阻滞剂交感神经反射性刺激,增加心肌耗氧量,致心律失常;负性变力作用;钙阻滞剂扩张血管作用使严重冠心病患者的冠脉供血分流至较小的冠脉侧支循环血管,至使局部心肌缺血;抗血小板聚集,增加手术病人出血危险等有关.

短效硝苯吡啶的此类副作用能否推及其他类型钙拮抗剂成长效硝苯吡啶,只有大型,前瞻性研究才能证实.目前尚不能下定论.但它告诫临床医生,仍应将利尿剂和(或)b阻滞剂患者,有使用钙拮抗剂\ACEI等其它抗高血压药物指征时,应选择对病人个体最适宜的药物.

综上所述,目前已有临床提示在心血管疾病中使用短效,第一代钙拮抗剂对心血管疾病患者预后的不良影响.因此建议临床医生治疗心力衰竭\心绞痛及高血压患者时,应根据病情的个体差异,选择适宜药物,并避免长期使用短效,第一代钙拮抗剂.

 

参考文献：

1.Elkayam U,Amin J et al. A prospective, randomized double-blind,crossover study to       compare the efficacy and safety of chronic nifedipine therapy with that of isosorbide dinitrate and their combination in the treatment of chronic congestive heart failure. Circulation, 1990,82(6):1954

2.Gray S,Francis. Calcium channel blockers and congestive heart failure. Circulation,1991,83(1):36

3.Goldstein RE, Boccuzzi ST,et al.Diltizam increases late-onset congestive heart  failure in postinfarction patients with early reduction in ejection fraction. Circulation,1991,83(1):52

4.Milton Packer. Calcium channel blockers in chronic heart failure: the risks of " physiologically rational" therapy. Circulation,1990,82(6):2254

5.Packer M.Pathophysiollgical mechanisms underlying the adverse effect of calcium channel-blocking drugs in patients with chronic heart failure. Circulation,1989,80(6):59

6.Egstrup K, Andersen PE.Transient myocardial ischemia during nifedipine therapy in stable angina pectoris, and its relation to coronary collateral flow and comparison with Metoprolol. Am. J. Cardiol,1993,7:177

7.Muller JE, Tofler GH ,Stone PH, et al.Circadian variation and triggers of onset of acute cardiovascular disease. Circulation,1989,79(4):733

8.Furberger CD,Psaty BM, et al .Nifedipine Dose-Related increase in mortality in patients with coranary heart disease.Circulation.1995,92(5):1326

9.Pahor M,Grurolnik Jm. Corti MC, et al.Long-term survival and use of antihypertension medications in older persons. J . Am.Geriatric Soc, 1995 Nov.

10。徐叔云等《现代实用临床药理学》 北京：华夏出版社1997：563