Abascal V M, Larson M G, Evans J C, Blohm A T, Poli K, Levy D
National Heart, Lung, and Blood Institute's Framingham Heart Study, Mass 01702, USA.
Arch Intern Med. 1998 Sep 28;158(17):1882-6. doi: 10.1001/archinte.158.17.1882.
Several recent studies have suggested that calcium antagonist drugs, which are widely used for the treatment of hypertension, are associated with increased risk of cardiovascular disease. These studies have cast doubts on the long-term safety of calcium antagonists.
To examine the association of calcium antagonist use with mortality in subjects with hypertension followed up in the Framingham Heart Study.
We stratified 3539 subjects (mean+/-SD age, 64+/-13 years) from the Framingham Heart Study who had hypertension at routine clinic examinations, according to the use of calcium antagonists and presence of coronary heart disease at the baseline examination. At each follow-up examination (every 2-4 years), subjects were reclassified with regard to the use of calcium antagonists. The end point of the study was all-cause mortality. Hazard ratios and 95% confidence intervals associated with the use of calcium antagonists were obtained using Cox proportional hazards regression models.
There were 970 deaths during follow-up. Hazard ratios for mortality associated with the use of calcium antagonists were 0.93 (95% confidence interval, 0.72-1.21; P=.59) for subjects with hypertension without coronary heart disease, and 0.92 (95% confidence interval, 0.69-1.24; P=.58) for those with coronary heart disease at baseline. All models were adjusted for age, sex, current smoking, systolic and diastolic blood pressure, use of beta-blockers, and use of other antihypertensive medications.
In this cohort of 3539 subjects with hypertension there were no differences in mortality among subjects with hypertension using a calcium antagonist compared with those who were not. Results were similar among subjects with hypertension with and without coronary heart disease. The results of ongoing long-term, randomized clinical trials will provide more definitive data on the safety of calcium antagonists.
最近的几项研究表明，广泛用于治疗高血压的钙拮抗剂药物与心血管疾病风险增加有关。这些研究对钙拮抗剂的长期安全性提出了质疑。
在弗雷明汉心脏研究中，研究使用钙拮抗剂与高血压患者死亡率之间的关联。
我们根据在基线检查时使用钙拮抗剂的情况以及是否存在冠心病，对弗雷明汉心脏研究中3539名在常规门诊检查时患有高血压的受试者（平均年龄±标准差为64±13岁）进行分层。在每次随访检查（每2 - 4年一次）时，根据使用钙拮抗剂的情况对受试者重新分类。研究的终点是全因死亡率。使用Cox比例风险回归模型获得与使用钙拮抗剂相关的风险比和95%置信区间。
随访期间有970人死亡。对于无冠心病的高血压患者，使用钙拮抗剂相关的死亡率风险比为0.93（95%置信区间为0.72 - 1.21；P = 0.59），对于基线时有冠心病的患者，风险比为0.92（95%置信区间为0.69 - 1.24；P = 0.58）。所有模型均根据年龄、性别、当前吸烟情况、收缩压和舒张压、β受体阻滞剂的使用以及其他抗高血压药物的使用进行了调整。
在这个由3539名高血压患者组成的队列中，使用钙拮抗剂的高血压患者与未使用钙拮抗剂的患者在死亡率上没有差异。有冠心病和无冠心病的高血压患者结果相似。正在进行的长期随机临床试验结果将为钙拮抗剂的安全性提供更确切的数据。
