In all actual clinical guidelines, dihydropyridine calcium channel blockers (CCBs) belong to the recommended first line antihypertensive drugs to treat essential hypertension. Several recent large clinical trials have confirmed their efficacy not only in lowering blood pressure but also in reducing cardiovascular morbidity and mortality in hypertensive patients with a normal or high cardiovascular risk profile. In clinical trials such as ALLHAT, VALUE or ASCOT, an amlodipine-based therapy was at least as effective, when not slightly superior, in lowering blood pressure and sometimes more effective in preventing target organ damages than blood pressure lowering strategies based on the use of diuretics, beta-blockers and blockers of the renin-angiotensin system. One of the main clinical side effects of the first and second generation CCBs including amlodipine is the development of peripheral edema. The incidence of leg edema can be markedly reduced by combining the CCB with a blocker of the renin-angiotensin system. This strategy has now led to the development of several fixed-dose combinations of amlodipine and angiotensin II receptor antagonists. Another alternative to lower the incidence of edema is to use CCBs of the third generation such as lercanidipine. Indeed, although no major clinical trials have been conducted with this compound, clinical studies have shown that lercanidipine and amlodipine have a comparable antihypertensive efficacy but with significantly less peripheral edema in patients receiving lercanidipine. In some countries, lercanidipine is now available in a single-pill association with an ACE inhibitor thereby further improving its efficacy and tolerability profile.

译文

:在所有实际的临床指南中,二氢吡啶类钙通道阻滞剂(CCB)属于推荐的用于治疗原发性高血压的一线抗高血压药物。最近的几项大型临床试验已经证实,它们不仅可以降低血压,而且可以降低具有正常或高心血管风险特征的高血压患者的心血管发病率和死亡率。在诸如ALLHAT,VALUE或ASCOT的临床试验中,基于氨氯地平的疗法在降低血压方面至少有同等效果(虽然效果不佳),有时在预防目标器官损伤方面比基于使用氨氯地平的降压策略更有效。利尿剂,β-受体阻滞剂和肾素-血管紧张素系统的阻滞剂。包括氨氯地平在内的第一代和第二代CCB的主要临床副作用之一是周围水肿的发展。通过将CCB与肾素-血管紧张素系统的阻滞剂联合使用,可以显着降低腿部浮肿的发生率。现在,该策略导致了氨氯地平和血管紧张素II受体拮抗剂的几种固定剂量组合的开发。降低水肿发生率的另一种方法是使用第三代CCB,例如lercanidipine。确实,尽管尚未对该化合物进行重大临床试验,但临床研究表明,lercanidipine和amlodipine具有相当的降压功效,但接受lercanidipine的患者外周水肿明显减少。在某些国家/地区,乐卡地平现在可以与ACE抑制剂一起以单药形式使用,从而进一步提高了其疗效和耐受性。

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