The role of existing and newer calcium channel blockers in the treatment of hypertension.
The role of existing and newer calcium channel blockers in the treatment of hypertension.
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DOI：
10.1111/j.1524-6175.2004.03683.x
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发表时间：
2004-11-01
期刊：
影响因子：
--
通讯作者：
Basile, Jan
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文献类型：
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作者：
Basile, Jan
钙通道阻滞剂(CCB)既包括硝苯地平和氨氯地平等二氢吡啶类药物，也包括非二氢吡啶类药物(维拉帕米和地尔硫卓)，是治疗高血压最广泛的处方药物之一。几项大型结局风险试验和综合荟萃分析发现，CCB降低了与包括中风在内的未受控制的高血压相关的心血管发病率和死亡率。然而，CCBS在预防心力衰竭和心肌梗死方面似乎不如血管紧张素转换酶抑制剂和利尿剂有效。在高血压管理指南中，CCBS被列为潜在的一线治疗药物之一，无论是单独使用还是与其他药物联合使用。此外，CCBS适合与利尿剂、血管紧张素转换酶抑制剂和血管紧张素-II受体阻滞剂联合使用。CCBS可能部分适用于合并雷诺氏综合征、单纯收缩期高血压(二氢吡啶)或心绞痛(非二氢吡啶)的患者。新的内在长效二氢吡啶类药物(如拉西地平、乐卡地平)目前在美国尚未上市，似乎具有与旧的二氢吡啶类药物相当的疗效，但可能具有更好的耐受性，特别是在外周水肿方面。
Calcium channel blockers (CCBs), which include both dihydropyridines such as nifedipine and amlodipine and non-dihydropyridines (verapamil and diltiazem), are among the most widely prescribed agents for the management of essential hypertension. Several large outcome risk trials and comprehensive meta-analyses have found that CCBs reduce the cardiovascular morbidity and mortality associated with uncontrolled hypertension, including stroke. CCBs, however, appear less effective than angiotensin-converting enzyme inhibitors and diuretics for preventing heart failure and myocardial infarction. CCBs are among the agents listed as potential first-line therapy, either alone or in combination with other agents in hypertension management guidelines. Furthermore, CCBs are suitable for add-on therapy in combination with diuretics, angiotensin-converting enzyme inhibitors, and angiotensin-II receptor blockers. CCBs may be partially suitable for patients with comorbid Raynaud's syndrome, isolated systolic hypertension (dihydropyridine), or angina pectoris (non-dihydropyridine). The newer inherently long-acting dihydropyridine agents (e.g., lacidipine, lercanidipine), which are not currently available in the United States, appear to have comparable efficacy to older agents of the dihydropyridine class but may have an improved tolerability profile, especially with regard to peripheral edema.