Thase M E
Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, PA 15213, USA.
J Clin Psychiatry. 1998 Oct;59(10):502-8. doi: 10.4088/jcp.v59n1002.
Venlafaxine hydrochloride, a structurally novel antidepressant, is also the first nontricyclic serotonin/norepinephrine reuptake inhibitor. Although venlafaxine has an overall side effect and safety profile that is comparable to other newer antidepressants, it can cause both transient and sustained elevations of supine diastolic blood pressure (SDBP), probably the result of noradrenergic potentiation.
Presented here is a meta-analysis of original data on blood pressure, using both random effects and a multivariate survival analyses. The sample consisted of 3744 patients with major depression who were studied in controlled clinical trials comparing venlafaxine with imipramine and/or placebo. Patients were treated for 6 weeks of acute phase therapy; some responders received up to 1 year of continuation phase therapy.
Venlafaxine and imipramine were associated with small, but statistically significant, increases in SDBP during acute phase therapy. When compared with imipramine and placebo, venlafaxine was also associated with a greater proportion of persistent elevations of SDBP during continuation therapy. The effect of venlafaxine was highly dose dependent, and the incidence of elevated SDBP was statistically and clinically significant only at dosages above 300 mg/day. Venlafaxine did not adversely affect the control of blood pressure for patients with preexisting high blood pressure or elevated baseline values.
Venlafaxine has a dose-dependent effect on SDBP that is clinically significant at high dosages. Concern about blood pressure effects should not deter first-line use of this effective antidepressant, although more extensive studies of patients with cardiovascular diseases are still necessary.
盐酸文拉法辛是一种结构新颖的抗抑郁药，也是首个非三环类5-羟色胺/去甲肾上腺素再摄取抑制剂。尽管文拉法辛的总体副作用和安全性与其他新型抗抑郁药相当，但它可导致仰卧位舒张压（SDBP）短暂和持续升高，这可能是去甲肾上腺素能增强的结果。
本文呈现的是一项关于血压原始数据的荟萃分析，采用随机效应和多变量生存分析。样本包括3744例重度抑郁症患者，这些患者在对照临床试验中接受研究，比较了文拉法辛与丙咪嗪和/或安慰剂。患者接受6周的急性期治疗；一些缓解者接受长达1年的延续期治疗。
在急性期治疗期间，文拉法辛和丙咪嗪与SDBP的小幅但具有统计学意义的升高相关。与丙咪嗪和安慰剂相比，在延续期治疗期间，文拉法辛还与更高比例的SDBP持续升高相关。文拉法辛的作用高度依赖剂量，且仅在剂量高于300mg/天时，SDBP升高的发生率在统计学和临床上才有意义。文拉法辛对已有高血压或基线值升高的患者的血压控制没有不利影响。
文拉法辛对SDBP有剂量依赖性作用，在高剂量时具有临床意义。尽管仍有必要对心血管疾病患者进行更广泛的研究，但对血压影响的担忧不应妨碍一线使用这种有效的抗抑郁药。
