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題名 | Once-Daily Nifedipine Sustained Release (Nifelan) on Forearm Vascular Resistance and Regression of Left Ventricular Hypertrophy in Patients with Mild to Moderate Essential Hypertension=長效型Nifelan對輕、中度本態性高血壓患者前臂血管阻力與左心室質量的影響 |
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作者 | 張坤正; 程文俊; Chang, Kuan-cheng; Cherng, Wen-jin; |
期刊 | 長庚醫學 |
出版日期 | 19980300 |
卷期 | 21:1 1998.03[民87.03] |
頁次 | 頁28-36 |
分類號 | 418.221 |
語文 | eng |
關鍵詞 | 高血壓; 心臟超音波; 前臂血行動力; Nifelan; Hypertension; Echocardiography; Forearm hemodynamics; |
中文摘要 | 背景:Nifelan是屬於新開發的特續釋放型與Mfedipjne同型之抗高血壓藥,除了 對血壓的影響外,血管阻力與左心室質量的影響亦是值得探討的主題。 方法:本研究針對20位輕、中度本態性高血壓患者,探討Nifelan的抗高血壓效果及臨床安 全性,同時對左心室質量及血管血行動力做一比較。在2星期的安慰劑管制期(placebo- qualifying)後,符合條件的患者則開始8星期Nifelan每天10~40毫克的主動治療期。 結果:總共有17位患者包括8位男性,9位女性,年齡介於43至72歲之間(平均52歲),完成 整個研究。在8星期的治療後,Nifelan每天平均劑量為27.1±1.7毫克,平均坐姿收縮壓 降低13.8毫米水銀柱,舒張壓降低9.6毫米水銀柱(兩者之p值分別小於0.0001),而心跳則 無改變(75.9±1.3對,3.6±0.9次/每分鐘,p=NS),4位患者(20%)有頭痛、臉潮紅、心悸 及下肢水腫等併發症,其中2位因此需要停藥,1位患者並沒有併發症的報告卻不明原因的 退出本研究。心臟超音波左心室質量指數有意表的由104.2±4.6克/平方公尺降至96.6± 5.2克平方公尺(p<0.05),而左心室E/A比例則由0.97±0.06上升至1.10±0.07(p=0.06)。 兩手前臂血流由3.36±0.28進步至4.04±0.31毫升/100毫升/分(p<0.05),前臂血管阻力 由37.75±4.95下降至28.73±3.34毫米水銀柱/毫升/100毫升/分(p<0.05),血液中高密度 脂蛋白由51.8±3.0上升至54.4±3.3毫克/100毫升(p=NS),低密度脂蛋白由146.1±8.8下 降至139.9±10.6毫克/100毫升(p=NS),其他血液及生化值在治療前後並無改變。 結論:本研究的結論是對輕、中度本態性高血壓的中國人,Nifelan每天1次,單獨服用可 有效的降低血壓,減少左心室質量及改善前臂血管血行動力的變化。 |
英文摘要 | Background: Nifelan, a sustained-release formulation of nifedipine, is a new antibypertensive agent. However, its effect on peripheral vascular resistance and left ventricular mass is still controversial. Methods: We evaluated the antihypertensive efficacy and safety of nifelan in 20 patients with mild to moderate essential hypertension. After 2 weeks of a placebo-qualifying phase, the eligible patients were entered into an 8- week active treatment period in which nifelan was given 10-40 mg once-daily with gradual titration. Results: Seventeen patients (8 men, 9 women; age range 43-72 years, mean 52 years) completed the entire study. The mean sitting systolic and diastolic blood pressures were significantly reduced (p<0.0001) by 13.8 mmHg and 9.6 mmHg, respectively, with a mean nifelan dose of 27.1 * 2.7 mg per day, while the heart rate remained unchanged (75.9 * 1.3 vs. 73.6 @ 0.9 beats per minute, p = NS). Four patients (20%) reported side effects necessitating termination of nifelan treatment in 2 patients because of intolerance. One patient was found to be poorly compliant and withdrew prematurely from the study for unknown reasons without complaints of adverse effects. Echocardiographic left ventricular mass index was significantly reduced from 104.2 4.6 g/M□ to 96.6 ± 5.2 g/m□ (p < 0.05), and the left ventricular diastolic function evaluated by E/A ratio showed a trend toward improvement from 0.97 ± 0.06 to 1.10 ± 0.07 (p = 0.06). Both forearm hemodynamic parameters showed favorable changes from baseline to the end of the study ( forearm blood flow, 3.39 ± 0.28 vs. 4.04 ± 0.31 ml/100ml/min, p < 0.05; forearm vascular resistance, 37.75 ± 4.95 vs. 28.73 ± 3.34 mmHg/ml/100ml/ min, p < 0.05). The lipid profiles followed trends toward favorable changes after treatment (high density lipoprotein, 51.8 ± 3.0 vs. 54.4 ± 3.3 mg/ dl, p = NS; low density lipoprotein, 146.1 ± 8.8 vs. 139.9 ± 10.6 mg/dl, p = NS). Hematological and biochemical parameters did not change at the end of treatment. Conclusion: Once-daily nifelan as monotherapy was safe and effective in Chinese patients with mild to moderate essential hypertension. Regression of left ventricular mass and reversal of unfavorable forearm hemodynamics were observed in these patients after short-term therapy. |
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