Breithaupt-Grögler K, Gerhardt G, Lehmann G, Notter T, Belz G G
Center for Cardiovascular Pharmacology, ZeKaPha GmbH, Mainz-Wiesbaden, Mainz, Germany.
Int J Clin Pharmacol Ther. 1998 Aug;36(8):425-31.
The effects of 2 fixed antihypertensive combination drugs on blood pressure and aortic elastic properties were compared in 2 parallel groups. Twenty-six patients for 6 months received a calcium antagonist plus ACE inhibitor (verapamil SR 180 mg/trandolapril 1 mg (Vera/Tran)) and 25 patients a beta-adrenoceptor antagonist plus diuretic (metoprolol 100 mg/hydrochlorothiazide 12.5 mg (Meto/HCTZ)). In addition to blood pressure (SBP, DBP), carotidofemoral pulse wave velocity (PWV) was assessed non-invasively. Total peripheral resistance (TPR) was determined from cardiac output derived by electrical impedance cardiography. Sitting DBP decreased for -14.4 mmHg following Vera/Tran compared with -9.2 mmHg following Meto/HCTZ (p = 0.02 for difference between treatments). Blood pressure was normalized (i.e. DBP < 90 mmHg) in 69% of patients with Vera/Tran and in 52% with Meto/HCTZ. PWV was lowered with Vera/Tran to a higher extent than with Meto/HCTZ (differences between group means -0.46 to -0.98 m/sec, statistically not significant). Vera/Tran induced a decrease in TPR of about 15% of baseline values, whereas Meto/HCTZ showed no influence. Treatment-related adverse events following Meto/HCTZ were bradycardia and associated symptoms; following Vera/Tran these were cough and edema in 1 case each. In the Meto/HCTZ group, there were more withdrawals/drop-outs (9/25) than in the Vera/Tran group (2/26). The somewhat more intense reduction in PWV with Vera/Tran is indicative of an increase in aortic elastic properties associated with the more potent decrease in BP. In the present study, the combination of calcium antagonist plus ACE inhibitor was found to be an effective and well tolerated antihypertensive regimen and in these respects appears to have some advantages compared with a combination of beta-blocker plus diuretic.
在两个平行组中比较了两种固定复方抗高血压药物对血压和主动脉弹性特性的影响。26例患者接受钙拮抗剂加ACE抑制剂（缓释维拉帕米180mg/群多普利1mg（维拉/群多））治疗6个月，25例患者接受β-肾上腺素能受体拮抗剂加利尿剂（美托洛尔100mg/氢氯噻嗪12.5mg（美托/氢氯噻嗪））治疗。除血压（收缩压、舒张压）外，还采用非侵入性方法评估了颈股脉搏波速度（PWV）。总外周阻力（TPR）由电阻抗心动图得出的心输出量确定。维拉/群多治疗后坐位舒张压下降了14.4mmHg，而美托/氢氯噻嗪治疗后下降了9.2mmHg（治疗组间差异p = 0.02）。维拉/群多治疗使69%的患者血压正常化（即舒张压<90mmHg），美托/氢氯噻嗪治疗使52%的患者血压正常化。维拉/群多使PWV降低的程度高于美托/氢氯噻嗪（组间均值差异为-0.46至-0.98m/sec，无统计学意义）。维拉/群多使TPR降低约为基线值的15%，而美托/氢氯噻嗪无影响。美托/氢氯噻嗪治疗相关的不良事件为心动过缓和相关症状；维拉/群多治疗相关的不良事件为咳嗽和水肿，各1例。美托/氢氯噻嗪组的退出/脱落患者（9/25）多于维拉/群多组（2/26）。维拉/群多使PWV有更明显的降低，这表明主动脉弹性特性增加，与血压更显著降低有关。在本研究中，钙拮抗剂加ACE抑制剂的联合用药被发现是一种有效且耐受性良好的抗高血压方案，在这些方面似乎比β受体阻滞剂加利尿剂的联合用药有一些优势。
