Ferrara L A, Marotta T
Institute of Internal Medicine and Metabolic Diseases, Second Medical School, University of Naples, Italy.
J Cardiovasc Pharmacol. 1991;18 Suppl 5:S19-21.
Abnormalities of glucose and lipoprotein metabolism have frequently been found in hypertensive patients in both epidemiological and clinical studies. Reduction of blood pressure favorably affects the rate of cardiovascular diseases mainly when concomitant with a decrease in glucose and lipid serum levels. For these reasons antihypertensive drugs without untoward metabolic side effects should be preferred, particularly in hypertensive patients with metabolic impairment. Nitrendipine, a dihydropiridine derivative, like other calcium-entry blockers, has been proved not to deteriorate fasting glucose (75 +/- 12 vs. 75 +/- 10 mg/dl) and serum insulin (8.5 +/- 3 vs. 10.8 +/- 5 microU/ml) levels. Glucose and insulin response to an oral carbohydrate challenge (glucose % removal rate 1.4 +/- 0.2 vs. 1.5 +/- 0.3%/min; incremental area for serum insulin 955 +/- 279 vs. 905 +/- 458 microU/ml/min), serum cholesterol (192 +/- 33 vs. 200 +/- 43 mg/dl), triglyceride (83 +/- 57 vs. 84 +/- 37 mg/dl) and high-density lipoprotein cholesterol (46 +/- 9 vs. 50 +/- 14 mg/dl) were not affected as well. It is therefore possible to conclude that nitrendipine may be safely prescribed when the antihypertensive activity of a calcium-entry blocker is required.
在流行病学和临床研究中，经常发现高血压患者存在葡萄糖和脂蛋白代谢异常。血压降低主要在伴随血清葡萄糖和脂质水平下降时，对心血管疾病发生率产生有利影响。基于这些原因，应优先选用无不良代谢副作用的抗高血压药物，尤其是对有代谢损害的高血压患者。尼群地平，一种二氢吡啶衍生物，与其他钙通道阻滞剂一样，已被证明不会使空腹血糖（75±12对75±10mg/dl）和血清胰岛素（8.5±3对10.8±5μU/ml）水平恶化。口服碳水化合物激发试验后的葡萄糖和胰岛素反应（葡萄糖清除率1.4±0.2对1.5±0.3%/分钟；血清胰岛素增量面积955±279对905±458μU/ml/分钟）、血清胆固醇（192±33对200±43mg/dl）、甘油三酯（83±57对84±37mg/dl）和高密度脂蛋白胆固醇（46±9对50±14mg/dl）也未受影响。因此可以得出结论，当需要钙通道阻滞剂的抗高血压活性时，尼群地平可以安全使用。
