伊贝沙坦对原发性高血压的疗效及心率变异性的影响

Effects of irbesartan on blood pressure and heart rate variability in patients with essential hypertension

目的 :观察伊贝沙坦对原发性高血压 (EH)的疗效及心率变异性的变化。方法 :原发性高血压患者 40例每日口服伊贝沙坦 1 5 0～ 3 0 0mg,共 8wk。观察血压变化 ,记录用药前后 2 4h动态心电图 ,分析心率变异 (HRV)时域和频域指标 ,并与 3 5例健康对照组比较。结果 :①EH患者应用伊贝沙坦后收缩压 (SBP)和舒张压 (DBP)由 2 1 .62± 0 .47/1 2 .0 1±0 .3 2kPa分别下降至 1 8.9± 0 .3 2 /8.0 1± 2 .3 5kPa,有效率达 73 .1 %。②与对照组相比 ,EH患者相邻正常RR间期标准差 (SDNN) ,正常相邻RR间期差值 (RMSSD) ,相邻正常RR间期差值大于 5 0ms的窦性心律 (PNN50 ) ,高频功率 (HF)明显下降 ,低频功率(LF)不变 ,低频功率 /高频功率 (LF/HF)值增加。应用伊贝沙坦后 ,SDNN、RMSSD、PNN50 、HF增加 ,LF/HF值降低。结论 :原发性高血压患者存在HRV下降 ,而伊贝沙坦在有效降低血压同时提高HRV ,改善自主神经功能失衡。

AIM: To study the effects of irbesartan on blood pressure and heart rate variability (HRV) in patients with essential hypertension (EH). METHODS: 40 patients with EH received 150- 300 mg·d -1 irbesartan for 8 weeks. The changes in blood pressure were assessed. The time and frequency domain measurements of HRV from 24 hours ambulartory electrocardiographyic recordings were analyzed in 35 healthy controls and in patients with EH before and after the treatment. RESULTS: Compared to baseline, the systolic and diastolic blood pressure decreased from 21.62 ± 0.47 / 12.01 ± 0.32 kPa to 18.90 ± 0.32 / 8.01 ± 2.35 kPa in the irbesartan groups, and respond rates were 73.1 %. Compared with controls, the standard deviation of normal to normal intervals (SDNN), rate mean square of the differences of successive RR intervals (RMSSD), the percentage of RR intervals differing >50 ms (PNN 50 ) and the high frequency (HF) in patients with EH were decreased, While the ratio between low frequency and high frequency (LF/HF) were increased. After the treatment of irbesartan, the values of SDNN, RMSSD, PNN 50 , and HF were increased, and the LF/HF was decreased significantly. CONCLUSION: Irbersartan can increase the lowed HRV in patients with EH, which improves the cardiovascular automatic function.