Byyny R L, LoVerde M, Mitchell W
Division of Internal Medicine, University of Colorado, Denver.
Am J Med. 1989 Jan;86(1):49-55. doi: 10.1016/0002-9343(89)90229-5.
Treatment of hypertension in the elderly decreases cardiovascular morbidity and mortality. We hypothesized that nitrendipine would be efficacious in the treatment of hypertension in the elderly. We evaluated potential differences between nitrendipine and the commonly used drug hydrochlorothiazide (HCTZ).
The study was conducted as a double-blind randomized clinical trial of nitrendipine or HCTZ. Thirty hypertensive subjects over age 60 with a median sitting blood pressure greater than or equal to 95 mm of Hg were recruited into the study. A diastolic blood pressure with treatment of less than 95 mm Hg with a 5 mm Hg or greater decrease from baseline was considered a successful response.
Nitrendipine decreased mean (+/- SEM) blood pressure from 163 +/- 3/102 +/- 1 to 142 +/- 2/89 +/- 2 mm Hg, and HCTZ decreased it from 164 +/- 4/102 +/- 1 to 143 +/- 5/91 +/- 2 mm Hg. A greater proportion of patients had a successful response with nitrendipine (81 percent) than with HCTZ (64 percent). The antihypertensive effect of nitrendipine twice daily appeared to be sustained for 24 hours. Blood pressure response to exercise was attenuated with both drugs. HCTZ caused gout, leg pains, muscle aches, hypokalemia, increased uric acid levels, and increased total cholesterol and triglyceride levels. Nitrendipine caused edema and tachycardia.
Nitrendipine significantly reduces blood pressure with few side effects and no adverse metabolic effects, and offers a reasonable alternative for treating hypertension in the elderly.
治疗老年人高血压可降低心血管疾病的发病率和死亡率。我们假设尼群地平对治疗老年人高血压有效。我们评估了尼群地平和常用药物氢氯噻嗪（HCTZ）之间的潜在差异。
该研究作为一项关于尼群地平或HCTZ的双盲随机临床试验进行。招募了30名年龄超过60岁、坐位血压中位数大于或等于95毫米汞柱的高血压患者进入研究。治疗后舒张压低于95毫米汞柱且较基线下降5毫米汞柱或更多被视为成功反应。
尼群地平使平均（±标准误）血压从163±3/102±1降至142±2/89±2毫米汞柱，氢氯噻嗪使其从164±4/102±1降至143±5/91±2毫米汞柱。尼群地平治疗取得成功反应的患者比例（81%）高于氢氯噻嗪（64%）。尼群地平每日两次的降压作用似乎可持续24小时。两种药物均可减弱运动对血压的反应。氢氯噻嗪导致痛风、腿痛、肌肉疼痛、低钾血症、尿酸水平升高以及总胆固醇和甘油三酯水平升高。尼群地平导致水肿和心动过速。
尼群地平能显著降低血压，副作用少且无不良代谢影响，为治疗老年人高血压提供了合理的替代选择。
