Gradman A H
Division of Cardiovascular Disease, Western Pennsylvania Hospital, Pittsburgh 15224, USA.
Can J Cardiol. 1995 Apr;11 Suppl B:14B-21B.
Calcium channel blockers are used extensively in the treatment of the three major anginal syndromes. In the treatment of Prinzmetal's angina, their antivasospastic properties account for their therapeutic effectiveness. Calcium channel blockers are drugs of first choice in this syndrome. In chronic stable angina, calcium channel blockers may be used as monotherapy or in combination with beta-blockers and/or nitrates. In patients with unstable angina, reduction in the incidence of ischemic episodes produced by calcium channel blockers is well documented. Recent data suggest that calcium channel blockers should generally be used in combination with beta-blockers, nitrates and antithrombotic agents. Patients with ischemic heart disease often exhibit reduced ventricular function. All of the first generation calcium channel blockers exacerbate symptoms in patients with established heart failure and may precipitate heart failure, particularly when combined with beta-blockers. Second generation vascular-selective dihydropyridines have been introduced recently. Vascular selectivity determines the drug's degree of negative inotropic effect. Felodipine is one of the most vascular selective of the available dihydropyridines and has no negative inotropic effects at clinically administered doses. In a long term study, felodipine, 20 mg/day, abolished symptoms and chronic ischemic episodes in 81% of treated subjects with Prinzmetal's angina. In patients with stable angina, felodipine has been found to be effective either as monotherapy or in combination with beta-blockers. In patients with known or suspected ventricular dysfunction, vascular-selective dihydropyridines such as felodipine offer advantages over the nonselective calcium channel blockers, particularly in patients receiving beta-blockers.
钙通道阻滞剂广泛用于治疗三种主要的心绞痛综合征。在治疗变异型心绞痛时，其抗血管痉挛特性决定了其治疗效果。钙通道阻滞剂是该综合征的首选药物。在慢性稳定型心绞痛中，钙通道阻滞剂可作为单一疗法使用，或与β受体阻滞剂和/或硝酸盐联合使用。在不稳定型心绞痛患者中，钙通道阻滞剂降低缺血发作发生率的作用已有充分记录。最近的数据表明，钙通道阻滞剂通常应与β受体阻滞剂、硝酸盐和抗血栓药物联合使用。缺血性心脏病患者常表现出心室功能降低。所有第一代钙通道阻滞剂都会加重已确诊心力衰竭患者的症状，并可能诱发心力衰竭，尤其是与β受体阻滞剂合用时。第二代血管选择性二氢吡啶类药物最近已被引入。血管选择性决定了药物负性肌力作用的程度。非洛地平是现有二氢吡啶类药物中血管选择性最高的之一，在临床给药剂量下无负性肌力作用。在一项长期研究中，每天服用20毫克非洛地平可使81%的变异型心绞痛患者症状消失且不再出现慢性缺血发作。在稳定型心绞痛患者中，已发现非洛地平作为单一疗法或与β受体阻滞剂联合使用均有效。在已知或疑似心室功能不全的患者中，非洛地平这类血管选择性二氢吡啶类药物比非选择性钙通道阻滞剂更具优势，尤其是在接受β受体阻滞剂治疗的患者中。
