β受体阻滞剂对不同基础心率的高血压患者的疗效分析
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摘要
目的:探讨β受体阻滞剂对不同基础心率下的高血压患者的疗效。方法:未使用β受体阻滞剂的高血压患者191例,根据不同的基础心率分成3组,其中A组:70~79次/mi(nn=58);B组:80~89次/min(n=90);C组:≥90次/min(n=43)。所有患者予美托洛尔缓释片每日47.5 mg口服,2周后未达目标心率者每日增加23.75 mg,即71.25 mg,4周后仍未达目标心率,剂量加倍,即95 mg,总疗程8周。2周随访一次,测量血压及心率。结果:62%的高血压患者基础心率>80次/min,36%的患者基础心率>85次/min,20%的患者基础心率>90次/min。所有患者的美托洛尔缓释片平均每日剂量为(59.7±17.0)mg。3组患者治疗后心率均明显下降(P均<0.05),下降幅度依次为C组(29.3±7.8)次/min、B组(18.7±4.9)次/min、A组(11.0±4.0)次/min(P<0.01);基础心率每增加10次/min,心率降低幅度约增加7.9%。3组患者间治疗前后血压的下降幅度差异无统计学意义(P>0.05)。每日口服47.5 mg、71.25 mg及95 mg美托洛尔缓释片的患者心率平均降幅依次为(17.6±8.1)次/min、(19.5±8.7)次/min和(22.5±9.2)次/min;美托洛尔缓释片每日剂量增至71.25 mg和95 mg,平均心率降幅分别增加10.8%和27.8%。研究期间仅1例患者出现窦性心动过缓,1例出现头晕,减量或停药后均好转。结论:本研究62%的高血压患者基础心率>80次/min;患者基础心率越快,美托洛尔缓释片降低心率的幅度越大。高血压患者每日口服47.5~95 mg美托洛尔缓释片安全、有效。
Objective: To explore the effect of β-blocker in hypertension patients with different basic heart rate(HR). Methods: A total of 191 hypertension patients without using β-blocker were enrolled. Based on different basic HR, the patients were divided into 3 groups: Group A: HR(70-79) beats/min, n =58, Group B: HR(80-89) beats/min, n =90 and Group C: HR≥90 beats/min, n=43. All patients received metoprolol extended release at 47.5 mg/d for 2 weeks, for those didn't reach the target HR, 23.75 mg/d was added as 71.25 mg/d for 4 weeks, for those still didn't reach target HR, the dose was added to 95 mg/d, total length of medication was 8 weeks. Blood pressure(BP) and HR were measured every 2 weeks in all patients.Results: 62% patients had basic HR>80 beats/min, 36% had basic HR>85 beats/min and 20% had basic HR>90 beats/min. The average dose of metoprolol was(59.7±17.0) mg/d. HR decreased in 3 groups after medication, all P <0.05. The reducing level in Group C was(29.3±7.8) beats/min, in Group B was(18.7±4.9) beats/min and in Group A was(11.0±4.0) beats/min, P<0.05; upon HR elevating 10 beats/minute, metoprolol caused HR reducing may increase 7.9%. BP was similar among 3 groups before and after medication, P>0.05. The average HR decreasing levels in patients with metoprolol 47.5 mg/d, 71.25 mg/d and 95 mg/d were(17.6±8.1) beats/min,(19.5±8.7) beats/min and(22.5±9.2) beats/min respectively; upon dose elevated to 71.25 mg/d and 95 mg/d, metoprolol caused HR reducing may increase10.8% and 27.8%. 1 patient had sinus bradycardia and 1 had dizziness during medication, the symptoms improved by dose reducing or drug withdrawal.Conclusion: About 2/3 hypertension patients had basic HR>80 beats/min, metoprolol could cause more HR reducing in patients with the faster basic HR. Metoprolol(47.5-95) mg/d was safe and effective in hypertension patients.
Objective: To explore the effect of β-blocker in hypertension patients with different basic heart rate(HR). Methods: A total of 191 hypertension patients without using β-blocker were enrolled. Based on different basic HR, the patients were divided into 3 groups: Group A: HR(70-79) beats/min, n =58, Group B: HR(80-89) beats/min, n =90 and Group C: HR≥90 beats/min, n=43. All patients received metoprolol extended release at 47.5 mg/d for 2 weeks, for those didn't reach the target HR, 23.75 mg/d was added as 71.25 mg/d for 4 weeks, for those still didn't reach target HR, the dose was added to 95 mg/d, total length of medication was 8 weeks. Blood pressure(BP) and HR were measured every 2 weeks in all patients.Results: 62% patients had basic HR>80 beats/min, 36% had basic HR>85 beats/min and 20% had basic HR>90 beats/min. The average dose of metoprolol was(59.7±17.0) mg/d. HR decreased in 3 groups after medication, all P <0.05. The reducing level in Group C was(29.3±7.8) beats/min, in Group B was(18.7±4.9) beats/min and in Group A was(11.0±4.0) beats/min, P<0.05; upon HR elevating 10 beats/minute, metoprolol caused HR reducing may increase 7.9%. BP was similar among 3 groups before and after medication, P>0.05. The average HR decreasing levels in patients with metoprolol 47.5 mg/d, 71.25 mg/d and 95 mg/d were(17.6±8.1) beats/min,(19.5±8.7) beats/min and(22.5±9.2) beats/min respectively; upon dose elevated to 71.25 mg/d and 95 mg/d, metoprolol caused HR reducing may increase10.8% and 27.8%. 1 patient had sinus bradycardia and 1 had dizziness during medication, the symptoms improved by dose reducing or drug withdrawal.Conclusion: About 2/3 hypertension patients had basic HR>80 beats/min, metoprolol could cause more HR reducing in patients with the faster basic HR. Metoprolol(47.5-95) mg/d was safe and effective in hypertension patients.
引文
[1]Palatini P,Benetos A,Julius S.Impact of increased heart rate on clinical outcomes in hypertension:implications for antihypertensive drug therapy.Drugs,2006,66:133-144.
[2]白梅,李学文,米小龙,等.动态心率的变化对高血压病人预后的影响.中国循环杂志,2013,28:103.
[3]Yusuf S,Islam S,Chow CK,et al.Use of secondary prevention drugs for cardiovascular disease in the community in high-income,middleincome,and low-income countries(the PURE Study):a prospective epidemiological survey.Lancet,2011,378:1231-1243.
[4]中国高血压防治指南修订委员会.中国高血压防治指南2010.中华高血压杂志,2011,19:701-743.
[5]王文,张维忠,孙宁玲,等.中国血压测量指南.中华高血压杂志,2011,19:1101-1114.
[6]Levy RL,White PD,Stroud WD,et al.Transient tachycardia prognostic significance alone and in association with transient hypertension.J Am Med Assoc,1945,129:585-588.
[7]Inoue T,Iseki K,Iseki C,et al.Higher heart rate predicts the risk of developing hypertension in a normotensive screened cohort.Circ J,2007,71:1755.
[8]Morcet JF,Safar M,Thomas F,et al.Associations between heart rate and other risk factors in a large French population.J Hypertens,1999,17:1671-1676.
[9]Palatini P,Dorigatti F,Zaetta V,et al.Heart rate as a predictor of development of sustained hypertension in subjects screened for stage1 hypertension:the HARVEST Study.J Hypertens,2006,24:1873-1880.
[10]Fox K,Borer JS,Camm AJ,et al.Resting heart rate in cardiovascular disease.J Am Coll Cardiol,2007,50:823-830.
[11]Cucherat M.Quantitative relationship between resting heart rate reduction and magnitude of clinical benefits in post-myocardial infarction:a meta-regression of randomized clinical trials.Eur Heart J,2007,28:3012-3019.
[12]Okin PM,Kjeldsen SE,Julius S,et al.Effect of changing heart rate during treatment of hypertension on incidence of heart failure.Am JCardiol,2012,109:699-704.
[13]Mann J,Julius S.The Valsartan Antihypertensive Long-term Use Evaluation(VALUE)trial of cardiovascular events in hypertension.Blood Press,1998,7:176-183.
[14]Kolloch R,Legler UF,Champion A,et al.Impact of resting heart rate on outcomes in hypertensive patients with coronary artery disease:findings from the INternational VErapamil-SR/trandolapril STudy(INVEST).Eur Heart J,2008,29:1327-1334.
[15]Fox K,Ford I,Steg PG,et al.Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction(BEAUTIFUL):a subgroup analysis of a randomised controlled trial.Lancet,2008,372:817-821.
[16]Hoffmann C,Leitz M,Oberdorf-Maass S,et al.Comparative pharmacology of humanβ-adrenergic receptor subtypescharacterization of stably transfected receptors in CHO cells.N-SArch Pharmacol,2004,369:151-159.
[17]Falkner B,Kushner H.Treatment with metoprolol succinate,a selective beta adrenergic blocker,lowers blood pressure without altering insulin sensitivity in diabetic patients.J Clin Hypertens,2008,10:51-57.
[18]Wikstrand J,Warnold I,Tuomilehto J,et al.Metoprolol versus thiazide diuretics in hypertension.Morbidity results from the MAPHY study.Hypertension,1991,17:579-588.
[2]白梅,李学文,米小龙,等.动态心率的变化对高血压病人预后的影响.中国循环杂志,2013,28:103.
[3]Yusuf S,Islam S,Chow CK,et al.Use of secondary prevention drugs for cardiovascular disease in the community in high-income,middleincome,and low-income countries(the PURE Study):a prospective epidemiological survey.Lancet,2011,378:1231-1243.
[4]中国高血压防治指南修订委员会.中国高血压防治指南2010.中华高血压杂志,2011,19:701-743.
[5]王文,张维忠,孙宁玲,等.中国血压测量指南.中华高血压杂志,2011,19:1101-1114.
[6]Levy RL,White PD,Stroud WD,et al.Transient tachycardia prognostic significance alone and in association with transient hypertension.J Am Med Assoc,1945,129:585-588.
[7]Inoue T,Iseki K,Iseki C,et al.Higher heart rate predicts the risk of developing hypertension in a normotensive screened cohort.Circ J,2007,71:1755.
[8]Morcet JF,Safar M,Thomas F,et al.Associations between heart rate and other risk factors in a large French population.J Hypertens,1999,17:1671-1676.
[9]Palatini P,Dorigatti F,Zaetta V,et al.Heart rate as a predictor of development of sustained hypertension in subjects screened for stage1 hypertension:the HARVEST Study.J Hypertens,2006,24:1873-1880.
[10]Fox K,Borer JS,Camm AJ,et al.Resting heart rate in cardiovascular disease.J Am Coll Cardiol,2007,50:823-830.
[11]Cucherat M.Quantitative relationship between resting heart rate reduction and magnitude of clinical benefits in post-myocardial infarction:a meta-regression of randomized clinical trials.Eur Heart J,2007,28:3012-3019.
[12]Okin PM,Kjeldsen SE,Julius S,et al.Effect of changing heart rate during treatment of hypertension on incidence of heart failure.Am JCardiol,2012,109:699-704.
[13]Mann J,Julius S.The Valsartan Antihypertensive Long-term Use Evaluation(VALUE)trial of cardiovascular events in hypertension.Blood Press,1998,7:176-183.
[14]Kolloch R,Legler UF,Champion A,et al.Impact of resting heart rate on outcomes in hypertensive patients with coronary artery disease:findings from the INternational VErapamil-SR/trandolapril STudy(INVEST).Eur Heart J,2008,29:1327-1334.
[15]Fox K,Ford I,Steg PG,et al.Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction(BEAUTIFUL):a subgroup analysis of a randomised controlled trial.Lancet,2008,372:817-821.
[16]Hoffmann C,Leitz M,Oberdorf-Maass S,et al.Comparative pharmacology of humanβ-adrenergic receptor subtypescharacterization of stably transfected receptors in CHO cells.N-SArch Pharmacol,2004,369:151-159.
[17]Falkner B,Kushner H.Treatment with metoprolol succinate,a selective beta adrenergic blocker,lowers blood pressure without altering insulin sensitivity in diabetic patients.J Clin Hypertens,2008,10:51-57.
[18]Wikstrand J,Warnold I,Tuomilehto J,et al.Metoprolol versus thiazide diuretics in hypertension.Morbidity results from the MAPHY study.Hypertension,1991,17:579-588.