• 四川大學(xué)華西醫(yī)院神經(jīng)內(nèi)科,成都 610041;

通過檢索MEDLINE和Cochrane圖書館,了解鈣通道阻滯劑的作用機(jī)制,對其應(yīng)用于腦卒中一﹑二級預(yù)防的證據(jù)進(jìn)行總結(jié)和評價.結(jié)果發(fā)現(xiàn),鈣通道阻滯劑除具有降低血壓作用以外,還有抗動脈粥樣硬化的作用,能夠降低中風(fēng)的發(fā)生率,在腦卒中一級預(yù)防中有一定作用,但也有增加心臟病變包括心肌梗塞和心衰的風(fēng)險.目前尚無證據(jù)證明鈣通道阻滯劑在腦卒中二級預(yù)防中的效果,因此不推薦鈣通道阻滯劑作為腦卒中預(yù)防的一線藥物.

引用本文： 吳 波,何 俐. 鈣通道阻滯劑預(yù)防腦卒中的臨床證據(jù). 中國循證醫(yī)學(xué)雜志, 2005, 05(10): 792-796. doi: 復(fù)制

1. 顧東風(fēng),吳錫桂,甘文奇,劉東海,宿少勇,段秀芳,黃廣勇.中國成年人高血壓的患病率、知曉率、治療和控制狀況[J].中華預(yù)防醫(yī)學(xué)雜志,2003;37(2):84～89.
2. Gu DF,Wu XG,Gan WQ,Liu DH,Shu SY,Duan XF,Huang GY.The morbidity rate,treatment and control[J].Chinese Journal of Phylaxiology,2003;37(2):84-89.
3. Song YM,Sung J,Lawlor DA,Smith DG,Shin Y,Ebrahim S.Blood pressure,haemorrhagic stroke,and ischaemic stroke:the Korean national prospective occupational cohort study[J].BMJ,2004;328(7435):324-325.
4. He J,Whelton PK.Elevated systolic blood pressure and risk of cardiovascular and renal disease:overview of evidence from observational epidemiologic studies and randomized controlled trials[J].Am Heart J,1999;138(3 Pt 2):211-219.
5. Luscher TF,Cosentino F.The classification of calcium antagonists and their selection in the treatment of hypertension,A reappraisal[J].Drugs,1998;55(4):509-517.
6. Asmar R,Benetos A,Ghodsi N,Meilhac B,Safar M.Regional arterial hemodynamics and carotid circulation in essential arterial hypertension.Effect of nitrendipine in patients over 40 years of age[J].Presse Medicale,1993;22(35):1770-1775.
7. Zanchetti A,Bond MG,Hennig M,Neiss A,Mancia G,Dal Palu C,et al.European Lacidipine Study on Atherosclerosis investigators.Calcium antagonist lacidipine slows down progression of asymptomatic carotid atherosclerosis:principal results of the European Lacidipine Study on Atherosclerosis (ELSA),a randomized,double-blind,long-term trial[J].Circulation,2002;106(19):2422-2427.
8. Simon A,Gariepy J,Moyse D,Levenson J.Differential effects of nifedipine and co-amilozide on the progression of early carotid wall changes[J].Circulation,2001;103(24):2949-2954.
9. Neal B,MacMahon S,Chapman N.Blood Pressure Lowering Treatment Trialists Collaboration.Effects of ACE inhibitors,calcium antagonists,and other blood-pressure-lowering drugs:results of prospectively designed overviews of randomised trials.Blood Pressure Lowering Treatment Trialists’Collaboration[J].Lancet,2000;356(9246):1955-1964.
10. Kaplan NM.Hypertension trials:1990 to 2000[J].Current Opinion in Nephrology & Hypertension,2001;10(4):501-505.
11. Opie LH,Schall R.Evidence-based evaluation of calcium channel blockers for hypertension:equality of mortality and cardiovascular risk relative to conventional therapy[J].Journal of the American College of Cardiology,2002;39(2):315-322.
12. Kloner RA,Vetrovec GW,Materson BJ,Levenstein M.Safety of long-acting dihydropyridine calcium channel blockers in hypertensive patients[J].American Journal of Cardiology,1998;81(2):163-169.
13. Pahor M,Psaty BM,Alderman MH,Applegate WB,Williamson JD,Cavazzini C,Furberg CD.Health outcomes associated with calcium antagonists compared with other first-line antihypertensive therapies:a meta-analysis of randomised controlled trials[J].Lancet,2000;356(9246):1949-1954.
14. Stason WB,Schmid CH,Niedzwiecki D,Whiting GW,Caubet JF,Luo D,Ross SD,Chalmers TC.Safety of nifedipine in patients with hypertension:a meta-analysis[J].Hypertension,1997;30(1 Pt 1):7-14.
15. Black HR,Elliott WJ,Grandits G,Grambsch P,Lucente T,White WB.CONVINCE Research Group.Principal results of the Controlled Onset Verapamil Investigation of Cardiovascular End Points (CONVINCE) trial[J].JAMA,2003;289(16):2073-2082.
16. Pepine CJ,Handberg EM,Cooper-DeHoff RM,Marks RG,Kowey P,Messerli FH.INVEST Investigators.A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease.The International Verapamil-Trandolapril Study (INVEST):a randomized controlled trial[J].JAMA,2003;290(21):2805-2816.
17. Liu L,Wang JG,Gong L,Liu G,Staessen JA.Comparison of active treatment and placebo in older Chinese patients with isolated systolic hypertension.Systolic Hypertension in China (Systtaab2China) Collaborative Group[J].Journal of Hypertension,1998;16(12 Pt 1):1823-1829.
18. Staessen JA,Fagard R,Thijs L,Celis H,Arabidze GG,Birkenhager WH.Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension.The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators[J].Lancet,1997;350(9080):757-764.
19. Borhani NO,Mercuri M,Borhani PA,Buckalew VM,Canossa-Terris M,Carr AA.Final outcome results of the Multicenter Isradipine Diuretic Atherosclerosis Study (MIDAS).A randomized controlled trial[J].JAMA,1996;276(10):785-791.
20. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group.The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic:The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) [J].JAMA,2002;288(23):2981-2997.
21. Anonymous.A prospective study on the effect of nifedipine of the cardiovascular complications in the elderly hypertensive[J].Chinese Journal of Cardiology,1992;20 (5):281-284.
22. Sun M,Zhou H,Jia Z.Prevention and treatment of stroke after hypertension for ten years in Hunan Province[J].Chinese Journal of Internal Medicine,1997;36(5):312-314.
23. Zannad F.Effects of calcium antagonists on atherosclerosis progression and intima media thickness[J].Drugs,2000;59(Spec No 2):39-46.
24. Rodgers A,MacMahon S,Gamble G,Slattery J,Sandercock P,Warlow C.Blood pressure and risk of stroke in patients with cerebrovascular disease.The United Kingdom Transient Ischaemic Attack Collaborative Group[J].BMJ,1996;313(7050):147.
25. Rashid P,Leonardi-Bee J,Bath P.Blood pressure reduction and secondary prevention of stroke and other vascular events:a systematic review[J].Stroke,2003;34(11):2741-2748.
26. Ogasawara K,Noda A,Yasuda S,Kobayashi M,Yukawa H,Ogawa A.Effect of calcium antagonist on cerebral blood flow and oxygen metabolism in patients with hypertension and chronic major cerebral artery occlusion:a positron emission tomography study[J].Nuclear Medicine Communications,2003;24(1):71-76.
  1. 1. 顧東風(fēng),吳錫桂,甘文奇,劉東海,宿少勇,段秀芳,黃廣勇.中國成年人高血壓的患病率、知曉率、治療和控制狀況[J].中華預(yù)防醫(yī)學(xué)雜志,2003;37(2):84～89.
  2. 2. Gu DF,Wu XG,Gan WQ,Liu DH,Shu SY,Duan XF,Huang GY.The morbidity rate,treatment and control[J].Chinese Journal of Phylaxiology,2003;37(2):84-89.
  3. 3. Song YM,Sung J,Lawlor DA,Smith DG,Shin Y,Ebrahim S.Blood pressure,haemorrhagic stroke,and ischaemic stroke:the Korean national prospective occupational cohort study[J].BMJ,2004;328(7435):324-325.
  4. 4. He J,Whelton PK.Elevated systolic blood pressure and risk of cardiovascular and renal disease:overview of evidence from observational epidemiologic studies and randomized controlled trials[J].Am Heart J,1999;138(3 Pt 2):211-219.
  5. 5. Luscher TF,Cosentino F.The classification of calcium antagonists and their selection in the treatment of hypertension,A reappraisal[J].Drugs,1998;55(4):509-517.
  6. 6. Asmar R,Benetos A,Ghodsi N,Meilhac B,Safar M.Regional arterial hemodynamics and carotid circulation in essential arterial hypertension.Effect of nitrendipine in patients over 40 years of age[J].Presse Medicale,1993;22(35):1770-1775.
  7. 7. Zanchetti A,Bond MG,Hennig M,Neiss A,Mancia G,Dal Palu C,et al.European Lacidipine Study on Atherosclerosis investigators.Calcium antagonist lacidipine slows down progression of asymptomatic carotid atherosclerosis:principal results of the European Lacidipine Study on Atherosclerosis (ELSA),a randomized,double-blind,long-term trial[J].Circulation,2002;106(19):2422-2427.
  8. 8. Simon A,Gariepy J,Moyse D,Levenson J.Differential effects of nifedipine and co-amilozide on the progression of early carotid wall changes[J].Circulation,2001;103(24):2949-2954.
  9. 9. Neal B,MacMahon S,Chapman N.Blood Pressure Lowering Treatment Trialists Collaboration.Effects of ACE inhibitors,calcium antagonists,and other blood-pressure-lowering drugs:results of prospectively designed overviews of randomised trials.Blood Pressure Lowering Treatment Trialists’Collaboration[J].Lancet,2000;356(9246):1955-1964.
  10. 10. Kaplan NM.Hypertension trials:1990 to 2000[J].Current Opinion in Nephrology & Hypertension,2001;10(4):501-505.
  11. 11. Opie LH,Schall R.Evidence-based evaluation of calcium channel blockers for hypertension:equality of mortality and cardiovascular risk relative to conventional therapy[J].Journal of the American College of Cardiology,2002;39(2):315-322.
  12. 12. Kloner RA,Vetrovec GW,Materson BJ,Levenstein M.Safety of long-acting dihydropyridine calcium channel blockers in hypertensive patients[J].American Journal of Cardiology,1998;81(2):163-169.
  13. 13. Pahor M,Psaty BM,Alderman MH,Applegate WB,Williamson JD,Cavazzini C,Furberg CD.Health outcomes associated with calcium antagonists compared with other first-line antihypertensive therapies:a meta-analysis of randomised controlled trials[J].Lancet,2000;356(9246):1949-1954.
  14. 14. Stason WB,Schmid CH,Niedzwiecki D,Whiting GW,Caubet JF,Luo D,Ross SD,Chalmers TC.Safety of nifedipine in patients with hypertension:a meta-analysis[J].Hypertension,1997;30(1 Pt 1):7-14.
  15. 15. Black HR,Elliott WJ,Grandits G,Grambsch P,Lucente T,White WB.CONVINCE Research Group.Principal results of the Controlled Onset Verapamil Investigation of Cardiovascular End Points (CONVINCE) trial[J].JAMA,2003;289(16):2073-2082.
  16. 16. Pepine CJ,Handberg EM,Cooper-DeHoff RM,Marks RG,Kowey P,Messerli FH.INVEST Investigators.A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease.The International Verapamil-Trandolapril Study (INVEST):a randomized controlled trial[J].JAMA,2003;290(21):2805-2816.
  17. 17. Liu L,Wang JG,Gong L,Liu G,Staessen JA.Comparison of active treatment and placebo in older Chinese patients with isolated systolic hypertension.Systolic Hypertension in China (Systtaab2China) Collaborative Group[J].Journal of Hypertension,1998;16(12 Pt 1):1823-1829.
  18. 18. Staessen JA,Fagard R,Thijs L,Celis H,Arabidze GG,Birkenhager WH.Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension.The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators[J].Lancet,1997;350(9080):757-764.
  19. 19. Borhani NO,Mercuri M,Borhani PA,Buckalew VM,Canossa-Terris M,Carr AA.Final outcome results of the Multicenter Isradipine Diuretic Atherosclerosis Study (MIDAS).A randomized controlled trial[J].JAMA,1996;276(10):785-791.
  20. 20. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group.The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic:The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) [J].JAMA,2002;288(23):2981-2997.
  21. 21. Anonymous.A prospective study on the effect of nifedipine of the cardiovascular complications in the elderly hypertensive[J].Chinese Journal of Cardiology,1992;20 (5):281-284.
  22. 22. Sun M,Zhou H,Jia Z.Prevention and treatment of stroke after hypertension for ten years in Hunan Province[J].Chinese Journal of Internal Medicine,1997;36(5):312-314.
  23. 23. Zannad F.Effects of calcium antagonists on atherosclerosis progression and intima media thickness[J].Drugs,2000;59(Spec No 2):39-46.
  24. 24. Rodgers A,MacMahon S,Gamble G,Slattery J,Sandercock P,Warlow C.Blood pressure and risk of stroke in patients with cerebrovascular disease.The United Kingdom Transient Ischaemic Attack Collaborative Group[J].BMJ,1996;313(7050):147.
  25. 25. Rashid P,Leonardi-Bee J,Bath P.Blood pressure reduction and secondary prevention of stroke and other vascular events:a systematic review[J].Stroke,2003;34(11):2741-2748.
  26. 26. Ogasawara K,Noda A,Yasuda S,Kobayashi M,Yukawa H,Ogawa A.Effect of calcium antagonist on cerebral blood flow and oxygen metabolism in patients with hypertension and chronic major cerebral artery occlusion:a positron emission tomography study[J].Nuclear Medicine Communications,2003;24(1):71-76.