Ashizawa Naoto, Seto Shinji, Shibata Yoshisada, Yano Katsusuke
Division of Cardiovascular Medicine, Nagasaki University, Nagasaki, Japan.
Int Heart J. 2007 Sep;48(5):597-603. doi: 10.1536/ihj.48.597.
Morning blood pressure (BP) level plays an important role in the incidence of cardiovascular disease. Recently, Kario, et al proposed the usefulness of ME difference (morning minus evening systolic BP) and ME average (average of morning and evening systolic BP) for the evaluation of antihypertensive treatment. Cilnidipine is a novel calcium channel blocker (CCB) that exerts inhibitory actions not only on L-type but also on N-type calcium channels. We investigated the effect of bedtime administration of cilnidipine (10 mg) in addition to the antihypertensive treatment for uncontrolled morning hypertension. Twenty-three hypertensive outpatients (13 males and 10 females; mean age, 66.9 years) with stable antihypertensive medication and uncontrolled morning BP were studied using self-measured BP monitoring in the morning and evening. Morning SBP (P < 0.001) and DBP (P < 0.001) decreased significantly from 150.2 +/- 8.7 and 87.8 +/- 9.3 to 132.7 +/- 7.4 and 77.5 +/- 8.5 mmHg, respectively, after the addition of cilnidipine. Morning heart rate did not change (63.3 +/- 7.0 to 64.1 +/- 9.4). The evening SBP, but not DBP, decreased significantly after treatment. Both the ME average (P < 0.001) and ME difference (P < 0.01) significantly decreased from 143.0 +/- 9.2 and 14.3 +/- 12.4 to 131.3 +/- 7.2 and 2.8 +/- 9.2 mmHg after treatment, respectively. The microalbuminuria decreased from 39.6 +/- 13.2 to 27.3 +/- 8.4 mg/g Cr. In conclusion, L-/N-type CCB cilnidipine may be useful for patients with uncontrollable morning hypertension by reducing both ME average and ME difference.
清晨血压水平在心血管疾病的发生中起着重要作用。最近，卡里奥等人提出了平均血压差值（清晨收缩压减去夜间收缩压）和平均血压均值（清晨和夜间收缩压的平均值）在评估降压治疗效果方面的有用性。西尼地平是一种新型钙通道阻滞剂（CCB），它不仅对L型钙通道有抑制作用，对N型钙通道也有抑制作用。我们研究了在降压治疗基础上，睡前服用西尼地平（10毫克）对未控制的清晨高血压的影响。对23例高血压门诊患者（13例男性和10例女性；平均年龄66.9岁）进行了研究，这些患者正在接受稳定的降压治疗，但清晨血压未得到控制，采用早晚自行测量血压监测。添加西尼地平后，清晨收缩压（P<0.001）和舒张压（P<0.001）分别从150.2±8.7和87.8±9.3显著降至132.7±7.4和77.5±8.5毫米汞柱。清晨心率未发生变化（63.3±7.0至64.1±9.4）。治疗后夜间收缩压显著降低，但舒张压未降低。治疗后，平均血压均值（P<0.001）和平均血压差值（P<0.01）分别从143.0±9.2和14.3±12.4显著降至131.3±7.2和2.8±9.2毫米汞柱。微量白蛋白尿从39.6±13.2降至27.3±8.4毫克/克肌酐。总之，L-/N型CCB西尼地平通过降低平均血压均值和平均血压差值，可能对无法控制的清晨高血压患者有用。
