Houston M C, Olafsson L, Burger M C
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Angiology. 1991 Sep;42(9):681-90. doi: 10.1177/000331979104200901.
Forty-nine patients, with ages ranging from eighteen to seventy years and with mild to moderate primary hypertension (sitting diastolic blood pressure of greater than or equal to 95 mmgH and less than or equal to 115 mmHg) were randomized into a twenty-one-week, double-blind, prospective study to determine the effects of monotherapy of nifedipine GITS (gastrointestinal therapeutic system) versus atenolol on serum lipids, lipid subfractions, apolipoproteins, (apo), and blood pressure (BP). Nifedipine GITS and atenolol significantly reduced blood pressure, but nifedipine GITS reduced sitting and standing systolic BP significantly more than atenolol (p = .001). Sitting and standing heart rate decreased significantly (p = 0.001) during atenolol therapy but did not change significantly during nifedipine GITS therapy. Atenolol increased weight (mean change + 2.2 lb; p = 0.011), but nifedipine GITS decreased weight (mean change - 2.4 lb; p = 0.07). Nifedipine GITS had a more favorable effect on the lipid profile. High density lipoprotein cholesterol (HDL-C) and HDL2 subfractions were increased significantly (p = .001) as were apo A1 (p = 0.037) and apo A2 (p = 0.025). Nifedipine GITS increased HDL3 (NS), reduced triglycerides (TG) (NS), and had no significant effect on total cholesterol (TC) low density lipoprotein cholesterol (LDL-C) and apo B. Atenolol significantly increased serum total cholesterol (p = 0.039) and HDL-C and HDL2 (p = 0.049 and 0.048 respectively). Atenolol increased TG (NS) and apo B (NS) with little change in apo A1 and apo A2. It is concluded that nifedipine GITS had equal or better antihypertensive efficacy than atenolol and had a more favorable effect on the lipid profile. These effects may offer advantages in reducing CHD risk.
四十九名年龄在18岁至70岁之间、患有轻度至中度原发性高血压（坐位舒张压大于或等于95 mmHg且小于或等于115 mmHg）的患者被随机纳入一项为期21周的双盲前瞻性研究，以确定硝苯地平胃肠道治疗系统（GITS）单药治疗与阿替洛尔对血脂、脂质亚组分、载脂蛋白（apo）和血压（BP）的影响。硝苯地平GITS和阿替洛尔均显著降低了血压，但硝苯地平GITS降低坐位和立位收缩压的幅度明显大于阿替洛尔（p = 0.001）。在阿替洛尔治疗期间，坐位和立位心率显著下降（p = 0.001），但在硝苯地平GITS治疗期间无显著变化。阿替洛尔使体重增加（平均变化 + 2.2磅；p = 0.011），而硝苯地平GITS使体重减轻（平均变化 - 2.4磅；p = 0.07）。硝苯地平GITS对血脂谱有更有利的影响。高密度脂蛋白胆固醇（HDL-C）和HDL2亚组分显著增加（p = 0.001），载脂蛋白A1（p = 0.037）和载脂蛋白A2（p = 0.025）也显著增加。硝苯地平GITS使HDL3升高（无统计学意义），降低甘油三酯（TG）（无统计学意义），对总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）和载脂蛋白B无显著影响。阿替洛尔显著增加血清总胆固醇（p = 0.039）以及HDL-C和HDL2（分别为p = 0.049和0.048）。阿替洛尔使TG升高（无统计学意义）和载脂蛋白B升高（无统计学意义），而载脂蛋白A1和载脂蛋白A2变化不大。得出的结论是，硝苯地平GITS的降压疗效与阿替洛尔相当或更好，并且对血脂谱有更有利的影响。这些作用可能在降低冠心病风险方面具有优势。
