缬沙坦对原发性高血压患者窦性心率震荡及心率变异性的影响

Effect of Valsartan on Heart Rate Turbulence and Heart Rate Variation of Essential with Essential Hypertension

目的:探讨缬沙坦对原发性高血压(EH)患者窦性心率震荡(HRT)和心率变异性(HRV)的影响。方法:45例轻中度EH患者(观察组)予缬沙坦胶囊80 mg,po qd,若血压控制不佳,加至160 mg·d^(-1),连用12周。另选择同期年龄、性别相匹配健康体检者30例作为对照组。比较治疗组治疗前后血压、心率及HRT、HRV相关指标,并与对照组比较。结果:观察组患者收缩压和舒张压均控制于正常范围(P<0.05或0.01),而治疗前后心率无明显改变(P>0.05)。治疗前,观察组患者初始值(T0)和起始时间(TT)明显高于对照组,斜率(TS)明显低于对照组(P<0.01);治疗后,其TO和TT均较前明显下降,TS较前明显上升(P<0.01)。治疗前,观察组患者标准差(SDNN)、每5min时段正常RR间期标准差的平均值(SDANN)和相邻RR之差的均方根值(RMSSD)均明显低于对照组,低频(LF)/高频功率(TF)比值明显高于对照组(P<0.01);治疗后,其SDNN、SDANN和RMSSD均较前明显上升,LF/TF比值较前明显下降(P<0.05)。结论:EH患者存在HRT和HRV指标异常,缬沙坦除具有良好降压作用外,还能明显改善患者的自主神经调节功能紊乱,减轻心脏功能受损,有利于减少恶性心血管事件发生,改善患者预后。

Objective：To discuss the effect of valsartan on heart rate turbulence（HRT） and heart rate variation（HRV） of patients with essential hypertension（EH）.Methods：45 cases of moderate EH patients were selected as the treatment group,who were given 80mg valsartan capsules through the mouth once a day,and if their blood pressure was not controlled well,their dose would be added to 160mg per day for 12 weeks.30 cases of healthy people,who had the same age and gender and took their physical examination,were selected as the controlled group.The blood pressure,heart rate, HRT,HRV and other relevant indexes of the patients in the treatment group were compared before and after medical treatment.Results：After 12 weeks＇ medical treatment,the systolic pressure and diastolic pressure of the patients in treatment group were controlled within the normal seope（P 0.05 or P 0.01）,and the heart rates had no obvious change before and after the medical treatment.The origin value（TO） and start time（TT） of the patients in the treatment group were much higher than those in the controlled group,and the slope ratio（TS） in the treatment group was much lower than that in the controlled group（P0.01 on average）.After 12 weeks＇ medical treatment,TO and TT obviously declined and TS obviously rose than before（P 0.01 on average）.The values of standard deviation（SDNN）,standard deviation average（SDANN） in normal RR time period for every 5 minutes and root mean square standard deviation（RMSSD） were much lower than those in the controlled group,but the low frequency（LF） /tall frequency（TF） ratios were much higher than those in the controlled group（P0.01 on average）.After 12 weeks＇ medical treatment,SDNN,SDANN and RMSSD obviously rose than before,and the LF/TF ratios obviously declined than before（P 0.05）.Conclusion：The HRT and HRV indexes of EH patients were abnormal,which showed that the regulation of autonomic nerve function was in disorder, and the heart function was damaged.Besides its favorable antihypertensive effect,valsartan could obviously improve the disorder of regulation of autonomic nerve function,and lighten the damage of the heart function,which was in favor of the reduction of occurrences of malignant cardiovascular disease and improvement of prognosis of patients.