Kiowski W
Department of Internal Medicine, University Hospital, Kantosspital, Basel, Switzerland.
Cor Vasa. 1990;32(2 Suppl 1):2-11.
The reduction of transmembraneous calcium influx into vascular smooth muscle cells by calcium antagonists leads to a reduction of tension development and vascular tone. Calcium antagonists reduce forearm vascular resistance dose dependently and this effect can be successfully utilized for the treatment of essential hypertension where they act by reducing increased peripheral vascular resistance thereby normalizing the main haemodynamic derangement of hypertensive patients. In contrast to other direct acting vasodilators the antihypertensive effect is not accompanied by sympathetic reflex activation or volume retention making it feasible to use calcium antagonists as monotherapy for hypertensive patients. In view of the well documented efficacy, tolerability and an excellent safety profile calcium antagonists have become drugs of choice for treatment of hypertension in many patients. Although all calcium antagonists have been shown to lower blood pressure they differ with respect to their vasodilating potency and their negative inotropic effects. The development of dihydropyridine calcium antagonists which are potent arterial vasodilators but have little if any negative inotropic effects at clinically used dosages further improves the safety profile of calcium antagonists, particularly when used in hypertensive patients with impaired left ventricular function.
钙拮抗剂减少跨膜钙流入血管平滑肌细胞，从而导致张力发展和血管紧张度降低。钙拮抗剂可剂量依赖性地降低前臂血管阻力，这种作用可成功用于治疗原发性高血压，它们通过降低外周血管阻力增加来发挥作用，从而使高血压患者的主要血流动力学紊乱恢复正常。与其他直接作用的血管扩张剂不同，钙拮抗剂的降压作用不会伴有交感神经反射激活或容量潴留，这使得钙拮抗剂作为高血压患者的单一疗法成为可能。鉴于钙拮抗剂有充分记录的疗效、耐受性和出色的安全性，它们已成为许多患者治疗高血压的首选药物。虽然所有钙拮抗剂都已被证明能降低血压，但它们在血管扩张效力和负性肌力作用方面存在差异。二氢吡啶类钙拮抗剂的开发，这类药物是强效动脉血管扩张剂，但在临床使用剂量下几乎没有负性肌力作用，进一步改善了钙拮抗剂的安全性，特别是用于左心室功能受损的高血压患者时。
