Department of Internal Medicine and Cardiology, Tama-Nagayama Hospital, Nippon Medical School, Tokyo, Japan.
Circ J. 2011;75(7):1696-705. doi: 10.1253/circj.cj-10-1078. Epub 2011 May 17.
Beta-blockers (BB) have been widely used in the management of hypertension and acute myocardial infarction (AMI), and both national and international guidelines have recommended them as first-line agents. Calcium channel antagonists (CCA) are also effective in the treatment of hypertension and angina pectoris. However, the efficacy of CCA in the prevention of cardiovascular events in post-myocardial infarction (MI) patients in comparison to that of BB remains unclear.
A total of 120 post-MI patients (71 patients who were at least 1 month after the onset AMI and 49 stable coronary artery disease patients with a history of MI) were randomly assigned to receive a BB (atenolol, 25-50mg/day, n=60) or a CCA (benidipine, 4-8 mg/day, n=60). All patients with AMI within the previous 1 month or with vasospastic angina were excluded from the present study. The baseline clinical characteristics were generally similar in the BB and CCA groups. The rate of primary composite outcome was 26.3% in the BB group in comparison to 13.3% in the CCA group, with no significant between-group differences (hazard ratio with the CCA group 0.640, P=0.276). Both treatments were well tolerated with few severe adverse events.
CCA treatment was found to be as effective as BB in reducing cardiovascular events in post-MI patients.
β受体阻滞剂（BB）已广泛用于高血压和急性心肌梗死（AMI）的治疗，国内外指南均推荐其作为一线药物。钙通道拮抗剂（CCA）在高血压和心绞痛的治疗中也同样有效。然而，CCA 在预防心肌梗死后（MI）患者心血管事件方面的疗效与 BB 相比，其效果尚不清楚。
共有 120 例 MI 后患者（71 例至少在 AMI 发病后 1 个月，49 例有 MI 病史的稳定型冠心病患者）被随机分配接受 BB（阿替洛尔，25-50mg/天，n=60）或 CCA（贝尼地平，4-8mg/天，n=60）治疗。本研究排除了 1 个月内发生 AMI 或有血管痉挛性心绞痛的患者。BB 组和 CCA 组的基线临床特征一般相似。BB 组主要复合终点发生率为 26.3%，而 CCA 组为 13.3%，两组间无显著差异（CCA 组的危险比为 0.640，P=0.276）。两种治疗方法均耐受良好，严重不良事件较少。
CCA 治疗在降低 MI 后患者心血管事件方面与 BB 同样有效。
