不同降压药物对原发性高血压患者心率变异性的影响

Influence of hypotensive drug on heart rate variability in patients with primary hypertension

目的探讨替米沙坦、美托洛尔、雷米普利、氨氯地平对原发性高血压患者心率变异性的影响。方法将120例原发性高血压患者分为替米沙坦组、美托洛尔组、雷米普利组和氨氯地平组,每组30例。治疗前与治疗后8周做动态心电图监测并进行心率变异性分析。结果4组治疗前心率变异性指标比较差别均无统计学意义(P>0.05);替米沙坦组、美托洛尔组和雷米普利组治疗后时域指标中全部窦性心搏RR间期的标准差(SDNN),全程每5 min的RR间期平均值的标准差(SDANN),每5 min窦性RR间期标准差的均值(SDNNindex)均显著增高(P<0.01),频域指标中低频(LF)明显下降,高频(HF)明显增加(P<0.05或<0.01),而氨氯地平组治疗前、后心率变异性比较差别无统计学意义(P>0.05)。替米沙坦组和美托洛尔组的SDNN、SDANN、SDNNindex和DNN50高于雷米普利组,差别均有统计学意义(P<0.01,P<0.05)。结论替米沙坦、美托洛尔、雷米普利均可改善原发性高血压患者的心率变异性,尤以替米沙坦、美托洛尔更为显著,而氨氯地平片对原发性高血压患者的心率变异性无明显影响。

Objective To study the effect of telmisartan, metoprolol, ramipril and amlodipine on heart rate variability （HRV） in patients with primary hypertension. Methods One hundred and twenty cases of primary hypertension were divided into telmisartan, metoprolol, ramipril and amlodipine group, thirty cases in each group. Twenty-four hours dynamic electrocardiogram recordings and HRV were observed before and after eight weeks medication. Results There was no statistical difference in the indexes of HRV among four groups （P 〉 0.05）. Compared with pretreatment, in metoprolol, telmisartan and ramipril group, the standard deviation of all normal RR intervals（SDNN） ,standard deviation of the average normal RR intervals for 5 min segments（ SDANN）, and average standard deviation of all normal RR intervals for 5 min segments （SDNN index） were increased significantly（ P 〈 0. 01 ） ,low frequency（LF） was decreased obviously ,while high frequency（HF） was increased obviously（ P 〈 0.05 or 〈 0.01 ）. In amlodipine group, there was no marked difference before and after treatment（P 〉 0.05 ）. The effect of telmisartan and metoprolol groups was better than that of ramipril group （ P 〈 0. 05 or 〈 0. 01 ）. Conclusion Metoprolol ,telmisarran and ramipril can improve significantly the HRV in patients with primary hypertension, especially, the effect of telmisartan and metoprolol on HRV are better. Amlodipine can not improve significantly the HRV.