Gottlieb S O, Ouyang P, Achuff S C, Baughman K L, Traill T A, Mellits E D, Weisfeldt M L, Gerstenblith G
J Am Coll Cardiol. 1984 Aug;4(2):382-8. doi: 10.1016/s0735-1097(84)80230-2.
Reports of acute ischemic events after withdrawal of calcium antagonist therapy in outpatients and during bypass surgery in patients with prior angina at rest prompted the examination of the effect of nifedipine withdrawal in 81 patients who had completed a prospective, double-blind randomized trial of nifedipine versus placebo for rest angina. Thirty-nine patients underwent bypass surgery for uncontrolled angina or left main coronary artery disease. No significant difference between patients withdrawn from nifedipine or placebo was seen in the incidence of perioperative myocardial infarction, hypotension requiring intraaortic balloon counterpulsation, vasopressor or vasodilator requirements or incidence of significant arrhythmias. An additional 42 patients had completed 2 years on a protocol consisting of nitrates and propranolol in addition to nifedipine or placebo. During a mean of 66 hours of continuous monitoring after withdrawal of nifedipine or placebo, heart rate and blood pressure were unchanged. A worsening of previously present angina at rest occurred in five patients who had continued to experience rest angina before drug withdrawal, four of whom were withdrawn from nifedipine. No patient with class I to III angina experienced new onset of rest angina during drug withdrawal. No patient experienced myocardial infarction. There was no significant difference between patients withdrawn from nifedipine or placebo in the duration or frequency of ischemic ST changes on continuous electrocardiographic monitoring, or in duration or positive results of serial exercise treadmill testing. Thus, no early adverse effects of acute nifedipine withdrawal were found in patients with prior rest angina at the time of bypass surgery or in stable patients receiving long-term medical therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
门诊患者停用钙拮抗剂治疗后以及既往有静息性心绞痛的患者在搭桥手术期间出现急性缺血事件的报告，促使对81例患者进行硝苯地平撤药效果的研究，这些患者完成了一项硝苯地平与安慰剂治疗静息性心绞痛的前瞻性、双盲随机试验。39例患者因无法控制的心绞痛或左主干冠状动脉疾病接受搭桥手术。在围手术期心肌梗死发生率、需要主动脉内球囊反搏的低血压、血管升压药或血管扩张剂的使用需求或严重心律失常发生率方面，停用硝苯地平或安慰剂的患者之间未见显著差异。另外42例患者除硝苯地平或安慰剂外，还按照由硝酸盐和普萘洛尔组成的方案完成了2年治疗。在停用硝苯地平或安慰剂后的平均66小时连续监测期间，心率和血压未发生变化。5例在撤药前仍有静息性心绞痛的患者，其先前存在的静息性心绞痛病情恶化，其中4例停用了硝苯地平。I至III级心绞痛患者在撤药期间均未出现新的静息性心绞痛发作。无患者发生心肌梗死。在连续心电图监测中，停用硝苯地平或安慰剂的患者在缺血性ST段改变的持续时间或频率方面，或在连续运动平板试验的持续时间或阳性结果方面，均无显著差异。因此，在搭桥手术时既往有静息性心绞痛的患者或接受长期药物治疗的稳定患者中，未发现急性停用硝苯地平有早期不良反应。（摘要截短于250字）
