Toshima H, Koga Y, Nagata H, Toyomasu K, Itaya K, Matoba T
Jpn Heart J. 1986 Sep;27(5):701-15. doi: 10.1536/ihj.27.701.
The effects of oral diltiazem, 180 mg/day, were compared with those of oral verapamil, 240 mg/day, in 32 patients with hypertrophic cardiomyopathy (HCM), using a double-blind crossover study design. In the first treatment period, diltiazem and verapamil improved subjective complaints in 83% and 71% of those who were symptomatic in the baseline period. Maximal oxygen consumption on exercise stress test increased with verapamil by 2.9 +/- 4.2 ml/Kg/min (p less than 0.05), and tended to increase with diltiazem. Verapamil also reduced the amplitude of negative T wave. In the statistical analysis based on the crossover design, diltiazem and verapamil did not differ in global improvement, overall safety and global utility ratings. In addition, both drugs showed comparable effects on electrocardiographic and echocardiographic variables and exercise tolerance except for minor differences in diastolic blood pressure, T wave amplitude and peak exercise heart rate. On the other hand, verapamil tended to induce more serious side effects, forcing the discontinuation of medication in 3 patients. Therefore, the present study indicates that diltiazem is essentially equally as effective as verapamil and is preferable in the treatment of patients with HCM since it may exhibit fewer serious side effects.
采用双盲交叉研究设计，对32例肥厚型心肌病（HCM）患者比较了口服地尔硫䓬（180毫克/天）与口服维拉帕米（240毫克/天）的疗效。在第一个治疗期，地尔硫䓬和维拉帕米使基线期有症状患者中83%和71%的主观症状得到改善。运动应激试验中的最大耗氧量，维拉帕米使其增加了2.9±4.2毫升/千克/分钟（p<0.05），地尔硫䓬使其有增加趋势。维拉帕米还降低了负向T波的幅度。在基于交叉设计的统计分析中，地尔硫䓬和维拉帕米在总体改善、总体安全性和总体效用评分方面无差异。此外，除舒张压、T波幅度和运动高峰心率存在微小差异外，两种药物对心电图和超声心动图变量及运动耐量的影响相当。另一方面，维拉帕米倾向于引发更严重的副作用，致使3例患者停药。因此，本研究表明地尔硫䓬在疗效上基本与维拉帕米相当，且在治疗HCM患者时更可取，因为它可能出现的严重副作用较少。
