坎地沙坦对高血压并阵发性心房颤动患者心率变异性和P波离散度的影响

Effects of Candesartan on Heart Rate Variability and P Wave Dispersion in Hypertensive Patients with Paroxysmal Atrial Fibrillation

目的探讨坎地沙坦对高血压并阵发性心房颤动患者心率变异性(HRV)、P波离散度(Pd)的影响。方法将高血压并阵发性心房颤动患者160例随机分为治疗组(n=80)和对照组(n=80)。治疗组给予坎地沙坦4mg/d,对照组给予非洛地平5mg/d,疗程20周,并在治疗前后行24h动态心电图(Holter)及普通心电图检查,对比观察治疗前后HRV、P波最大时限(Pmax)和Pd的变化。结果治疗后两组血压均较治疗前明显降低[对照组(133.8±8.9)/(74.4±7.1)比治疗前(157.2±10.6)/(87.6±10.4)mmHg;治疗组(134.6±7.5)/(76.3±6.9)比治疗前(158.9±8.3)/(85.6±10.2)mmHg;均P<0.01];治疗后两组血压之间无明显差异(P>0.05)。治疗组心房颤动复发率(56.3%比对照组63.8%)、发作持续时间[(16.9±5.7)比对照组(23.8±5.1)h]、发作时心室率[(105.5±11.4)比对照组(118.0±17.0)次/min]均较对照组明显改善(均P<0.05);治疗组HRV较治疗前明显改善(均P<0.05),Pmax、Pd明显减小(均P<0.01);治疗20周后与对照组比较,治疗组HRV[SDNN(170.3±51.7)比对照组(146.6±36.6)ms;SDANN(145.1±43.2)比对照组(118.3±29.1)ms;高频(201.6±71.3)比对照组(167.4±67.3)ms2;低频(346.6±120.5)比对照组(440.9±181.5)ms2;低频/高频(2.0±1.2)比对照组(3.8±1.0)、Pmax(116.4±16.6)比对照组(125.4±19.0)ms]和Pd[(31.8±8.3)比对照组(37.2±12.7)ms]改善有明显差异(均P<0.05)。结论坎地沙坦在降压的同时可改善高血压并阵发性心房颤动患者的HRV、Pmax、Pd,并可能减少阵发性心房颤动的发作。

Objective To study the effects of candesartan on heart rate variability（HRV） and P wave dispersion（Pd） in hypertensives with paroxysmal atrial fibrillation.Methods one hundred and sixty hypertensive patients with paroxysmal atrial fibrillation were randomly divided into the candesartan treated group （n=80） and control group （n=80）.Patients in treated group took candesartan 4 mg/d orally and the patients in control group took felodipine 5 mg/d orally for 20 weeks.HRV,Pd,maximal time of P wave （Pmax） on the Holter and ECG were measured before and after treatment.Results Blood pressure in two groups decreased significantly [control group （133.8±8.9）/（74.4±7.1） vs before treatment （157.2±10.6）/（87.6±10.4）mm Hg;treat group （134.6±7.5）/（76.3±6.9） vs before treatment （158.9±8.3）/（85.6±10.2）mm Hg;all P0.01] as compared to baseline,but there were no difference between the two groups after treatment （P0.05）;Compared with control group,atrial fibrillation recurrence rate （56.3% vs control group：63.8%）,persistant duration of atrial fibrillation [（16.9±5.7） vs control group （23.8±5.1）h],ventricular rate [（105.5±11.4） vs control group （118.0±17.0）beat/min] were improved in treat group （all P0.05）.HRV were improved [SDNN（170.3±51.7） vs control group （146.6±36.6）ms;SDANN （145.1±43.2） vs control group （118.3±29.1）ms;HF （201.6±71.3） vs control group （167.4±67.3）ms2;LF （346.6±120.5） vs control group （440.9±181.5）ms2;LF/HF（2.0±1.2） vs control group （3.8±1.0）;all P0.05],while Pmax[（116.4±16.6） vs control group （125.4±19.0）ms] and Pd [（31.8±8.3） vs control group （37.2±12.7）ms] were decreased （all P0.01） after candesartan treatment for 20 weeks,and they were significantly improved compared with control group （all P0.05）.Conclusion Candesartan shows beneficial effect on HRV,Pmax,Pd in hypertension complicated with atrial fibrillation,and reduce the onsets of atrial fibrillation.