富马酸比索洛尔与阿替洛尔对原发性高血压患者静息心率及交感神经活性的影响  

Effects of bisoprolol fumarate and atenolol on resting heart rate and sympathetic nervous system's activity in patients with essential hypertension

作　　者：周伟君[1,2] 王明生[3] 王仁颖 谭丽玲[3] 高平进[1] 

机构地区：[1]上海瑞金医院高血压科上海市高血压重点实验室上海市高血压研究所上海交通大学医学院,上海200025 [2]上海瑞金医院急诊科上海交通大学医学院 [3]北京市石景山医院心内科

出　　处：《中华高血压杂志》2014年第11期1061-1065,共5页Chinese Journal of Hypertension

摘　　要：目的研究富马酸比索洛尔与阿替洛尔对静息心率≥70次/min的原发性高血压患者交感神经活性的影响。方法采用随机、平行和对照研究（国际注册编号：NCT01251146）,入选2010年10月至2012年3月就诊于上海交通大学医学院附属瑞金医院和北京市石景山医院门诊的轻、中度原发性高血压患者177例,随机服用富马酸比索洛尔（5.0、7.5、10.0mg/d,n=86）或阿替洛尔（50、75、100mg/d,n=91）4~8周。利用12导联心电图测量2min所显示的心率代表静息心率;利用连续性手指脉压测量仪Finometer计算压力反射敏感度（BRS）、心率变异（包括低频,高频和低频与高频比值）和血压变异,通过此3项指标评价交感神经活性,数据采集时间30min。结果富马酸比索洛尔组达到目标心率（静息心率≤65次/min）者80例,其中服用5.0、7.5、10.0 mg/d分别占90.0%、8.8%和1.2%;阿替洛尔组达到目标心率者78例,其中服用50、75和100mg/d分别占92.3%、7.7%和0%。与治疗前比较,两组末次随访的24h平均收缩压、24h平均舒张压、24h平均动脉压、静息心率和低频与高频比值明显下降,高频明显上升（均P〈0.05）。与治疗前比较,富马酸比索洛尔组末次随访低频升高[（360.8±334.9）比（261.8±208.4）ms2,P〈0.05）],而阿替洛尔组差异无统计学意义。心率控制后和末次随访BRS值明显高于治疗前（均P〈0.05）。富马酸比索洛尔组无不良事件发生,阿替洛尔组有2例共发生5次不良事件。结论富马酸比索洛尔与阿替洛尔能有效控制BRS、静息心率和心率变异,抑制高血压患者交感神经活性。Objective To evaluate the effects of bisoprolol fumarate（Concor？）and atenolol on sympathetic nervous system’s activity（SNA）in essential hypertensive patients who had resting heart rate（RHR）≥70beats/min.Methods This was a randomized,parallel and controlled study（registered at the Clinicaltrial.Gov;NCT01251146）.A total of177 hypertensive subjects were enrolled from outpatient clinics of RuiJin Hospital Affiliated to Shanghai Jiaotong University and Beijing Shijingshan Hospital from October 2010 to March 2012,and they were randomized to the treatment of bisoprolol fumarate（5.0,7.5,10mg/d,n=86）or atenolol（50,75,100mg/d,n=91）for 4-8weeks. RHR was measured by 12-lead electrocardiography with patient at supine position for 2 minmutes. To evaluate SNA,baroreflex sensitivity（BRS）,heart rate variability（HRV）including the low-frequency（LF）,high frequency（HF）and LF/HF ratio,and blood pressure variability（BPV）were measured by power spectral analyses using a Finometer,30 minutes were needed to collect these data. Results Eighty patients in bisoprolol fumarate group achieved target heart rate（RHR≤65beats/min）,while 78 patients in atenolol group achieved target heart rate. In these patients,the distribution of different doses in bisoprolol fumarate group（5.0,7.5,10.0mg/d）was90.0%,8.8%,1.2%,respectively,and in atenolol group（50,75,100mg/d）was 92.3%,7.7%,0%,respectively. Compared with the baseline,24 hmean systolic and diastolic blood pressure,24 hmean arterial pressure,RHR and LF/HF ration were significantly reduced,while HF waa increased at the last visit（all P 〈0.05）.Compared with the baseline,LF of HRV was significantly increased in patients from the bisoprolol fumarate group[（360.8±334.9）vs（261.8±208.4）ms2,P〈0.05],while no significant change was observed for patients from the atenolol group. Compared with the baseline,the index of BRS of both groups was greatly improved after RHR control and in the last visit（all P〈0.05）. In patients from

关 键 词：原发性高血压 富马酸比索洛尔 阿替洛尔 静息心率 压力反射敏感度 心率变异 

分 类 号：R544.11[医药卫生—心血管疾病]