Guazzi M D, Polese A, Fiorentini C, Bartorelli A, Moruzzi P
Hypertension. 1983 Jul-Aug;5(4 Pt 2):II85-90. doi: 10.1161/01.hyp.5.4_pt_2.ii85.
Calcium channel blockers have a selective action on the cardiovascular system. They reduce the energy requirement of the heart, reduce vascular smooth muscle tone, and increase systemic blood flow. Vasodilatation occurs in both the systemic and the pulmonary systems to an extent proportional to the baseline level of vascular resistance, and results in reduction of blood pressure when it is elevated. Thus, these blockers are useful in patients with high blood pressure. Clinical experience of calcium channel blockers in hypertension is so far confined almost exclusively to verapamil and nifedipine. This article reviews the advantages and limitations of these two compounds, their acute hemodynamic effects in hypertensive subjects, and their use in the treatment of hypertensive emergencies, hypertensive encephalopathy, and pheochromocytoma, and as ventricular afterload reducing agents in hypertensive left ventricular failure. Similarities in the effects of nifedipine on systemic and pulmonary vascular tone are presented as evidence that altered intracellular Ca++ concentration is involved in the vasoconstriction seen in both systems in systemic high blood pressure. They also provide support for the hypothesis that inappropriate Ca++ handling may be involved in maintaining elevated blood pressure in human hypertension.
钙通道阻滞剂对心血管系统有选择性作用。它们降低心脏的能量需求，降低血管平滑肌张力，并增加全身血流量。全身和肺部系统都会发生血管舒张，其程度与血管阻力的基线水平成正比，当血压升高时会导致血压降低。因此，这些阻滞剂对高血压患者有用。迄今为止，钙通道阻滞剂在高血压方面的临床经验几乎完全局限于维拉帕米和硝苯地平。本文综述了这两种化合物的优缺点、它们在高血压患者中的急性血流动力学效应，以及它们在治疗高血压急症、高血压脑病和嗜铬细胞瘤中的应用，以及作为高血压左心室衰竭中降低心室后负荷的药物的应用。硝苯地平对全身和肺血管张力影响的相似性被作为证据提出，表明细胞内Ca++浓度的改变参与了全身性高血压时两个系统中所见的血管收缩。它们还为以下假设提供了支持，即不适当的Ca++处理可能参与维持人类高血压中的血压升高。
