Nifedipine retard prevents hospitalization for angina pectoris better than angiotensin-converting enzyme inhibitors in hypertensive Japanese patients with previous myocardial infarction (JMIC-B substudy)
Nifedipine retard prevents hospitalization for angina pectoris better than angiotensin-converting enzyme inhibitors in hypertensive Japanese patients with previous myocardial infarction (JMIC-B substudy)
复制标题
对于既往有心肌梗死的日本高血压患者，硝苯地平缓释剂比血管紧张素转换酶抑制剂更能预防心绞痛住院（JMIC-B 子研究）
作者：
Y. Yui;E. Shinoda;K. Kodama;A. Hirayama;H. Nonogi;K. Haze;T. Sumiyoshi;S. Hosoda;C. Kawai
目的和背景我们之前在日本多中心心血管疾病调查B研究中报道了硝苯地平缓蚀剂与血管紧张素转换酶（ACE）抑制剂在预防冠心病高血压患者心脏事件方面的疗效相当。在硝苯地平组中，与ACE抑制剂组相比，有心肌梗死（MI）病史的患者因心绞痛住院的次数显著减少。我们研究了这种差异是否与冠状动脉硬化的进展有关。方法采用冠状动脉造影（CAG）和冠状动脉造影定量分析来评价冠状动脉硬化。结果硝苯地平组心绞痛累计住院率显著低于对照组（log-rank检验P = 0.013）。需要住院治疗的心绞痛的病因是根据CAG结果确定的。硝苯地平组继发于新发病变或现有病变进展的发生率显著低于ACE抑制剂组（log-rank检验P = 0.042和P = 0.028）。采用定量冠状动脉分析，比较硝苯地平组和ACE抑制剂组冠状动脉管腔直径的变化。硝苯地平组冠脉最小直径无明显变化，而ACE抑制剂组冠脉最小直径明显降低（配对t检验P = 0.002），经协方差分析，两组间差异有统计学意义（P = 0.047）。结论硝苯地平通过抑制心肌梗死病史患者冠状动脉疾病的进展，更有效地预防心绞痛患者入院。
Objectives and background We previously reported that nifedipine retard showed comparable efficacy to angiotensin-converting enzyme (ACE) inhibitors for the prevention of cardiac events in hypertensive patients with coronary artery disease during the Japan Multicenter Investigation for Cardiovascular Diseases B study. In the nifedipine group, patients with a history of myocardial infarction (MI) showed a significant reduction in hospitalization for angina pectoris compared with the ACE inhibitor group. We investigated whether this difference was related to the progression of coronary arteriosclerosis. Methods To evaluate coronary arteriosclerosis, we performed coronary angiography (CAG) and a quantitative analysis of coronary angiograms. Results The cumulative incidence of hospitalization for angina was significantly lower in the nifedipine group (log-rank test P = 0.013). The etiology of angina requiring hospitalization was determined on the basis of CAG findings. Its incidence secondary to the development of new lesions or the progression of existing lesions was significantly lower in the nifedipine group than in the ACE inhibitor group (log-rank test P = 0.042 and P = 0.028, respectively). Using quantitative coronary analysis, changes in the coronary artery luminal diameter were compared between the nifedipine and ACE inhibitor groups. The minimum coronary lumen diameter did not show a significant change in the nifedipine group, whereas it decreased significantly in the ACE inhibitor group (paired t-test P = 0.002), and there was a significant difference between the two groups by analysis of covariance (P = 0.047). Conclusion These results indicate that nifedipine more effectively prevented admission for angina pectoris by inhibiting the progression of coronary artery disease in patients with a history of MI.