Dey H M, Soufer R, Hoffer P, Wackers F J, Black H R
Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA.
Am J Hypertens. 1996 Jun;9(6):598-606. doi: 10.1016/0895-7061(96)00168-9.
A randomized, double blind, parallel study was performed to compare the effects of nifedipine gastrointestinal therapeutic system (GITS) to hydrochlorothiazide (HCTZ) in the management of the elderly hypertensive. Eighteen patients, mean age 65 +/- 5 years, with Stage I-III diastolic hypertension (sitting diastolic BP between 90 and 115 mm HG) were included in each treatment group. Following a 2 to 8 week placebo washout phase, patients received either nifedipine GITS or HCTZ and were titrated over 5 weeks to achieve a goal diastolic blood pressure less than 90 mm Hg. Patients were then continued on medication during an 8 week maintenance phase. Treatment effect on systolic and diastolic blood pressure was assessed. Serum electrolytes, lipids, blood urea nitrogen, and creatinine were measured before and after treatment. Posttreatment changes in renal and cardiovascular function, as well as left ventricular mass were evaluated. The results showed significant reductions in systolic and diastolic blood pressure with both drugs; no treatment difference was found, although goal blood pressure was achieved more rapidly with nifedipine GITS (28 v 34 days, P < .05). BUN was significantly increased only after diuretic therapy (P < .01) and serum potassium fell to a greater degree with HCTZ (0.3 mEq/L v 0.1 mEq/L) than with nifedipine GITS. No statistically significant changes in left ventricular mass, ejection fraction, glomerular filtration rate, or renal blood flow were seen after therapy with either drug. However, the time peak LV diastolic filling rate decreased with nifedipine GITS (197 to 164 msec) and increased with HCTZ (172 to 198 msec). This treatment difference approached statistical significance (P = .07). Adverse side effects of treatment were reported by 50% of nifedipine GITS patients and 28% of patients treated with HCTZ. This treatment difference was not statistically significant. We conclude that both nifedipine GITS and HCTZ monotherapy provide significant blood pressure reduction in older hypertensives with Stage I-III diastolic hypertension. Both drugs are well tolerated with no significant adverse effect on renal or cardiovascular function after short term therapy.
进行了一项随机、双盲、平行研究，以比较硝苯地平胃肠道治疗系统（GITS）与氢氯噻嗪（HCTZ）治疗老年高血压患者的效果。每个治疗组纳入了18例平均年龄为65±5岁、患有I - III期舒张期高血压（坐位舒张压在90至115毫米汞柱之间）的患者。在经过2至8周的安慰剂洗脱期后，患者接受硝苯地平GITS或HCTZ治疗，并在5周内进行滴定，以达到舒张压目标低于90毫米汞柱。然后患者在8周的维持期继续用药。评估治疗对收缩压和舒张压的影响。在治疗前后测量血清电解质、血脂、血尿素氮和肌酐。评估治疗后肾脏和心血管功能以及左心室质量的变化。结果显示，两种药物均可显著降低收缩压和舒张压；尽管硝苯地平GITS能更快达到目标血压（28天对34天，P < 0.05），但未发现治疗差异。仅在利尿剂治疗后血尿素氮显著升高（P < 0.01），且氢氯噻嗪使血清钾下降的幅度（0.3毫当量/升对0.1毫当量/升）大于硝苯地平GITS。两种药物治疗后左心室质量、射血分数、肾小球滤过率或肾血流量均未见统计学显著变化。然而，硝苯地平GITS使左心室舒张期充盈率峰值时间缩短（从197毫秒降至164毫秒），氢氯噻嗪使其延长（从172毫秒增至198毫秒）。这种治疗差异接近统计学显著性（P = 0.07）。50%接受硝苯地平GITS治疗的患者和28%接受氢氯噻嗪治疗的患者报告了治疗的不良副作用。这种治疗差异无统计学显著性。我们得出结论，硝苯地平GITS和氢氯噻嗪单药治疗均可使I - III期舒张期高血压的老年高血压患者血压显著降低。两种药物耐受性良好，短期治疗后对肾脏或心血管功能无显著不良影响。
