硝苯地平联合美托洛尔对高血压合并冠心病患者的血压、心率的影响

摘要

目的:研究硝苯地平联合美托洛尔缓释片对高血压合并冠心病患者血压和心率的影响.方法:选择120例高血压合并冠心病患者作为研究对象,患者被随机均分为硝苯地平组(60例,接受单纯硝苯地平治疗)和联合治疗组(60例,接受硝苯地平联合美托洛尔治疗),疗程为12周.测量比较两组患者的血压、心率及心率变异性(HRV)指标.结果:与治疗前相比,治疗后两组 24h 平均心率和平均动脉压(MAP)均显著降低( P均＝0.001),而24h正常RR间期标准差(SDNN) 、 24h内每5min正常RR间期平均值的标准差(SDANN) 、连续正常RR间期差值均数的平方根(rMSSD)及差值＞50ms的心搏数占24h总RR间期的百分比(PNN50)均显著升高(P＜0.05或＜ 0.01).与硝苯地平组比较,联合治疗组治疗后24h平均心率[ (69.24 ± 10.67)次/min 比(64.08 ± 8.94)次/min]、 MAP [ (98.06 ± 5.18) mmHg比(92.64 ± 4.43) mmHg]降低更显著(P均＜0.01),SDNN [ (113.89 ± 20.93) ms比(124.57 ± 25.34) ms,P＜0.05]、 SDANN [ (108.31 ± 20.26) ms比(119.29 ± 19.37) ms,P＝0.001]、 rMSSD [ (29.67 ± 11.92) ms比(36.23 ± 12.34) ms,P＝0.001]、 PNN50 [ (11.25 ± 4.03)% 比(15.37 ± 4.82)%,P＝0.001]升高更显著.两组治疗总有效率无显著差异,P＝0.272.结论:硝苯地平联合美托洛尔用于高血压合并冠心病患者疗效显著,能有效控制心率、血压水平,改善心率变异性,值得推广.%Objective:To study influence of nifedipine combined metoprolol sustained release tablets on blood pressure and heart rate in hypertensive patients with coronary heart disease (CHD).Methods:A total of 120 hypertensive patients with CHD were selected,randomly and equally divided into nifedipine group (n＝60,received nifedipine monotherapy) and combined treatment group (n＝60,received nifedipine combined metoprolol ),both groups were treated for 12 weeks.Blood pressure,heart rate and indexes of heart rate variability (HRV) were measured and compared between two groups.Results:Compared with before treatment,after treatment,there were significant reductions in 24h mean heart rate (24h HR AV) and mean arterial pressure (MAP),P＝0.001 both,and significant rise in standard deviation of normal to normal RR intervals calculated over the 24h period (SDNN),standard devia-tion of normal to normal RR intervals in all 5min segments of the entire recording (SDANN),root-mean square of differences between successive normal to normal intervals (rMSSD) and adjacent normal RR interval difference ＞50ms stroke accounted for a percentage of 24h total RR interval (PNN50) in two groups,P＜ 0.05 or ＜ 0.01.Compared with nifedipine group after treatment,there were significant reductions in 24hmHR [ (69.24 ± 10.67) beats/min vs.(64.08 ± 8.94) beats/min] and MAP [ (98.06 ± 5.18) mmHg vs.(92.64 ± 4.43) mmHg,P＜0.01 all],and significant rise in SDNN [ (113.89 ± 20.93) ms vs.(124.57 ± 25.34) ms,P＜0.05],SDANN [ (108.31 ± 20.26) ms vs.(119.29 ± 19.37) ms,P＝0.001],rMSSD [ (29.67 ± 11.92) ms vs.(36.23 ± 12.34) ms,P＝0.001] and PNN50 [ (11.25 ± 4.03)% vs.(15.37 ± 4.82)%,P＝0.001] in combined treatment group.There was no significant difference in total effective rate between two groups,P＝ 0.272.Conclusion:Nifedipine combined Metoprolol sustained release tablets possesses significant therapeutic effect on hypertensive patients with CHD.It can effectively control heart rate and blood pressure,and contribute to improving HRV and prognosis,which is worth extending.