Lund-Johansen P
Am J Med. 1985 Oct 11;79(4A):11-8. doi: 10.1016/0002-9343(85)90495-4.
The main hemodynamic disturbance occurring in patients with essential hypertension is an increase in the total peripheral resistance. In young patients with hypertension, this disturbance is clearly seen during muscular exercise, even though the calculated resistance might be normal during rest. This article reports results of studies on the long-term hemodynamic effects of two calcium channel blockers, verapamil and nifedipine, in patients with mild to moderate hypertension. Twenty-five men, aged 20 to 64 years, with diastolic blood pressures between 100 and 120 mm Hg before treatment were studied at rest and during exercise on ergometer bicycles. Blood pressure was recorded intra-arterially, and cardiac output was measured. After this initial study, 10 patients were treated with verapamil (from 40 to 80 mg, three times daily) and 15 patients with nifedipine (long-acting form, from 40 to 80 mg daily). After one year, the hemodynamic study was repeated. Both drugs induced a reduction in blood pressure and in the total peripheral resistance without any reduction in the cardiac index. Verapamil reduced heart rate, particularly during exercise, but this effect was compensated by an increase in the stroke volume. The hemodynamic profile of these two calcium channel blockers clearly differs from the hemodynamic effects of beta blockers.
原发性高血压患者出现的主要血流动力学紊乱是总外周阻力增加。在年轻高血压患者中，即使静息时计算出的阻力可能正常，但在肌肉运动期间这种紊乱也很明显。本文报道了两项关于两种钙通道阻滞剂维拉帕米和硝苯地平对轻至中度高血压患者长期血流动力学影响的研究结果。研究对象为25名年龄在20至64岁之间、治疗前舒张压在100至120毫米汞柱之间的男性，在静息状态和进行功率自行车运动时接受研究。通过动脉内记录血压，并测量心输出量。在这项初始研究之后，10名患者接受维拉帕米治疗（40至80毫克，每日三次），15名患者接受硝苯地平治疗（长效制剂，每日40至80毫克）。一年后，重复进行血流动力学研究。两种药物均使血压和总外周阻力降低，而心指数无任何降低。维拉帕米降低心率，尤其是在运动期间，但这种作用被每搏输出量的增加所代偿。这两种钙通道阻滞剂的血流动力学特征明显不同于β受体阻滞剂的血流动力学效应。
