Polese A, Bartorelli A, De Cesare N, Fabbiocchi F, Loaldi A, Montorsi P, Guazzi M D
Istituto di Cardiologia, Centro Ricerche Cardiovascolari del Consiglio Nazionale delle Ricerche, Milan, Italy.
Eur Heart J. 1988 Dec;9 Suppl N:15-20. doi: 10.1093/eurheartj/9.suppl_n.15.
In 24 patients with spontaneous and effort-related angina (mixed angina), propranolol (80 mg q.i.d.) was significantly more beneficial than nifedipine (20 mg q.i.d.) on the number, duration and severity of the spontaneous manifestations. In some cases nifedipine elicited a paradoxical response. These patterns are unlikely to have resulted from different influences on the myocardial oxygen demands, since heart rate was steady before the occurrence of ischaemia and systemic arterial pressure was equally reduced in all patients. Sublingual nifedipine (10 mg) was tested in 12 patients and the residual lumen diameter of significant (greater than 50%) coronary stenoses (quantitative angiography) was unchanged in one, enhanced in seven and reduced in four of them. Lumen variations ranged from +1.59 to -1.2 mm and correlated closely with the results of oral nifedipine treatment. Propranolol (0.1 mg kg-1 i.v.) was tested in the other 12 cases and in none did variations of stenosis lumen diameter exceed 0.3 mm. These observations indicate that: in a number of lesions a portion of pliable wall may offer a compliant substrate for vasomotor influences; this may be the major factor whereby coronary obstructions cause spontaneous, besides effort-related angina; nifedipine is effective on the former manifestation provided that it does not promote stenosis constriction; propranolol may result in benefit through bradycardia facilitating coronary flow in diastole and reducing the baseline metabolic demands, to elevate the threshold of ischaemia during transient impedance to flow.
在24例自发性心绞痛和劳力性心绞痛（混合性心绞痛）患者中，普萘洛尔（80毫克，每日4次）在自发性症状的发作次数、持续时间和严重程度方面，比硝苯地平（20毫克，每日4次）显著更有益。在某些情况下，硝苯地平会引发矛盾反应。这些模式不太可能是由于对心肌需氧量的不同影响所致，因为在缺血发生前心率稳定，且所有患者的体动脉压均同等程度降低。对12例患者进行了舌下含服硝苯地平（10毫克）的测试，其中1例严重（大于50%）冠状动脉狭窄（定量血管造影）的残余管腔直径未变，7例增大，4例减小。管腔变化范围为+1.59至 -1.2毫米，与口服硝苯地平治疗的结果密切相关。在另外12例患者中测试了静脉注射普萘洛尔（0.1毫克/千克），无一例狭窄管腔直径变化超过0.3毫米。这些观察结果表明：在一些病变中，一部分柔韧的血管壁可能为血管舒缩影响提供顺应性底物；这可能是冠状动脉阻塞除导致劳力性心绞痛外还引起自发性心绞痛的主要因素；只要硝苯地平不促进狭窄收缩，它对前者的症状就有效；普萘洛尔可能通过使心率减慢促进舒张期冠状动脉血流并降低基础代谢需求，从而在短暂血流受阻期间提高缺血阈值而产生益处。
