Vlay S C, Olson L C
Department of Medicine, State University of New York, Stony Brook 11794.
Am Heart J. 1990 Aug;120(2):303-7. doi: 10.1016/0002-8703(90)90073-7.
Since not all patients tolerate beta-blockers, the efficacy of nifedipine and isosorbide dinitrate was evaluated alone and in combination in patients with stable angina pectoris. The study was a randomized double-blind crossover design with patients titrated to maximally tolerated doses of both drugs. Phases included isosorbide dinitrate alone, nifedipine alone, and isosorbide dinitrate plus nifedipine in combination, with efficacy determined by stress testing. Eleven men and one woman patient with a mean age of 60 years and a mean of five anginal episodes/week completed the study. Patients were in New York Heart Association (NYHA) classes I, II, and III. With nifedipine alone compared with isosorbide dinitrate alone, patients had fewer angina attacks/week (p less than 0.02), exercised longer before experiencing angina (p less than 0.03), and had less ST segment depression during (p less than 0.03) or after (p less than 0.05) exercise. When patients received isosorbide dinitrate plus nifedipine, only time to onset of angina during exercise (p less than 0.05) was significantly different from the response with isosorbide dinitrate alone. Analysis of variance between nifedipine and isosorbide dinitrate plus nifedipine was not significant. Diastolic blood pressure with isosorbide dinitrate plus nifedipine (p less than 0.04) was lower than with isosorbide dinitrate alone. No significant differences in systolic blood pressure were noted between the treatment groups. The drugs alone and in combination were relatively well tolerated. Nifedipine alone may be superior to isosorbide dinitrate alone. The combination of isosorbide dinitrate plus nifedipine demonstrated no advantage over nifedipine alone compared with isosorbide dinitrate alone.
由于并非所有患者都能耐受β受体阻滞剂，因此对硝苯地平和硝酸异山梨酯在稳定型心绞痛患者中的疗效进行了单独及联合评估。该研究采用随机双盲交叉设计，患者被滴定至两种药物的最大耐受剂量。阶段包括单独使用硝酸异山梨酯、单独使用硝苯地平以及硝酸异山梨酯加硝苯地平联合使用，疗效通过负荷试验确定。11名男性和1名女性患者完成了研究，平均年龄60岁，平均每周有5次心绞痛发作。患者属于纽约心脏协会（NYHA）I、II和III级。与单独使用硝酸异山梨酯相比，单独使用硝苯地平时，患者每周心绞痛发作次数更少（p<0.02），心绞痛发作前运动时间更长（p<0.03），运动期间（p<0.03）或运动后（p<0.05）ST段压低更少。当患者接受硝酸异山梨酯加硝苯地平时，仅运动期间心绞痛发作时间（p<0.05）与单独使用硝酸异山梨酯时的反应有显著差异。硝苯地平和硝酸异山梨酯加硝苯地平之间的方差分析无显著差异。硝酸异山梨酯加硝苯地平时的舒张压（p<0.04）低于单独使用硝酸异山梨酯时。各治疗组之间收缩压无显著差异。单独使用及联合使用这些药物耐受性相对良好。单独使用硝苯地平可能优于单独使用硝酸异山梨酯。与单独使用硝酸异山梨酯相比，硝酸异山梨酯加硝苯地平联合使用并未显示出比单独使用硝苯地平有优势。
