Deanfield J
Great Ormond Street Hospital for Children, London, U.K.
Eur Heart J. 1996 Dec;17 Suppl G:64-8. doi: 10.1093/eurheartj/17.suppl_g.64.
Anginal symptoms alone are not a reliable guide to the extent of patients' ischaemic heart disease and silent episodes of ischaemia are associated with increased morbidity and mortality. It is becoming apparent that effective treatment of ischaemia will have to target the pattern of ischaemic events seen in patients' daily lives and treatment strategies are now being developed which aim to eliminate both silent and symptomatic episodes of ischaemia over the whole 24-h period. For example, the Circadian Anti-ischaemia Program in Europe (CAPE) trial has shown that significant improvements in objective and subjective measures of ischaemia occurred over 24 h when the once-daily third-generation dihydropyridine calcium antagonist amlodipine was added to background medical therapy. In addition, the Canadian Amlodipine/Atenolol in Silent Ischaemia Study (CASIS) has clearly shown the complementary effects of combination therapy with amlodipine and the long-acting beta-blocker atenolol. Ongoing and future outcome studies will determine the impact of such approaches on the prognosis for patients with ischaemic heart disease.
仅心绞痛症状并不能可靠地反映患者缺血性心脏病的程度，而无症状性缺血发作与发病率和死亡率的增加相关。越来越明显的是，有效的缺血治疗必须针对患者日常生活中出现的缺血事件模式，目前正在制定治疗策略，旨在消除整个24小时内的无症状和有症状缺血发作。例如，欧洲昼夜抗缺血计划（CAPE）试验表明，在背景药物治疗基础上加用每日一次的第三代二氢吡啶类钙拮抗剂氨氯地平后，24小时内缺血的客观和主观指标有显著改善。此外，加拿大氨氯地平/阿替洛尔无症状性缺血研究（CASIS）清楚地显示了氨氯地平与长效β受体阻滞剂阿替洛尔联合治疗的互补作用。正在进行的和未来的结局研究将确定这些方法对缺血性心脏病患者预后的影响。
