Lundy Amber, Lutfi Nahla, Beckey Cherylyn
Veterans Affairs Medical Center, Pharmacy Service, west Palm Beach, FL 33410-6400, USA.
Vasc Health Risk Manag. 2009;5(1):429-40. doi: 10.2147/vhrm.s3066.
Nifedipine is a dihydropyridine calcium-channel blocker (CCB) introduced approximately 30 years ago for the prophylaxis of angina symptoms, and then later utilized as an anti-hypertensive agent. In the 1990s, several meta-analyses and a case-control study were published which raised concern regarding increased mortality and increased risk for myocardial infarction with short-acting nifedipine. Further evaluation of these meta-analyses and case control study underscores some important limitations and the need to further elucidate the role of this class of medications in high-risk patients. Until 2000, there was a paucity of data on the long-term effects as well as the long-term outcomes of CCBs in the treatment of stable coronary disease or in patients with manifestations of the disease such as hypertension or angina. While it has been well established that nifedipine and other dihydropyridines lower blood pressure and improve symptoms of angina, several studies were designed to evaluate the effect of dihydropyridines on "hard" outcomes, specifically cardiovascular and cerebrovascular events. In this review, we describe the clinical studies evaluating the use of nifedipine when compared to placebo as well as other anti-hypertensive therapies in an attempt to identify the most appropriate place in therapy for this class of medications and to further clarify its utilization in high-risk patients.
硝苯地平是一种二氢吡啶类钙通道阻滞剂（CCB），大约30年前被用于预防心绞痛症状，后来被用作抗高血压药物。在20世纪90年代，发表了几项荟萃分析和一项病例对照研究，引发了对短效硝苯地平导致死亡率增加和心肌梗死风险增加的担忧。对这些荟萃分析和病例对照研究的进一步评估强调了一些重要的局限性，以及进一步阐明这类药物在高危患者中作用的必要性。直到2000年，关于CCB在治疗稳定型冠心病或患有高血压或心绞痛等疾病表现的患者中的长期影响和长期结局的数据还很匮乏。虽然硝苯地平和其他二氢吡啶类药物能降低血压并改善心绞痛症状这一点已经得到充分证实，但仍有几项研究旨在评估二氢吡啶类药物对“硬”结局，特别是心血管和脑血管事件的影响。在这篇综述中，我们描述了评估硝苯地平与安慰剂以及其他抗高血压疗法相比的临床研究，试图确定这类药物在治疗中的最合适位置，并进一步阐明其在高危患者中的应用。
