Calcium antagonists and atherosclerosis protection in hypertension.
Calcium antagonists and atherosclerosis protection in hypertension.
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DOI：
10.1097/00045391-200311000-00006
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发表时间：
2003-11-01
影响因子：
4.2
通讯作者：
Armas-Padilla, Maria Cristina
中科院分区：
文献类型：
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作者：
Hernandez, Rafael Hernandez;Armas-Hernandez, Maria Jose;Armas-Padilla, Maria Cristina
钙拮抗剂在所有种族的高血压患者中均有效，与年龄、膳食盐摄入量、盐敏感性状态或血浆肾素活性特征无关。一些前瞻性研究表明，钙拮抗剂硝苯地平控释片和尼群地平降低心血管发病率和死亡率的程度至少与利尿剂相同。其他前瞻性研究正在进行中，以评估钙拮抗剂对高血压患者心血管发病率和死亡率以及动脉粥样硬化进展的影响。钙拮抗剂，特别是高度亲脂性的钙拮抗剂拉西地平和尼索地平，显示出具有抗氧化特性。这些药物减少LDL的氧化及其流入动脉壁，并减少动物的动脉粥样硬化病变。高血压患者血小板产生的丙二醛（氧自由基形成的标志物）被氯地平、拉西地平或硝苯地平抑制。钙拮抗剂长期临床试验的新证据表明，这些药物可以降低高血压和冠心病患者动脉粥样硬化的进展速度。在他汀类药物的回归生长评价研究（REGRESS）中，钙拮抗剂、氨氯地平或硝苯地平与普伐沙汀联合给药可显著减少新血管造影病变的出现。在维拉帕米治疗高血压和动脉粥样硬化研究（VHAS）中，维拉帕米在促进颈动脉增厚病变消退以及降低心血管事件发生率方面比氯噻酮更有效。在络活喜试验（PREVENT）的血管效应的前瞻性随机评价中，络活喜减缓了冠状动脉疾病患者早期冠状动脉粥样硬化的进展。在高血压治疗干预为目标（INSIGHT）研究的子方案中，硝苯地平GITS与氨氯噻嗪（氢氯噻嗪+阿米洛利）相比显著降低了内膜中层厚度。欧洲拉西地平动脉粥样硬化研究（艾尔莎）的初步结果表明，拉西地平与阿替洛尔相比，可降低内膜中层厚度进展率。因此，选择性钙拮抗剂是潜在的抗动脉粥样硬化剂。
Calcium antagonists are effective in hypertensive patients of all ethnic groups, irrespective of age, dietary salt intake, salt-sensitivity status or plasma renin activity profile. Some prospective studies show that the calcium antagonists, nifedipine GITS and nitrendipine, reduce cardiovascular morbidity and mortality at least to the same extent as the diuretics. Other prospective studies are in progress to evaluate the effect of calcium antagonists on cardiovascular morbidity and mortality, and the progression of atherosclerosis in hypertensive patients. Calcium antagonists, especially the highly lipophilic amlodipine, lacidipine and nisoldipine, are shown to possess antioxidant properties. These drugs reduce the oxidation of LDL and its influx into the arterial wall, and reduce atherosclerotic lesions in animals. Platelet production of malondialdehyde, a marker of oxygen free radical formation, is suppressed by amlodipine, lacidipine or nifedipine in hypertensive patients. New evidence from long-term clinical trials of calcium antagonists indicates that these drugs can reduce the rate of progression of atherosclerosis in hypertensive and coronary heart disease patients. In the Regression Growth Evaluation Statin Study (REGRESS), co-administration of calcium antagonist, amlodipine or nifedipine with pravasatin caused a significant reduction in the appearance of new angiographic lesions. In the Verapamil in Hypertension and Atherosclerosis Study (VHAS), verapamil was more effective than chlorthalidone in promoting regression of thicker carotid lesions in parallel with a reduction in the incidence of cardiovascular events. In the Prospective Randomized Evaluation of the Vascular Effects of Norvasc Trial (PREVENT), amlodipine slowed the progression of early coronary atherosclerosis in patients with coronary artery disease. In a subprotocol of the Intervention as a Goal in the Hypertension Treatment (INSIGHT) study, nifedipine GITS significantly decreased intima-media thickness as compared to co-amilozide (hydrochlorothiazide + amiloride). Preliminary results of the European Lacidipine Study on Atherosclerosis (ELSA) show that lacidipine reduced the intima-media thickness progression rate as compared to atenolol. Thus, selective calcium antagonists are potential antiatherosclerotic agents.