缓释维拉帕米与比索洛尔对高血压病患者交感神经活性的影响  

Effects of verapamil SR and bisoprolol on the sympathetic nervous system

作　　者：孙宁玲[1] 洪婷婷[1] 张瑞军 杨璇 

机构地区：[1]北京医科大学人民医院心内科,100044 [2]山东齐鲁石化中心医院心内科

出　　处：《中华心血管病杂志》2000年第3期181-184,共4页Chinese Journal of Cardiology

摘　　要：目的　探讨高血压病 (EH)患者交感神经反应及缓释维拉帕米和比索洛尔对其的影响。方法　对 78例EH患者 (维拉帕米组 5 0例 ,比索洛尔组 2 8例 )采用握力试验 ,观察握前及握后血压(BP)、心率 (HR)变化 ,及药物治疗后血浆去甲肾上腺素 (NE)、肾上腺素 (E)、血管紧张素Ⅱ (AngⅡ )、肾素 (PRA)及内皮素 (ET 1)的变化。结果　 (1)EH患者中有 70 %为高交感型。急性应激后血压心率上升超过 2 0 %。SBP/DBP由 (15 5 9± 4 5 ) /(97 1± 2 0 )mmHg升至 (195 9± 4 3) /(12 2 7± 2 1)mmHg,HR从 (77 3± 2 0 9)次 /min升至 (81 2± 2 1)次 /min。 (2 )高交感型EH患者药物治疗前血浆活性物质均已高于正常交感型EH患者。缓释维拉帕米组中高交感型治疗前血浆中NE ,ET 1,AngⅡ分别为 (5 92 4± 34 5 ) ,(72 4± 1 8) ,(92 6± 2 2 )ng/L ,比索洛尔组中高交感型治疗前血浆中NE ,ET 1,AngⅡ分别为 (4 2 4 3± 40 7) ,(6 7 2± 2 4) ,(72 4± 2 3)ng/L。 (3)药物治疗 6周后 ,两组的血压均有明显下降。缓释维拉帕米可使NE ,AngⅡ及ET 1水平降低 ,在高交感型中分别降至 (2 92 4± 31 2 ) ,(34 4± 1 4) ,(38 2± 1 6 )ng/L ,PRA浓度升高 ,比索洛尔能使E及PRA的水平明显降低。Objective To assess the response of the sympathetic nervous system (SNS) to handgrip test in patients with essential hypertension (EH) and evaluate the effects of verapamil SR and bisoprolol on reducing the SNS activity. Methods Totally, 78 patients with EH (verapamil group SR 50, bisoprolol group 28) performed handgrip test and the SBP, DBP and HR were measured before and after the text. Before and after the patients received the treatment of verapamil SR or bisoprolol, the plasma concentration of epinephrine (E), norepinephrine (NE), angiotensin Ⅱ (AngⅡ), aldosterone (ALD), endothelin 1 (ET 1) and renin activity (RA) were measured. Results (1) About 70% of patients with EH had a hyperreactive SNS. Their HR and BP increased by more than 20% when responsed to stress. SBP/DBP increased from 155 9±4 5/97 1±2 0 to 195 9±4 3/122 7±2 1 (mm Hg), and HR increased from 77 3±2 0 to 81 2±2 1 (bpm). (2) In these patients, the plasma concentrations of E, NE, AngⅡ, ET 1, ALD and RA before treatment were higher than those of whose SNS activity were normal. In verapamil SR group, the concentrations of NE, ET 1 and AngⅡ in patients with hyperreactivity were 592 4±34 5, 72 4±1 8 and 92 6±2 2 ng/L,respectivly. In patients whose sympathetic nervous system activities were above normal in bisoprolol group, the concentrations of NE, ET 1 and AngⅡ were 424 3±40 7, 67 2±2 4 and 72 4±2 3 ng/L. (3) After 6 week treatment, all the patients BP decreased apparently. Verapamil SR could reduced the plasma concentration of NE, AngⅡ and ET 1 to 292 4±31 2, 34 4± 1 4, 38 2±1 6 ng/L, respectively and increase RA. Bisoprolol could reduce E and RA. Conclusion These two antihypertension drugs can both decrease BP and reduce the activity of SNS by different means.

关 键 词：高血压 交感神经系统 维拉帕米 比索洛尔 治疗 

分 类 号：R544.1[医药卫生—心血管疾病]