Lacourcière Y, Poirier L, Boucher S, Spenard J
Hypertension Research Unit, Le Centre Hospitalier de l'Université Laval, Ste-Foy, Québec, Canada.
Clin Pharmacol Ther. 1990 Sep;48(3):318-24. doi: 10.1038/clpt.1990.155.
We compared the effects of diltiazem sustained-release formulation and metoprolol on diurnal ambulatory blood pressure (BP) and plasma lipoprotein levels. Forty-nine patients with primary hypertension were included in a randomized, double-blind, crossover study, and 44 completed the trial. Both diltiazem and metoprolol significantly lowered office (p less than 0.001) and diurnal ambulatory BP (p less than 0.01). After 16 weeks of therapy with diltiazem, mean ambulatory BP decreased 10/7 mm Hg, whereas metoprolol lowered BP by 16/10 mm Hg (p less than 0.001 for systolic BP and p less than 0.01 for diastolic BP). Moreover, metoprolol seemed to induce a greater reduction in morning BP at work. Although diltiazem had no effect on lipid levels, treatment with metoprolol was associated with a significant rise in triglyceride levels (p less than 0.001 vs baseline and diltiazem), total cholesterol levels (p less than 0.05 vs baseline), atherogenic index (p less than 0.05 vs baseline and diltiazem) and very low-density lipoprotein and cholesterol levels (p less than 0.001 vs baseline and diltiazem) and a significant decrease in high-density lipoprotein cholesterol levels (p less than 0.01 vs baseline and p less than 0.001 vs diltiazem). These data suggest that both diltiazem and metoprolol provide adequate office BP control. The deleterious effects of metoprolol on lipid and lipoprotein levels may counterbalance its beneficial effects on reduction of ambulatory BP.
我们比较了地尔硫䓬缓释制剂和美托洛尔对日间动态血压（BP）及血浆脂蛋白水平的影响。49例原发性高血压患者纳入一项随机、双盲、交叉研究，44例完成试验。地尔硫䓬和美托洛尔均显著降低诊室血压（p<0.001）和日间动态血压（p<0.01）。地尔硫䓬治疗16周后，平均动态血压下降10/7 mmHg，而美托洛尔使血压下降16/10 mmHg（收缩压p<0.001，舒张压p<0.01）。此外，美托洛尔似乎能使工作时的晨起血压有更大降幅。虽然地尔硫䓬对血脂水平无影响，但美托洛尔治疗与甘油三酯水平显著升高（与基线和地尔硫䓬相比，p<0.001）、总胆固醇水平升高（与基线相比，p<0.05）、致动脉粥样硬化指数升高（与基线和地尔硫䓬相比，p<0.05）以及极低密度脂蛋白和胆固醇水平升高（与基线和地尔硫䓬相比，p<0.001）和高密度脂蛋白胆固醇水平显著降低（与基线相比，p<0.01；与地尔硫䓬相比，p<0.001）有关。这些数据表明，地尔硫䓬和美托洛尔均可有效控制诊室血压。美托洛尔对血脂和脂蛋白水平的有害影响可能会抵消其在降低动态血压方面的有益作用。
