Shehab Abdulla, Bhagavathula Akshaya Srikanth, Kaes Al Anee, Ragy Hany, Gupta Rajeev, El Mansour Ibrahim Mahmoud, Said Elkeshk Eman Eman
Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE.
Consultant Cardiologist, Mediclinic Al Ain Hospital, Al Ain, UAE.
Heart Views. 2020 Apr-Jun;21(2):75-79. doi: 10.4103/HEARTVIEWS.HEARTVIEWS_114_19. Epub 2020 Jun 29.
In patients undergoing coronary intervention, different vasodilators are used to prevent the radial artery spasm (RAS). To date, no studies investigated the effect of these vasodilators in blood pressure (BP) reduction.
The study aimed to investigate and compare the effect of vasodilatory medications on BP reduction in patients undergoing transradial coronary angiography procedure.
We consecutively included 300 patients undergoing transradial coronary angiography procedures and randomly assigned them into three equal groups to compare the effect of verapamil (2.5 mg), nitroglycerin (200 μg), and combination (verapamil 2.5 mg with nitroglycerin 200 (μg) was diluted in 5 ml of normal saline and given through radial sheath. Changes in the BP, heart rate (HR), and other clinical parameters were assessed and presented as standardized mean differences (SMD) with 95% confidence intervals (CIs). ANOVA test was performed to analyze the differences in the BP and other clinical parameters between the three groups.
Overall, the mean age of the study population was 53.26 years (standard deviation: 9.27), male patients (84%), with dyslipidemia (62.6%), and diabetes (45%). At baseline, the mean systolic BP (SBP) was 150.91 ± 31.66 mmHg, HR (72.34 ± 12.71 beats/min). After the administration of vasodilators, the combination group reduced SBP significantly (SMD: -33.35 [95% CI]: -40.27--26.42, < 0.001). There was a statistically significant difference between groups for the SBP ( [2,296] =3.38, = 0.035). Verapamil alone showed a significant decrease in the SBP by -27.23 mmHg and diastolic BP by -4.980 mmHg.
Intra-arterial administration of verapamil alone showed lower BP reduction compared to the combination of vasodilators. Verapamil could be a safer and effective alternative to prevent RAS with no deleterious effect on BP and HR in patients undergoing transradial coronary angiography.
在接受冠状动脉介入治疗的患者中，会使用不同的血管扩张剂来预防桡动脉痉挛（RAS）。迄今为止，尚无研究调查这些血管扩张剂对降低血压（BP）的效果。
本研究旨在调查和比较血管扩张药物对接受经桡动脉冠状动脉造影术患者降低血压的效果。
我们连续纳入300例接受经桡动脉冠状动脉造影术的患者，并将他们随机分为三组，以比较维拉帕米（2.5毫克）、硝酸甘油（200微克）以及联合用药（维拉帕米2.5毫克与硝酸甘油200微克）的效果，药物用5毫升生理盐水稀释后通过桡动脉鞘给药。评估血压（BP）、心率（HR）和其他临床参数的变化，并以标准化均数差（SMD）及95%置信区间（CI）表示。进行方差分析以分析三组之间血压和其他临床参数的差异。
总体而言，研究人群的平均年龄为53.26岁（标准差：9.27），男性患者占84%，患有血脂异常的占62.6%，患有糖尿病的占45%。基线时，平均收缩压（SBP）为150.91±31.66毫米汞柱，心率（HR）为72.34±12.71次/分钟。给予血管扩张剂后，联合用药组显著降低了收缩压（SMD：-33.35 [95% CI]：-40.27--26.42，P<0.001）。三组之间的收缩压存在统计学显著差异（F[2,296]=3.38，P = 0.035）。单独使用维拉帕米时，收缩压显著降低了27.23毫米汞柱，舒张压降低了4.980毫米汞柱。
与联合使用血管扩张剂相比，单独动脉内给予维拉帕米降低血压的幅度较小。在接受经桡动脉冠状动脉造影术的患者中，维拉帕米可能是预防RAS的一种更安全有效的替代药物，对血压和心率无有害影响。
