Psaty B M, Furberg C D
The Department of Medicine, University of Washington, Seattle 98101, USA.
J Hypertens. 1997 Nov;15(11):1197-200. doi: 10.1097/00004872-199715110-00001.
The controversy over the efficacy and safety of calcium antagonists is over 2 years old. Since millions of patients worldwide are currently using calcium antagonists for the treatment of high blood pressure and angina, a systematic review of their potential risks and benefits is much needed. In response to this need, the World Health Organization (WHO) and the International Society of Hypertension (ISH) recently convened an ad-hoc subcommittee to review the available evidence (J Hypertens 1997, 15:105-115). Importantly, the WHO-ISH statement does take a strong stand in favor of large long-term trials that compare antihypertensive agents, and we all agree that these comparative trials are urgently needed. However, the WHO-ISH statement is marred in part by errors of omission, by the selective use of evidence and epidemiologic principles, and by a narrow application of the viewpoint of those who believe that evidence can come only from the results of megatrials. As a result, practicing clinicians will find more useful information in existing hypertension and postmyocardial infarction guidelines (Arch Intern Med 1993, 153:154-183 and JAm Coll Cardiol 1996, 28:1328-1428).
关于钙拮抗剂疗效与安全性的争议已有两年多历史。鉴于全球数百万患者目前正在使用钙拮抗剂治疗高血压和心绞痛，对其潜在风险与益处进行系统回顾非常必要。为回应这一需求，世界卫生组织（WHO）和国际高血压学会（ISH）最近召集了一个特设小组委员会来审查现有证据（《高血压杂志》1997年，15:105 - 115）。重要的是，WHO - ISH声明坚决支持开展大型长期试验以比较抗高血压药物，而且我们都认同迫切需要这些比较试验。然而，WHO - ISH声明存在部分瑕疵，包括遗漏错误、对证据和流行病学原理的选择性使用，以及片面采用那些认为证据仅能来自大型试验结果者的观点。因此，临床医生会在现有的高血压和心肌梗死后指南中找到更有用的信息（《内科学文献》1993年，153:154 - 183以及《美国心脏病学会杂志》1996年，28:1328 - 1428）。
