[ACC2009]CCB在高血压治疗中的地位如何？—专访Norman Kaplan、Suzanne Oparil、Henry R. Black -国际循环网

[ACC2009]CCB在高血压治疗中的地位如何？—专访Norman Kaplan、Suzanne Oparil、Henry R. Black

作者:国际循环网日期:2009/5/15 19:20:00

Black博士：钙通道阻滞剂是非常好的抗高血压药物，无论是用于起始治疗，还是作为联合治疗的用药之一。ALLHAT试验证实CCB是很好的降压选择。ACCOMPLISH试验显示，CCB与ACEI联用优于利尿剂加ACEI。ASCOT试验也是如此。这些大型临床试验给我们的治疗提供了依据。特别是对于中国人群，发生卒中的风险很高，CCB是非常理想的药物，中国的高血压患者应当尽量早使用CCB。

Henry R. Black
美国高血压协会（ASH）现任主席
美国纽约大学医学院教授

Dr. Henry R. Black: Calcium channel blockers are an excellent drug for the initiation of therapy and also to add on to other things. I think now we know, from multiple studies including ALLHAT where they were an option, ACCOMPLISH they were proved to be better that diuretics when added to an ACE-inhibitor. In other studies as well like ASCOT , and we always depend on these large trials to give us advice. For the Chinese especially who are at high risk for stroke, they are really excellent agents and should be used really early.

Norman Kaplan
美国心脏协会（AHA）终身成就奖得主
WHO/ISH指南委员会成员
美国德克萨斯大学西南医学中心教授

Dr. Norman Kaplan: The longest acting, which is amlodipine. It is now being combined with a variety of other medications with ACE-inhibitors and ARBs and the direct renin inhibitor. It has been accepted as being the easiest on the patient and the more likely to maintain good control because of its long duration of action. Amlodipine is the most popular in the United States，because it is a slow acting and long acting drug. It is a true once a day，and as a matter of fact if doses are skipped, the blood pressure stays down. And it has been used in numerous clinical trials

Kaplan博士：在长效CCB中，氨氯地平的作用时间最长。目前氨氯地平是多种联合治疗方案的用药，与ACEI、ARB或者直接肾素抑制剂都可以联合使用。氨氯地平是公认的依从性最好的药物。由于其作用时间长，患者的血压能够控制得更好。在美国，最常用的CCB是氨氯地平。因为氨氯地平作用和缓，降压持久。氨氯地平是真正的每日只需服药一次的药物。事实上，即使是偶尔的漏服，氨氯地平的良好降压作用仍能在一定程度上保持。当然地，氨氯地平成为了众多大型临床研究的的经常选择。

Suzanne Oparil
JNC 8指南委员会主席
美国高血压协会（ASH）前任主席
美国阿拉巴马大学伯明翰分校教授

Dr. Suzanne Oparil: Sustained release nifedipine is also very powerful and works very well but the quality of the effect varies a little bit with the mechanism of the sustained release. We don't use a plain capsule with nifedipine because it has a very rapid effect and it is dangerous. Felodipine I think is a little bit weaker and it also has a shorter duration of action.

Oparil博士：硝苯地平缓释剂也是有效的降压药物。但是其作用的一致性存在一定的问题。主要的原因是由于剂型技术的效果很难在所有人群都能一致。在美国，我们不用普通剂型的硝苯地平。因为它起效非常迅速，会带来危险。非洛地平降压作用较弱，持续时间也较短。