Iida Takeshi, Morimoto Satoshi, Amari Yoshifumi, Ando Takashi, Ichihara Atsuhiro
Department of Medicine II, Endocrinology and Hypertension, Tokyo Women's Medical University, Tokyo, Japan.
Department of Nephrology and Dialysis, Moriguchi Keijinkai Hospital, Osaka, Japan.
Kidney Blood Press Res. 2017;42(5):933-941. doi: 10.1159/000485083. Epub 2017 Nov 22.
BACKGROUND/AIMS: Hemodialysis patients have poor prognosis due to increased prevalence of cardiovascular diseases. Treatment to suppress increases in sympathetic nerve activity and QT prolongation may have the potential to reduce the occurrence of these events. The L/N-type Calcium (Ca) channel blocker cilnidipine has unique inhibitory action to inhibit sympathetic nerve activity and in a canine model ameliorates QT prolongation. In this study, we investigated whether cilnidipine has inhibitory effects on heart rate, an index of sympathetic nerve activity, and QT prolongation in patients undergoing dialysis.
An L-type Ca channel blocker amlodipine was administered for 4 weeks followed by cilnidipine treatment for 4 weeks. On the last day of each period, heart rate and corrected QT interval were estimated and compared between the two periods.
Cilnidipine showed greater suppression of heart rate during dialysis than did amlodipine. The corrected QT interval in one dialysis session was significantly increased, and 3 of 17 patients showed prominent QT prolongation during administration of amlodipine but not cilnidipine.
These data suggested that cilnidipine may inhibit increases in heart rate and QT interval. Cilnidipine may have beneficial effects in reducing cardiovascular events, resulting from increased sympathetic nerve activity and lethal arrhythmias in hemodialysis patients.
背景/目的：由于心血管疾病患病率增加，血液透析患者预后较差。抑制交感神经活动增加和QT间期延长的治疗可能有降低这些事件发生的潜力。L/N型钙（Ca）通道阻滞剂西尼地平具有抑制交感神经活动的独特作用，并且在犬模型中可改善QT间期延长。在本研究中，我们调查了西尼地平对透析患者的心率（交感神经活动指标）和QT间期延长是否有抑制作用。
先给予L型钙通道阻滞剂氨氯地平4周，随后给予西尼地平治疗4周。在每个阶段的最后一天，估计心率和校正QT间期，并比较两个阶段的情况。
与氨氯地平相比，西尼地平在透析期间对心率的抑制作用更强。一次透析过程中的校正QT间期显著增加，在服用氨氯地平期间，17例患者中有3例出现明显的QT间期延长，但服用西尼地平时未出现。
这些数据表明，西尼地平可能抑制心率和QT间期增加。西尼地平可能对减少血液透析患者因交感神经活动增加和致命性心律失常导致的心血管事件具有有益作用。
