Department of Cardiology, Wuhan No.4 Hospital, Wuhan, China.
J Physiol Pharmacol. 2021 Aug;72(4). doi: 10.26402/jpp.2021.4.07. Epub 2021 Dec 31.
The present study aimed to investigate the effect of diltiazem on cardiovascular risk and exercise tolerance in patients with stable coronary artery disease and hypertension. From 2016 to 2018, 80 patients with stable coronary artery disease (5 < Gensini score < 20) and hypertension were enrolled into the present study. These patients were randomly divided into two groups: diltiazem group (Dil, 90 mg, bid), and control group (angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARB) for reducing blood pressure and β-receptor blockers for controlling heart rate). Liver and kidney function, heart rate variability (HRV), blood pressure variability (BPV) and bicycle exercise were measured at baseline and after six months. The incidence of cardiovascular events (re-hospitalization due to angina pectoris, acute myocardial infarction, and cardiogenic death) was also assessed. The differences in all indexes at baseline between these two groups were not statistically significant (P > 0.05, respectively). After six months of treatment, both groups of patients had significant improvements in HRV, BPV and exercise tolerance compared that before treatment (p < 0.05). The difference in the decrease in systolic blood pressure, improvement of HRV and BPV, and cardiovascular events between these two groups was not statistically significant (P = 0.588, 0.431, 0.152, 1.000, respectively). But the Dil group was significantly better than the control group in degree of heart rate decline, diastolic blood pressure decline, and improvement of ST segment depression (P < 0.001), and the improvement in exercise tolerance was also better than that of the control group. We found that diltiazem compared with ACEI/ARB and β-receptor blockers can further improve the exercise tolerance of patients with stable coronary artery disease and hypertension.
本研究旨在探讨地尔硫䓬对稳定性冠心病合并高血压患者心血管风险和运动耐量的影响。2016 年至 2018 年，共纳入 80 例稳定性冠心病（Gensini 评分 5＜评分＜20）合并高血压患者。将这些患者随机分为两组：地尔硫䓬组（Dil，90mg，bid）和对照组（血管紧张素转换酶抑制剂（ACEI）/血管紧张素Ⅱ受体阻滞剂（ARB）降压，β受体阻滞剂控制心率）。分别于基线和 6 个月时测量肝肾功能、心率变异性（HRV）、血压变异性（BPV）和踏车运动。还评估了心血管事件（因心绞痛、急性心肌梗死和心源性死亡而再住院）的发生率。两组患者在基线时的所有指标差异均无统计学意义（分别为 P＞0.05）。治疗 6 个月后，两组患者的 HRV、BPV 和运动耐量均较治疗前显著改善（均 P＜0.05）。两组间收缩压降低、HRV 和 BPV 改善及心血管事件发生率的差异均无统计学意义（分别为 P=0.588、0.431、0.152、1.000）。但与对照组相比，Dil 组心率下降程度、舒张压下降程度和 ST 段压低改善程度明显更好（均 P＜0.001），运动耐量改善也优于对照组。结果表明，与 ACEI/ARB 和β受体阻滞剂相比，地尔硫䓬可进一步提高稳定性冠心病合并高血压患者的运动耐量。
