β受体阻滞剂对不同基础心率的高血压患者的疗效分析

Efficacy of β-blocker in Hypertension Patients With Different Basic Heart Rate

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.