International Circulation: It has shown in several studies， that β-blockers and ARB would increase the blood pressure variability of patients with hypertension， while CCB decrease it. Therefore， should CCB be given priority in antihypertensive therapy?
　Cameron: It has been suggested that greater short and long term (visit to visit) variation in SBP might be associated with increased cardiovascular risk.?All anti-hypertensives reduce blood pressure but?the various classes of anti hypertensives have different defined side-effects. However there is also evidence suggesting that certain classes are associated with increased benefit in some patients through non-blood pressure effects. In this context it?has been noted that calcium channel blockers might be associated with decreased longer term SBP variability . This is an interesting observation in that CCBs are also regarded as preferentially preventing stroke compared to other manifestations of hypertensive disease such as atherogenic progression and are perhaps to be preferred in the elderly on the basis of clinical trials.
To fully answer the question long term clinical trials confirming the hypothesis that CCBs decrease SBP variation and that SBP variation is directly and positively associated with cardiovascular events are required - these would take some years to complete if they were to begin. In the meantime the suggestion that CCBs decrease BP variation does add further weight to the current use of CCBs in the elderly but the evidence is not strong enough to change the commendations from other anti-hypertensives. In my opinion beta-blockers are not appropriate in essential hypertension and ARBs remain second line for inhibition of the RAAS in those who are intolerant of ACEIs.
《国际循环》：几项研究显示，β阻滞剂和ARB增加高血压患者的血压变异性，CCB能够降低血压变异性。那么，降压治疗是否应当优先选择CCB？
Cameron教授：研究显示，SBP的短时和长时（随访间）变异性增加可能与心血管风险增加相关。所有降压药物都能够降低血压，但是各类降压药物的不良反应有所不同。但是，也有证据显示，某些类别的降压药物通过降压以外的效应而给某些患者带来更多益处。在这方面，我们已经发现CCB可能降低SBP的长时变异。一个有意思的发现是，CCB预防卒中的作用比延缓动脉粥样硬化进展等高血压的其他表现更为有效，基于临床试验，老年患者可能要优先选择CCB。
为了全面回答这个问题，我们需要有长期随访的临床试验验证CCB降低SBP变异性，同时证实SBP变异性与心血管事件具有直接的正相关，这样的试验可能需要几年时间才能完成。在此期间，CCB降低血压变异性这一发现确实为当前在老年患者中应用CCB提供了更多的佐证，但是现有证据还不是很强，不足以改变现有的对降压药物的临床推荐。在我看来，β受体阻滞剂不适合原发性高血压的治疗，而ARB仍为二线药物，用于不能耐受ACEI的患者。