Machnig T, Henneke K H, Engels G, Pongratz G, Schmalzl M, Gellert J, Bachmann K
Second Medical Unit, University Hospital, Erlangen, Germany.
Cardiology. 1994;85(2):101-10. doi: 10.1159/000176657.
Both nitrendipine and captopril have been shown to reverse left ventricular hypertrophy in hypertensive patients. So far, no study allowed a true comparison of these drugs in this regard and with respect to their potential of reducing circadian blood pressure. Therefore, a total of 86 patients with newly diagnosed arterial hypertension and echocardiographic evidence of left ventricular hypertrophy underwent randomized treatment with captopril (n = 43) or nitrendipine (n = 43). Eighteen patients had to be put on a combination therapy of nitrendipine and captopril during the course of the study to control blood pressure effectively. Before and after the 6th and 38th weeks of treatment all patients underwent ambulatory 24-hour blood pressure monitoring, M-mode echo assessment of left ventricular mass and Doppler evaluation of left ventricular filling. The 24-hour blood pressure data were smoothed with a Fourier series and then compared with a normotensive reference profile with respect to blood pressure load and variability. The daytime and nighttime mean and the office blood pressure were also analyzed. Substance-specific profiles of action were obtained by subtracting the smoothed profiles after therapy from the profiles before therapy. After 38 weeks ambulatory blood pressure had decreased from 152 +/- 11/101 +/- 7 to 137 +/- 13/87 +/- 10 mm Hg on nitrendipine and from 147 +/- 11/99 +/- 6 to 134 +/- 13/89 +/- 9 mm Hg on captopril. The substance-specific profiles calculated for captopril and nitrendipine showed a balanced antihypertensive effect throughout the day and the night. The mean percentage decreases in left ventricular muscle mass under nitrendipine was 15% and did not differ significantly from the decrease of 21% under treatment with captopril (p < 0.001). There is no significant association between the reduction in blood pressure and the regression of left ventricular hypertrophy. In patients with disturbances of left ventricular diastolic function the early-to-late diastolic left ventricular flow ratio and the isovolumetric relaxation time were improved independent of the drug used. It is concluded that a long-term therapy with captopril and nitrendipine leads to a comparable degree of circadian blood pressure reduction and regression of hypertensive left ventricular hypertrophy.
硝苯地平与卡托普利均已被证明可使高血压患者的左心室肥厚逆转。到目前为止，尚无研究能在这方面以及就它们降低昼夜血压的潜力对这些药物进行真正的比较。因此，共有86例新诊断的动脉高血压且有左心室肥厚超声心动图证据的患者接受了卡托普利（n = 43）或硝苯地平（n = 43）的随机治疗。在研究过程中，18例患者不得不采用硝苯地平和卡托普利联合治疗以有效控制血压。在治疗第6周和第38周前后，所有患者均接受了24小时动态血压监测、左心室质量的M型超声评估以及左心室充盈的多普勒评估。24小时血压数据用傅里叶级数进行平滑处理，然后就血压负荷和变异性与正常血压参考曲线进行比较。还分析了白天和夜间的平均血压以及诊室血压。通过从治疗前的曲线中减去治疗后的平滑曲线获得药物特异性作用曲线。38周后，硝苯地平治疗组的动态血压从152±11/101±7 mmHg降至137±13/87±10 mmHg，卡托普利治疗组从147±11/99±6 mmHg降至134±13/89±9 mmHg。为卡托普利和硝苯地平计算的药物特异性曲线显示出全天和夜间均衡的降压效果。硝苯地平治疗下左心室肌肉质量平均下降百分比为15%，与卡托普利治疗下21%的下降无显著差异（p < 0.001）。血压降低与左心室肥厚消退之间无显著关联。在左心室舒张功能障碍的患者中，舒张早期至晚期左心室血流比值和等容舒张时间得到改善，且与所用药物无关。得出的结论是，卡托普利和硝苯地平的长期治疗导致昼夜血压降低程度相当以及高血压性左心室肥厚消退程度相当。
