Ostergren J, Isaksson H, Brodin U, Schwan A, Ohman K P
Department of Medicine, Karolinska Hospital, Stockholm, Sweden.
Am J Hypertens. 1998 Jun;11(6 Pt 1):690-6. doi: 10.1016/s0895-7061(98)00032-6.
Amlodipine and felodipine are calcium antagonists of the dihydropyridine type. The elimination half-life of amlodipine is longer than that of felodipine. To study whether the different elimination rates of the drugs were reflected in different duration of blood pressure (BP) control, we compared amlodipine and felodipine extended release (ER) by both conventional clinic BP 24 h after drug intake and 24 h ambulatory BP monitoring (ABPM), with special reference to nighttime and morning blood pressure. Two hundred and sixteen patients with primary hypertension (supine diastolic BP, 95 to 115 mm Hg) were randomized to receive amlodipine or felodipine ER in a multicenter study. The starting dose of both drugs was 5 mg. If the target clinic diastolic BP (90 mm Hg) had not been achieved after 4 weeks the dose was increased to 10 mg. Twenty-four-hour ABPM was performed with the subjects taking placebo medication before randomization and after 4 and 8 weeks undergoing active treatment. Significantly more patients responded after 4 weeks of treatment with amlodipine (50%) as compared with felodipine (33%) (P = .013). ABPM during daytime (07:00 to 23:00) was similar during both treatments, but nighttime systolic (P = .026) and diastolic (P = .019) BP was more effectively reduced by amlodipine than by felodipine. After 8 weeks 82% achieved the target pressure with amlodipine and 69% with felodipine (P = .036 for the difference). Amlodipine seems to be more effective than felodipine when the drugs are compared in the same dose, with regard to the effect on clinic BP 24 h after dosing and to ambulatory BP during the night. The longer elimination half-life of amlodipine as compared to felodipine is the probable reason for this finding.
氨氯地平和非洛地平是二氢吡啶类钙拮抗剂。氨氯地平的消除半衰期比非洛地平长。为研究药物不同的消除速率是否反映在血压（BP）控制的不同持续时间上，我们通过药物摄入后24小时的常规临床血压测量以及24小时动态血压监测（ABPM），比较了氨氯地平和非洛地平缓释剂（ER），特别关注夜间和早晨血压。在一项多中心研究中，216例原发性高血压患者（仰卧位舒张压为95至115 mmHg）被随机分配接受氨氯地平或非洛地平ER治疗。两种药物的起始剂量均为5 mg。如果4周后未达到目标临床舒张压（90 mmHg），则将剂量增加至10 mg。在随机分组前以及接受积极治疗4周和8周后，让受试者服用安慰剂进行24小时ABPM。与非洛地平（33%）相比，氨氯地平治疗4周后有更多患者有反应（50%）（P = 0.013）。两种治疗期间白天（07:00至23:00）的ABPM相似，但氨氯地平比非洛地平更有效地降低了夜间收缩压（P = 0.026）和舒张压（P = 0.019）。8周后，82%的患者使用氨氯地平达到目标血压，69%的患者使用非洛地平达到目标血压（差异P = 0.036）。在相同剂量下比较这两种药物时，就给药后24小时的临床血压和夜间动态血压的影响而言，氨氯地平似乎比非洛地平更有效。氨氯地平与非洛地平相比消除半衰期更长可能是这一发现的原因。
