Kailasam M T, Parmer R J, Cervenka J H, Wu R A, Ziegler M G, Kennedy B P, Adegbile I A, O'Connor D T
Department of Medicine, University of California, San Diego 92161, USA.
Hypertension. 1995 Jul;26(1):143-9. doi: 10.1161/01.hyp.26.1.143.
Calcium channel antagonists differ by class in reported frequency of side effects that suggest reflex sympathoadrenal activation. Do such differences result from differential effects on autonomic and baroreflex function? The present study compared acute and chronic effects of two classes of calcium channel antagonists, the dihydropyridine type (felodipine) and the phenylalkylamine type (verapamil), on efferent sympathetic outflow and baroreflex slope in 15 essential hypertensive subjects. Blood pressure, heart rate, hemodynamics, and biochemistries were determined at baseline and after acute (first dose) and chronic (4 weeks) administration of the drugs versus placebo. Acutely, felodipine caused a greater decrease in blood pressure associated with a larger decline in systemic vascular resistance than the corresponding effects produced by verapamil. Chronically, there were similar, significant declines in blood pressure (P = .001) and systemic vascular resistance (P = .001) after each drug. Acutely, increased sympathetic activity after felodipine was suggested by reflex tachycardia (from 69 +/- 3 to 74 +/- 2 beats per minute, P = .014) and elevation of plasma norepinephrine (from 264 +/- 25 to 323 +/- 25 pg/mL, P = .037), whereas after verapamil the corresponding changes were closely similar to those after placebo.(ABSTRACT TRUNCATED AT 250 WORDS)
钙通道拮抗剂在提示反射性交感神经肾上腺激活的副作用报告频率上因类别而异。这些差异是由对自主神经和压力反射功能的不同影响导致的吗？本研究比较了两类钙通道拮抗剂，即二氢吡啶类（非洛地平）和苯烷基胺类（维拉帕米）对15名原发性高血压患者传出交感神经流出和压力反射斜率的急性和慢性影响。在基线以及药物与安慰剂的急性（首剂）和慢性（4周）给药后，测定血压、心率、血流动力学和生化指标。急性给药时，与维拉帕米产生的相应效应相比，非洛地平导致血压下降幅度更大，同时全身血管阻力下降幅度也更大。慢性给药时，每种药物给药后血压（P = .001）和全身血管阻力（P = .001）均出现相似且显著的下降。急性给药时，非洛地平给药后反射性心动过速（从69±3次/分钟增至74±2次/分钟，P = .014）和血浆去甲肾上腺素升高（从264±25 pg/mL增至323±25 pg/mL，P = .037）提示交感神经活动增加，而维拉帕米给药后的相应变化与安慰剂给药后非常相似。（摘要截断于250字）
