a Department of Cardiovascular Medicine , Toho University Faculty of Medicine , Tokyo , Japan.
Clin Exp Hypertens. 2017;39(4):350-354. doi: 10.1080/10641963.2016.1267198. Epub 2017 May 17.
The optimal therapy in patients with heart failure preserved ejection fraction (HFpEF) and hypertension (HT) has not been revealed. The beta blocker (BB) and the renin angiotensin aldosterone system inhibitor (RAAS-I) are recommend as class IIa in patients with HFpEF. The calcium channel blocker (CCB), a major anti-hypertensive drugs in Japan, is also recommend as class IIa in patients with HFpEF. However, the difference between azelnidipine, an L type CCB, and cilnidipine, an N type CCB, is unclear. We investigated the difference between azelnidipine and cilnidipine in patients with HFpEF and HT.
Twenty-five consecutive HFpEF patients treated with BB and RAAS-I from April 2013 to March 2015 were enrolled. Initially, cilnidipine was used, and then switched to azelnidipine. Age, gender, blood pressure (BP), heart rate (HR), blood tests, echocardiography, and cardiac-scintigraphy (I-metaiodobenzylguanidine: MIBG) were measured before and after six months from azelnidipine administration.
There was no statistically significant difference in BP. B type natriuretic peptides were significantly reduced (pre-state: 195.4 ± 209.7 pg/ml and post-state: 140.7 ± 136.4 pg/ml, p = 0.050). In echocardiography, the TEI index tended to be decreased (pre-state: 0.47 ± 0.15 and post-state: 0.42 ± 0.08, p = 0.057). As for MIBG, there was no significant change in the heart/mediastinum ratio. However, the washout rate was significantly reduced (pre-state: 44.7 ± 12.2 and post-state: 40.7 ± 12.1, p = 0.011). In addition, there was no statistically significant change, although HR tended to decrease by switching to azelnidipine (pre-state: 62.7 ± 11.6 and post-state: 61.8 ± 16.5, p = 0.373).
In patients with HT and HFpEF, azelnidipine improved the severity of HF and cardiac sympathetic nerve activity compared with cilnidipine.
射血分数保留的心力衰竭（HFpEF）合并高血压（HT）患者的最佳治疗方法尚未明确。β受体阻滞剂（BB）和肾素-血管紧张素-醛固酮系统抑制剂（RAAS-I）被推荐为 HFpEF 患者的 IIa 类药物。钙通道阻滞剂（CCB），一种日本主要的抗高血压药物，也被推荐为 HFpEF 患者的 IIa 类药物。然而，L 型 CCB 中的氨氯地平与 N 型 CCB 中的西尼地平之间的差异尚不清楚。我们研究了 HFpEF 和 HT 患者中西尼地平和氨氯地平之间的差异。
2013 年 4 月至 2015 年 3 月期间，连续入选 25 例接受 BB 和 RAAS-I 治疗的 HFpEF 患者。最初使用西尼地平，然后换用氨氯地平。在开始使用氨氯地平前和 6 个月后，测量年龄、性别、血压（BP）、心率（HR）、血液检查、超声心动图和心脏闪烁照相术（I-间碘苄胍：MIBG）。
BP 无统计学差异。B 型利钠肽显著降低（治疗前：195.4±209.7 pg/ml 和治疗后：140.7±136.4 pg/ml，p=0.050）。在超声心动图中，TEI 指数有下降趋势（治疗前：0.47±0.15 和治疗后：0.42±0.08，p=0.057）。对于 MIBG，心脏/纵隔比值无明显变化。然而，洗脱率明显降低（治疗前：44.7±12.2 和治疗后：40.7±12.1，p=0.011）。另外，虽然切换到氨氯地平后 HR 有下降趋势，但无统计学差异（治疗前：62.7±11.6 和治疗后：61.8±16.5，p=0.373）。
在 HT 和 HFpEF 患者中，与西尼地平相比，氨氯地平改善了 HF 的严重程度和心脏交感神经活性。
