Ivleva A Ia, Kobalava Zh D, Antiia I D, Krasnobaeva G M, Iartsev V E, Lepakhin V K, Moiseev V S
Ter Arkh. 1991;63(9):97-100.
The purpose of the study was to define prognostic criteria that determine individual sensitivity to the hypotensive effect of slow calcium channel blockers. After two weeks of placebo therapy 45 patients suffering from essential hypertension underwent an acute pharmacological test (APT) with nifedipine in a dose of 30 mg. Then the patients received monotherapy with nitrendipine in the increasing doses for 12 weeks. The drug effect on the renin-angiotensin-aldosterone system and the level of ionized calcium in the blood serum was estimated. In 17 patients who responded to the APT by a decrease of the mean arterial pressure (MAP) by not less than 20%, arterial pressure was corrected with nitrendipine administered in a dose not exceeding 20 mg. 28 patients whose MAP dropped by 10 to 20% in response to the APT required higher drug doses (40 mg). 7 patients in whom the MAP dropped less than 10% were practically refractory to the monotherapy with nitrendipine. A close negative correlation was found between the degree of the MAP lowering in response to the APT during nitrendipine monotherapy and plasma renin activity as well as the concentration of ionized calcium in the blood serum. The low content (less than 1.0 mmol/l) of ionized calcium in the blood serum of patients suffering from essential hypertension appeared the most valuable predictor for the hypotensive effect of the slow calcium channel blockers.
该研究的目的是确定能够决定个体对慢钙通道阻滞剂降压效果敏感性的预后标准。在进行两周的安慰剂治疗后，45例原发性高血压患者接受了剂量为30mg的硝苯地平急性药理试验（APT）。然后患者接受剂量递增的尼群地平单药治疗，为期12周。评估了药物对肾素 - 血管紧张素 - 醛固酮系统以及血清中离子钙水平的影响。在17例平均动脉压（MAP）因APT降低不少于20%的患者中，使用不超过20mg的尼群地平来校正血压。28例因APT导致MAP下降10%至20%的患者需要更高剂量的药物（40mg）。7例MAP下降小于10%的患者对尼群地平单药治疗几乎无效。在尼群地平单药治疗期间，APT引起的MAP降低程度与血浆肾素活性以及血清中离子钙浓度之间发现密切的负相关。原发性高血压患者血清中离子钙含量低（低于1.0mmol/L）似乎是慢钙通道阻滞剂降压效果最有价值的预测指标。
