动态血压监测比较两种β_1受体阻滞剂的降压疗效

Comparison of the Efficacy of Bevantolol and Metoprolol in Patients With Essential Hypertension

目的 :用动态血压监测 (ABPM )的方法比较两种 β1受体阻滞剂———贝凡洛尔 (bevantolol)与美托洛尔 (metoprolol)治疗原发性高血压的疗效。方法 :选择原发性高血压患者 5 0例 ,随机分为贝凡洛尔组 2 4例 ,美托洛尔组 2 6例。分别观察服药前和服药后 8周末的 2 4h、白昼、夜间及各时点的动态血压变化。结果 :贝凡洛尔组和美托洛尔组服药前、服药后 8周末的 2 4h、白昼和夜间的平均收缩压、舒张压明显下降 ,有显著性差异(P <0 0 5或P <0 0 1)。贝凡洛尔组服药后 8周末各时点收缩压和舒张压均较服药前下降 ,有显著性差异 (P <0 0 5 )。美托洛尔组服药后 8周末各时点的收缩压和舒张压较服药前下降 ,但服药后的第 2 3～ 2 4h血压下降不明显 (P >0 0 5 )。结论 :贝凡洛尔 ( 10 0～ 2 0 0mg/d ,分两次口服 )可维持 2 4h平稳降压 ;美托洛尔 ( 10 0～ 15 0mg/d ,分两次口服 )仅能维持 2 2h内血压下降。

Objective: To compare the clinical efficacy of two β 1-adrenoceptor antagonists(bevantolol and metoprolol) in the treatment of essential hypertension using ambulatory blood pressure monitoring(ABPM). Methods: It was a randomized,double blind,single-center,controlled clinical trial. After 2 weeks of wash-out period,patients with 24h mean diastolic blood pressure(DBP)≥85 mmHg were randomly treated with either bevantolol 100-200 mg/d or metoprolol 100-150 mg/d(twice a day) for 8 weeks. The dosage was titrated at the end of the 4 th week. ABPM was conducted at the end of placebo period and 8 weeks after treatment. Results: At the end of the 8 th week,In bevantolol group the mean of systolic blood pressure(SBP)/DBP of 24h,day-time and night-time dropped by(11.52±8.58)/(7.90±6.95)mmHg,(11.49±10.11)/(7.96±7.67)mmHg,(10.75±9.29)/(7.23±8.04)mmHg (p<0.05),respectively. SBP/DBP were decreased at every time point of 24h-ABPM in treatment. In metoprolol group the mean SBP/DBP of 24h,day-time and night-time was (5.57±10.69)/(4.94±6.78)mmHg,(6.53±11.41)/(5.10±7.47)mmHg,(4.88±11.45)/(5.90±8.02 )mmHg(p<0.05),respectively. DBP and SBP were decreased at every time point of 24h-ABPM in the treatment,but during the 23-24 th hour the decrease had no statistical significance(p>0.05). Conclusion: Bevantolol(100-200 mg/d,twice a day) can keep blood pressure smoothly decreasing for 24h,but metoprolol(100-150 mg/d,twice a day) only for 22h in some patients.