Vanhaleweyk G L, Serruys P W, Hugenholtz P G
Eur Heart J. 1983 Jul;4 Suppl D:117-28. doi: 10.1093/eurheartj/4.suppl_d.117.
Nitrates and beta-blockers have been the mainstay in the therapy of chronic stable angina pectoris for many years. Since an important number of patients remains symptomatic, new potent anti-ischemic agents like the calcium antagonists fulfil a great clinical need. Combined therapy with beta-blockers and calcium antagonists is attractive, since both classes of drugs have differing and eventually complementary modes of action. On the other hand, both have direct negative inotropic and chronotropic effects. We reviewed the anti-anginal, electrophysiologic and hemodynamic effects of combined treatment with a beta-blocker and verapamil or nifedipine. Combined therapy provides greater symptomatic relief than monotherapy with beta-blockers or slow channel blockers alone. While incidental adverse negative inotropic and chronotropic interactions have been reported, particularly when verapamil is involved, their hemodynamic interplay appears beneficial rather than detrimental in the majority of patients. Indeed, combined therapy is effective and safe, at least when a preserved or only moderately impaired left ventricular function is present. However, caution must be exercised in patients with more impaired left ventricular function, and combined therapy with verapamil must be avoided when conduction disturbances are likely to occur.
多年来，硝酸盐类药物和β受体阻滞剂一直是治疗慢性稳定型心绞痛的主要药物。由于仍有相当数量的患者存在症状，因此像钙拮抗剂这样的新型强效抗缺血药物满足了巨大的临床需求。β受体阻滞剂与钙拮抗剂联合治疗很有吸引力，因为这两类药物具有不同且最终互补的作用方式。另一方面，两者都有直接的负性肌力和负性变时作用。我们回顾了β受体阻滞剂与维拉帕米或硝苯地平联合治疗的抗心绞痛、电生理和血流动力学效应。联合治疗比单独使用β受体阻滞剂或慢通道阻滞剂的单一疗法能提供更大程度的症状缓解。虽然已报告偶尔会出现不良的负性肌力和负性变时相互作用，尤其是涉及维拉帕米时，但在大多数患者中，它们的血流动力学相互作用似乎是有益而非有害的。事实上，联合治疗是有效且安全的，至少在左心室功能正常或仅轻度受损时是这样。然而，对于左心室功能受损更严重的患者必须谨慎，并且当可能发生传导障碍时，必须避免与维拉帕米联合治疗。
