Luft F C, Fineberg N S, Weinberger M H
Department of Internal Medicine-Nephrology, University of Erlangen-Nürnberg, Germany.
Am J Hypertens. 1991 Sep;4(9):752-60. doi: 10.1093/ajh/4.9.752.
To elucidate and compare the effects of nifedipine (NIF) and hydrochlorothiazide (HCTZ) on blood pressure (BP) and sodium (Na) balance, we conducted a randomized, double-blind, crossover study with 50 mg/day HCTZ and 90 mg/day NIF (as the sustained-release gastrointestinal therapeutic system preparation) in 10 mildly hypertensive patients over approximately 8 weeks. Prior to treatment, the subjects were brought into balance at an intake of 150 mmol/day. During treatment, Na intake was lowered and raised to 50 and 300 mmol/day, respectively, in random order. Then, the subjects were brought into balance on treatment at a level of 150 mmol/day. Balance observations were made during and after the drugs were discontinued. Both HCTZ and NIF lowered BP similarly. When Na intake was lowered from 150 to 50 mmol/day, a significant decrease in diastolic BP was observed with HCTZ. Increasing Na intake to 300 mmol/day did not affect BP. At an intake of 150 mmol/day, HCTZ caused prompt natriuresis, with a negative balance of 150 mmol by 3 days. No initial natriuresis could be shown with NIF. Decreasing Na intake to 50 mmol/day caused prompt negative Na balance with both drugs; increasing it to 300 mmol/day was associated with +150 mmol Na balance with HCTZ while no significant increase was seen with NIF. Discontinuing both drugs caused prompt increase in BP and Na retention over 6 days, which was not different for the drugs. Plasma renin activity (PRA) increased with HCTZ but not with NIF. Further, changing Na intake affected PRA with HCTZ. With NIF, PRA appeared to be uncoupled from the effects of dietary Na intake. In contrast to HCTZ, no adverse metabolic effects were observed with NIF. The data suggest that NIF results in chronic mild natriuresis similar in magnitude to HCTZ. The PRA appears inactivated, although not lowered. The effects of NIF on BP may be at least in part related to the natriuresis and blunting of PRA.(ABSTRACT TRUNCATED AT 250 WORDS)
为阐明并比较硝苯地平（NIF）和氢氯噻嗪（HCTZ）对血压（BP）和钠（Na）平衡的影响，我们对10例轻度高血压患者进行了一项随机、双盲、交叉研究，给予患者每日50 mg氢氯噻嗪和每日90 mg硝苯地平（作为缓释胃肠道治疗系统制剂），为期约8周。治疗前，让受试者摄入150 mmol/天的钠，使其达到平衡状态。治疗期间，钠摄入量随机降低和升高，分别降至50 mmol/天和升至300 mmol/天。然后，让受试者在治疗时摄入150 mmol/天的钠，使其达到平衡状态。在用药期间和停药后进行平衡观察。氢氯噻嗪和硝苯地平降低血压的效果相似。当钠摄入量从150 mmol/天降至50 mmol/天时，氢氯噻嗪可使舒张压显著降低。将钠摄入量增至300 mmol/天对血压无影响。在摄入150 mmol/天的钠时，氢氯噻嗪可迅速引起利钠作用，3天时负平衡达150 mmol。硝苯地平未显示出初始利钠作用。将钠摄入量降至50 mmol/天时，两种药物均迅速导致钠负平衡；将钠摄入量增至300 mmol/天时，氢氯噻嗪使钠平衡增加+150 mmol，而硝苯地平未观察到显著增加。停用两种药物后，血压在6天内迅速升高，钠潴留，两种药物的情况无差异。氢氯噻嗪使血浆肾素活性（PRA）升高，而硝苯地平未使其升高。此外，改变钠摄入量会影响氢氯噻嗪的PRA。对于硝苯地平，PRA似乎与饮食中钠摄入量的影响无关。与氢氯噻嗪不同，未观察到硝苯地平有不良代谢作用。数据表明，硝苯地平导致的慢性轻度利钠作用在程度上与氢氯噻嗪相似。PRA似乎失活，尽管未降低。硝苯地平对血压的影响可能至少部分与利钠作用和PRA的减弱有关。（摘要截短至250字）
