findings suggest that nifedipine and carteolol differ in their influence on diurnal BP variation and on exercise-induced BP elevation. Carteolol may mainly attenuate stress-induced BP elevation and have little influence on nocturnal BP decline. In contrast, nifedipine may affect the BP profile uniformly over the entire day. Nifedipine+carteolol combination therapy may be superior to nifedipine monotherapy because carteolol has a minimal effect on nocturnal BP and decreases stress-induced BP elevation.
在10例原发性高血压患者中，将硝苯地平（每日2次，每次40毫克）加卡替洛尔（每日2次，每次10毫克）的联合用药与硝苯地平单药治疗进行比较。在硝苯地平治疗前（但在安慰剂期之后）、硝苯地平治疗4周后以及硝苯地平+卡替洛尔联合治疗4周后，进行了24小时动态血压监测和跑步机运动试验。在硝苯地平单药治疗结束时，24小时平均动态血压、睡眠期间最低动态血压、最高动态血压和偶测血压均显著下降（P<0.01）。然而，动态血压的标准差未受影响。跑步机运动时收缩压反应的变化增加。经过4周的硝苯地平+卡替洛尔联合治疗后，平均动态血压和最高动态血压进一步下降（P<0.01）。动态血压的标准差和运动时血压反应的变化显著下降（P<0.01），但最低动态血压未受影响。这些发现表明，硝苯地平和卡替洛尔对日间血压变化和运动诱发的血压升高的影响不同。卡替洛尔可能主要减轻应激诱发的血压升高，对夜间血压下降影响较小。相比之下，硝苯地平可能对全天的血压情况产生均匀影响。硝苯地平+卡替洛尔联合治疗可能优于硝苯地平单药治疗，因为卡替洛尔对夜间血压影响最小，并可降低应激诱发的血压升高。
