Horwitz L D, Weinberger H D, Clegg L
University of Colorado Health Sciences Center, Denver, USA.
Am J Hypertens. 1997 Nov;10(11):1263-9. doi: 10.1016/s0895-7061(97)00264-1.
The comparative effects of the once a day calcium channel antagonists amlodipine and long-acting diltiazem were assessed in a parallel design, investigator-blinded, multicenter trial in 123 patients with diastolic blood pressures ranging from 95 to 114 mm Hg before treatment. Patients were randomized to one of the two drugs and titrated at 2-week intervals to 5 or 10 mg of amlodipine or 180, 240, or 360 mg of long-acting diltiazem during a 10-week treatment period. Both drugs significantly reduced resting, sitting, standing, and 24-h ambulatory systolic and diastolic pressures. Amlodipine caused significantly greater reductions in sitting and standing systolic pressures, standing diastolic pressures, and 24-h ambulatory systolic and diastolic pressures versus diltiazem. Sitting systolic pressures were reduced from 151.9 +/- 2.0 (SE) at baseline to 137.9 +/- 1.8 mm Hg with amlodipine treatment and from 149.0 +/- 2.1 to 145.1 +/- 2.5 mm Hg with diltiazem. Sitting diastolic pressures were reduced from 100.2 +/- 0.6 to 87.8 +/- 1.0 mm Hg with amlodipine and from 101.1 +/- 1.0 to 91.9 +/- 1.1 mm Hg with diltiazem. Reductions in standing systolic pressures after treatment were -12.1 +/- 1.5 mm Hg amlodipine v -4.6 +/- 1.5 mm Hg diltiazem (P < .01), and reductions in standing diastolic pressures were -11.8 +/- 0.9 mm Hg amlodipine v -8.6 +/- 0.9 mm Hg diltiazem (P < .02). Heart rates did not change significantly with either drug during the study. Two subjects in each group dropped out because of adverse experiences. Although both agents were well tolerated and reduced blood pressures consistently over the 10-week test period, amlodipine was more effective than diltiazem in reducing systolic and diastolic blood pressures to the target pressures of < 140 mm Hg systolic and < 90 mm Hg diastolic over a range of doses widely used in clinical practice.
在一项平行设计、研究者设盲的多中心试验中，对每日一次给药的钙通道拮抗剂氨氯地平和长效地尔硫䓬的疗效进行了比较。该试验纳入了123例治疗前舒张压在95至114mmHg之间的患者。患者被随机分配至两种药物之一，并在为期10周的治疗期间，每隔2周进行滴定，使氨氯地平达到5或10mg，或使长效地尔硫䓬达到180、240或360mg。两种药物均能显著降低静息、坐位、站立位以及24小时动态收缩压和舒张压。与地尔硫䓬相比，氨氯地平能更显著地降低坐位和站立位收缩压、站立位舒张压以及24小时动态收缩压和舒张压。氨氯地平治疗使坐位收缩压从基线时的151.9±2.0（标准误）降至137.9±1.8mmHg，而地尔硫䓬治疗使坐位收缩压从149.0±2.1降至145.1±2.5mmHg。氨氯地平使坐位舒张压从100.2±0.6降至87.8±1.0mmHg，地尔硫䓬使坐位舒张压从101.1±1.0降至91.9±1.1mmHg。治疗后，氨氯地平使站立位收缩压降低12.1±1.5mmHg，地尔硫䓬使站立位收缩压降低4.6±1.5mmHg（P<0.01）；氨氯地平使站立位舒张压降低11.8±0.9mmHg，地尔硫䓬使站立位舒张压降低8.6±0.9mmHg（P<0.02）。在研究期间，两种药物对心率均无显著影响。每组各有两名受试者因不良事件退出试验。尽管在为期10周的试验期间，两种药物耐受性良好且能持续降低血压，但在临床实践中广泛使用的一系列剂量范围内，氨氯地平在将收缩压和舒张压降至收缩压<140mmHg、舒张压<90mmHg的目标血压方面比地尔硫䓬更有效。
