Silke B, Verma S P, Hussain M, Jackson N C, Hafizullah M, Reynolds G, Taylor S H
Herz. 1985 Apr;10(2):112-9.
The haemodynamic relevance of the disparate electrophysiological and structural differences between agents blocking the slow-calcium channels in patients with exercise-induced angina pectoris is controversial. We therefore evaluated the effects of single intravenous and equivalent hypotensive doses of nicardipine (7.5 mg) or verapamil (16 mg) in a randomized single-blind study of 30 patients with angiographically documented coronary artery disease. The randomization process achieved comparable distribution of 15 patients with similar demographic data and cardiac function to each drug. Patients were evaluated at rest and during four minutes upright bicycle exercise at an individually titrated symptom-limited load in both control and post-drug assessments; the reproducibility of the haemodynamics during such tests has been previously demonstrated. Both nicardipine and verapamil induced similar reductions in systemic mean arterial blood pressure and vascular resistance; the reduction in afterload resulted in increased resting cardiac index and stroke volume index on each agent. The magnitude of the former increase was greater following nicardipine (p less than 0.05). The pulmonary artery occluded pressure (PAOP) increased following verapamil (p less than 0.01) without change following nicardipine. During dynamic exercise, neither drug improved cardiac stroke volume index, the PAOP was significantly higher following verapamil compared with nicardipine (p less than 0.05). Analysis of the cardiac performance curve demonstrated its significant depression following verapamil but not following nicardipine. Thus clear haemodynamic advantages were present, both at rest and during exercise-induced angina, for nicardipine; whether such haemodynamic effects will be reflected in symptomatic terms should be critically evaluated.
在运动诱发型心绞痛患者中，不同的慢钙通道阻滞剂在电生理和结构上存在差异，但其血流动力学相关性仍存在争议。因此，我们在一项随机单盲研究中，对30例经血管造影证实患有冠状动脉疾病的患者，评估了单次静脉注射等效降压剂量的尼卡地平（7.5毫克）或维拉帕米（16毫克）的效果。随机分组过程使15例具有相似人口统计学数据和心功能的患者，在每种药物组中的分布具有可比性。在对照和用药后评估中，患者均在静息状态下以及在直立自行车运动4分钟期间，以个体滴定的症状限制负荷进行评估；此前已证明此类测试中血流动力学的可重复性。尼卡地平和维拉帕米均引起相似程度的系统性平均动脉血压和血管阻力降低；后负荷的降低导致每种药物在静息时的心脏指数和每搏量指数增加。尼卡地平用药后前者增加幅度更大（p小于0.05）。维拉帕米用药后肺动脉闭塞压（PAOP）升高（p小于0.01），而尼卡地平用药后无变化。在动态运动期间，两种药物均未改善心脏每搏量指数，维拉帕米用药后的PAOP显著高于尼卡地平（p小于0.05）。心脏功能曲线分析表明，维拉帕米用药后曲线显著压低，而尼卡地平用药后无此现象。因此，无论是在静息状态还是运动诱发心绞痛期间，尼卡地平都具有明显的血流动力学优势；此类血流动力学效应是否会在症状方面得到体现，应进行严格评估。
