舌下含服硝苯地平控释片快速降压作用的初步观察
摘要
目的探讨舌下含服硝苯地平控释片是否能作为一项有效安全的对血压明显增高患者较为快速降压的治疗方法。方法本文纳入30例收缩压≥175或≥160 mm Hg伴有头痛者的门诊成年高血压患者[女性18例,(63.5±12.8)岁]。先以2∶1比例随机分为舌下含服硝苯地平控释片30 mg(硝苯地平控释片治疗组,20例)或安慰剂(10例)两组,以观察5 min的血压变化。随后,安慰剂组患者改含硝苯地平控释片30 mg,与其他20例患者一样观察硝苯地平控释片治疗20 min的效果。电子血压计测量含服硝苯地平控释片前(0)和含服后5、10、15和20 min的血压。以20 min时与基线的血压差异为最大降低幅度;血压百分降低幅度(PD)=最大降低幅度/基础血压。结果在安慰剂对照试验阶段,安慰剂组和硝苯地平控释片治疗组的基本情况,收缩压[(187.2±15.1)比(186.7±12.6)mm Hg]和舒张压[(96.5±19.4)比(94.1±12.7)mm Hg]差异无统计学意义,硝苯地平控释片治疗组5 min时的收缩压PD明显大于安慰剂组[(7.8±3.8)%比(2.1±4.4)%,P<0.05]。在所有30例患者治疗观察中,含服硝苯地平控释片20 min使收缩压从(185.6±14.0)降到(160.6±17.5)mm Hg,舒张压从(94.5±17.2)降到(88.1±20.2)mm Hg;收缩压和舒张压的平均降压幅度分别为25.0和6.4 mm Hg。与此同时,心率降低(3.0±3.8)次/min。结论对于收缩压≥175或≥160 mm Hg伴头痛的高血压患者,舌下含服硝苯地平控释片30 mg在多数患者中能较为快速、平稳和有效地降低血压而不增加心率。
引文
[1] Gales MA.Oral antihypertensives for hypertensive urgencies[J].Ann Pharmacother,1994,28(3):352-358.
[2] Ceyhan B,Karaaslan Y,Caymaz O,et al.Comparison of sublingual captopril and sublingual nifedipine in hypertensive emergencies[J].Jpn J Pharmacol,1990,52(2):189-193.
[3] Yanturali S,Akay S,Ayrik C,et al.Adverse events associated with aggressive treatment of increased blood pressure[J].Int J Clin Pract,2004,58(5):517-519.
[4] The sixth report of the joint national committee on prevention,detection,evaluation,and treatment of high blood pressure[J].Arch Intern Med,1997,157(21):2413-2446.
[5] Karakili? E,Büyükcam F,Kocalar G,et al.Same effect of sublingual and oral captopril in hypertensive crisis[J].Eur Rev Med Pharmacol Sci,2012,16(12):1642-1645.
[6] Addad F,Ferjani H,Chaabani A,et al.A comparison of the effect of oral captopril and nicardipine in hypertensive crisis[J].Tunis Med,2008,86(2):150-154.
[7] Kaya A,Tatlisu MA,Kaplan Kaya T,et al.Sublingual vs.oral captopril in hypertensive crisis[J].J Emerg Med,2016,50(1):108-115.
[8] Chun G,Frishman WH.Rapid-acting parenteral antihypertensive agents[J].J Clin Pharmacol,1990,30(3):195-209.
[9] Shekhar S,Sharma C,Thakur S,et al.Oral nifedipine or intravenous labetalol for hypertensive emergency in pregnancy:a randomized controlled trial[J].Obstet Gynecol,2013,122(5):1057-1063.
[10] Meredith PA,Elliott HL.A review of the gastrointestinal therapeutic system (GITS) formulation and its effectiveness in the delivery of antihypertensive drug treatment (focus on nifedipine GITS)[J].Integr Blood Press Control,2013,6:79-87.
[11] Toal CB,Meredith PA,Elliott HL.Long-acting dihydropyridine calcium-channel blockers and sympathetic nervous system activity in hypertension:a literature review comparing amlodipine and nifedipine GITS[J].Blood Press,2012,21(Suppl 1):S3-10.
[12] Erbel R,Brand G,Meyer J,et al.Emergency treatment of hypertensive crisis with sub-lingual nifedipine[J].Postgrad Med J,1983,59(Suppl 3):134-136.
[2] Ceyhan B,Karaaslan Y,Caymaz O,et al.Comparison of sublingual captopril and sublingual nifedipine in hypertensive emergencies[J].Jpn J Pharmacol,1990,52(2):189-193.
[3] Yanturali S,Akay S,Ayrik C,et al.Adverse events associated with aggressive treatment of increased blood pressure[J].Int J Clin Pract,2004,58(5):517-519.
[4] The sixth report of the joint national committee on prevention,detection,evaluation,and treatment of high blood pressure[J].Arch Intern Med,1997,157(21):2413-2446.
[5] Karakili? E,Büyükcam F,Kocalar G,et al.Same effect of sublingual and oral captopril in hypertensive crisis[J].Eur Rev Med Pharmacol Sci,2012,16(12):1642-1645.
[6] Addad F,Ferjani H,Chaabani A,et al.A comparison of the effect of oral captopril and nicardipine in hypertensive crisis[J].Tunis Med,2008,86(2):150-154.
[7] Kaya A,Tatlisu MA,Kaplan Kaya T,et al.Sublingual vs.oral captopril in hypertensive crisis[J].J Emerg Med,2016,50(1):108-115.
[8] Chun G,Frishman WH.Rapid-acting parenteral antihypertensive agents[J].J Clin Pharmacol,1990,30(3):195-209.
[9] Shekhar S,Sharma C,Thakur S,et al.Oral nifedipine or intravenous labetalol for hypertensive emergency in pregnancy:a randomized controlled trial[J].Obstet Gynecol,2013,122(5):1057-1063.
[10] Meredith PA,Elliott HL.A review of the gastrointestinal therapeutic system (GITS) formulation and its effectiveness in the delivery of antihypertensive drug treatment (focus on nifedipine GITS)[J].Integr Blood Press Control,2013,6:79-87.
[11] Toal CB,Meredith PA,Elliott HL.Long-acting dihydropyridine calcium-channel blockers and sympathetic nervous system activity in hypertension:a literature review comparing amlodipine and nifedipine GITS[J].Blood Press,2012,21(Suppl 1):S3-10.
[12] Erbel R,Brand G,Meyer J,et al.Emergency treatment of hypertensive crisis with sub-lingual nifedipine[J].Postgrad Med J,1983,59(Suppl 3):134-136.