Opie L H
Ischaemic Heart Disease Research Unit, Medical Research Council, University of Cape Town Medical School, South Africa.
Eur Heart J. 1997 Jan;18 Suppl A:A92-104. doi: 10.1093/eurheartj/18.suppl_a.92.
Calcium antagonists have multiple mechanisms whereby they are able to protect against myocardial ischaemia. Recently questions have been posed about the long-term safety of this group of agents. This article is a selective rather than a complete review of the problems. Fears have largely centred around rapidly acting nifedipine when inappropriately used. This agent remains useful in Prinzmetal's angina, a condition in which there are no long-term comparative outcome studies. Current evidence is that verapamil is as safe and as effective as the beta-blocker in effort angina and that non-dihydropyridines (verapamil and diltiazem) are efficacious in the follow up of non-Q wave infarct. Verapamil post-infarct is safe and reduces reinfarction, provided that clinical heart failure is first excluded.
钙拮抗剂具有多种机制，使其能够预防心肌缺血。最近，人们对这类药物的长期安全性提出了疑问。本文是对这些问题的选择性而非全面的综述。人们的担忧主要集中在快速起效的硝苯地平使用不当时。在变异型心绞痛（一种尚无长期对比疗效研究的疾病）中，该药物仍然有用。目前的证据表明，在劳力型心绞痛中，维拉帕米与β受体阻滞剂一样安全有效，并且非二氢吡啶类（维拉帕米和地尔硫䓬）在非Q波梗死的后续治疗中有效。只要首先排除临床心力衰竭，维拉帕米在心肌梗死后使用是安全的，并且可降低再梗死发生率。
