Massie B M, Tubau J F, Szlachcic J, Vollmer C
Am J Cardiol. 1986 Sep 30;58(8):16D-19D. doi: 10.1016/0002-9149(86)90418-2.
Calcium channel blockers are highly effective antihypertensive agents and provide a good alternative to other medications used as initial or monotherapy. Although the calcium channel blockers act as peripheral vasodilators, they are unique among this group of drugs in lowering blood pressure in a sustained manner; several compensatory mechanisms are inhibited by virtue of either direct or indirect effects of these agents. In recent years, hypertension has generally been treated with a step-care approach, the limitations of which are now becoming apparent. Today, 4 classes of agents are effective and well tolerated as single therapy and might therefore be considered as first-line drug therapy: diuretics, beta blockers, converting enzyme inhibitors and calcium channel blockers. Preliminary results from an ongoing double-blind randomized trial comparing nitrendipine (a calcium channel blocker) and hydrochlorothiazide (a diuretic) in mild to moderate hypertension will be presented. Results from 63 patients showed the 2 agents to be equivalent in antihypertensive effects and in frequency of adverse reactions. Other data indicate that when nitrendipine and hydrochlorothiazide were combined, a further decrease in blood pressure was observed. Patient characteristics affecting drug choice and clinical situations in which calcium channel blockers can be used most effectively can now often be delineated.
钙通道阻滞剂是非常有效的抗高血压药物，是用作初始治疗或单一疗法的其他药物的良好替代品。尽管钙通道阻滞剂作为外周血管扩张剂起作用，但它们在这组药物中独特之处在于能持续降低血压；这些药物的直接或间接作用抑制了几种代偿机制。近年来，高血压一般采用阶梯式治疗方法，其局限性现在正变得明显。如今，有4类药物作为单一疗法有效且耐受性良好，因此可被视为一线药物治疗：利尿剂、β受体阻滞剂、转换酶抑制剂和钙通道阻滞剂。将展示一项正在进行的双盲随机试验的初步结果，该试验比较了尼群地平（一种钙通道阻滞剂）和氢氯噻嗪（一种利尿剂）治疗轻至中度高血压的效果。63例患者的结果显示，这两种药物在降压效果和不良反应发生率方面相当。其他数据表明，当尼群地平和氢氯噻嗪联合使用时，血压进一步降低。现在通常可以确定影响药物选择的患者特征以及能最有效地使用钙通道阻滞剂的临床情况。
