Bruun N E, Ibsen H, Nielsen F, Nielsen M D, Mølbak A G, Hartling O J
Medical Department C, Glostrup Hospital, Denmark.
J Hypertens Suppl. 1985 Dec;3(3):S223-5.
The influence of nifedipine treatment on plasma (PV) and extracellular fluid volume (ECV), the ratio of plasma volume to interstitial fluid volume (PV:IF), glomerular filtration rate (GFR), renal clearances of Na+ and K+, plasma concentrations of renin (PRC), angiotensin II (pANG II), aldosterone (pAldo), adrenaline (PA) and noradrenaline (PNA) were studied in 18 consecutive patients with essential hypertension. A 4-week placebo period was followed by a 6-week dose-titration period (period A). Thereafter the dose was kept constant for an additional 6 weeks (period B), the mean dose being 51 mg/day. As compared with placebo, diastolic blood pressure (DBP) decreased from 105 +/- 7 to 93 +/- 9 mmHg at the end of period B. Extracellular fluid volume, PV, and PV:IF were not significantly changed at the end of period A or B, neither in the group as a whole nor in a subgroup, who developed pedal oedema. After 2 weeks on nifedipine, PA as well as PNA increased slightly but returned to control values after 6 weeks of therapy. Plasma renin concentration, pANG II, pAldo and GFR did not change significantly. Renal sodium handling was also unchanged. It is concluded that long-term nifedipine therapy (exceeding 6 weeks) does not lead to activation of counter-regulatory mechanisms such as fluid retention, activation of the renin-angiotensin system and the adrenergic system. Renal function is unaffected by nifedipine.
对18例连续性原发性高血压患者研究了硝苯地平治疗对血浆容量（PV）、细胞外液容量（ECV）、血浆容量与组织间液容量之比（PV:IF）、肾小球滤过率（GFR）、钠和钾的肾清除率、血浆肾素浓度（PRC）、血管紧张素II（pANG II）、醛固酮（pAldo）、肾上腺素（PA）和去甲肾上腺素（PNA）的影响。先有4周的安慰剂期，随后是6周的剂量滴定期（A期）。此后剂量保持恒定再持续6周（B期），平均剂量为51毫克/天。与安慰剂相比，在B期末舒张压（DBP）从105±7降至93±9 mmHg。在A期或B期末，细胞外液容量、PV和PV:IF均无显著变化，无论是整个组还是出现足踝水肿的亚组均如此。服用硝苯地平2周后，PA以及PNA略有升高，但治疗6周后恢复至对照值。血浆肾素浓度、pANG II、pAldo和GFR无显著变化。肾脏对钠的处理也未改变。结论是，长期硝苯地平治疗（超过6周）不会导致诸如液体潴留、肾素-血管紧张素系统和肾上腺素能系统激活等反调节机制的激活。硝苯地平不影响肾功能。
