肾素-血管紧张素系统阻断剂对老年高血压异位心律的作用研究

The effect of renin-angiotensin system inhibition on the ectopic rhythm in elder hypertensive patients

目的 观察肾素-血管紧张素系统（renin-angiotensin system,RAS）阻断剂对室性或室上性异位心律的影响及作用.方法 将209例老年高血压患者随机分为RAS阻断剂组（n=111）和常规治疗组（n=98）.两组均接受常规抗心律失常治疗;RAS阻断剂组联合RAS阻断剂血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂.治疗前后24h动态心电图监测室性早搏（premature ventricular contractions,PVC）频率、室上性早搏（premature supraventricular contractions,PSVC）频率、短阵室性心动过速（ventricular tachycardia,VT）阵数或室上性心动过速（supraventricular tachycardia,SVT）阵数,比较治疗前后异位心律的频率.结果 治疗后常规治疗组与RAS阻断剂组24 h PVC频率均降低,常规治疗组[（6159.04±1435.00）vs（3979.25±1205.37）,P＜0.05];RAS阻断剂组[（6479.55±1344.21）vs （3123.52±1876.19）,P＜0.05].VT阵数也有所下降,常规治疗组[（17.85±3.98）vs（13.12 ±8.4）,P＜0.05];RAS 阻断剂组[（19.44±8.18）vs（7.69±3.07）,P＜0.05].RAS阻断剂组和常规治疗组PVC频率和VT阵数变化率分别为[（61.70±24.96）％ vs（41.79±16.26）％,P＜0.05]和[（82.17±37.15）％ vs （43.12±83.32）％,P＜0.05].治疗后RAS阻断剂组24h PSVC频率[（378.66±112.44）vs（99.01±78.24）,P＜0.05]和SVT阵数[（21.41±2.97）vs （8.92±4.30）,P＜0.05）均减少.常规治疗组治疗后SVT阵数减少[（17.85±3.98）vs （13.36±5.17）,P＜0.05）,而24h PSVC频率轻度增加[（359.33±141.09）vs（396.95±192.1）,P＞0.05].RAS阻断剂组和常规治疗组室上性异位心律变化率分别为[（66.60±40.22）％ vs（-8.72±16.23）％,P＜0.05]和[（46.48±16.23）％ vs （13.69±21.33）％,P＜0.05].RAS阻断剂组和常规治疗组治疗前后平均每小时异位心律频率均减少[（699.20±309.93） vs（211.05±139.22）,P＜0.05]和[（708±203.77）vs（369.31±95.64）,P＜0.05],RAS阻断剂组和常规治疗组变化率为[（59.15±22.03）％vs （22.77±23.64）％,P＜0.01].结论 RAS阻断剂对老年高血压患者室性及室上性异位心律有一定抑制作用.

Objective To investigate the effectiveness of renin-angiotensin system inhibitor on the ventricular or sup- reventricular ectopic rhythm in older patients with hypertension. Methods 209 subjects were included and divided into the RAS inhibitor group and control group randomly. Subjects in the control group were received routine anti-arrhythmia treat- ment, while those in RAS inhibitor group were received routine treatment and RAS inhibitors （ACEI or ARBs）. Holter monitor were carried to collect data as outcome measurement after treatment. The frequency of ectopic rhythm were analyzed. Results There was no significant difference of the baseline （epidemiology, Blood pressure level, frequency of ectopic rhythm） and in the treatment between the two groups （P 〉 0.05 ）. After treatment follow-up, the frequency of premature ventricular contractions of the two groups [the control group （6159.04±1435.00） ws （3979.25±1205.37）, P〈0.05, RAS inhibitor group （6479.55 ± 1344.21） vs （3123.52± 1876.19）, P〈 0.05] were decreased as well aswith that of ventricular tachycardia [the control group： （17.85 ±3.98） vs （13.12 ±8.4）, P〈 0.05, RAS inhibitor group （19.44 ±8.18） vs （7.69 ±3.07）, P〈0.05]. The change rate between the baseline and post-treatment follow-up timeline in the RAS inhibitor groups was more significant than that of the control group [PVC （61.70±24.96） % vs （41.79±16.26） %, P〈0.05, VT （82.17±37.15）% vs （43.12±83.32） %, P〈0.05]. The frequency of PSVC [（378.66±112.44） vs （99.01±78.24）, P〈0.05] andSVT [（21.41±2.97） vs （8.92±4.30）, P〈0.05] were significantly decreased dafter treatment in the RAS inhibitor group; the frequency of SVT [（17.85 ±3.98） vs （13.36±5.17）, P〈0.05] significantly decreased while premature sup- reventricular contraction slightly increased [（359.33±141.09） vs （396.95±192.11）, P〉0.05] after treatment in the control group. The change rate between the baseline and after treatment the in the RAS inhibitor group was more significant than that in the control group [PSVC （66.60±40.22） % vs （-8.72±16.23） %, P〈0.05] and [ PSVT （46.48±16.23） % vs （13.69±21.33） %, P〈0.05]. The average frequency of the ectopic rhythm per hour reduced after treatment in both the RAS inhibitor group and the control group were [（699.20±309.93） vs （211.05±139.220）, P〈0.05] and [（708 ±203.77 ） vs （369.31 ±95.64）, P〈0.05]. The change rate between the baseline and after treatment in the RAS inhibitor group was significant compare with that of the control group [（59.15 ±22.03） % vs （22.77 ±23.64） %, P 〈 0.01]. Conclusion The frequency of the ventricular and supraventricular ectopic rhythm could be decreased by RAS inhibition in elder hypertensive patients.