Effect of the renin-angiotensin system or calcium channel blockade on the circadian variation of heart rate variability, blood pressure and circulating catecholamines in hypertensive patients
Effect of the renin-angiotensin system or calcium channel blockade on the circadian variation of heart rate variability, blood pressure and circulating catecholamines in hypertensive patients
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DOI：
10.1097/01.hjh.0000170389.69202.53
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发表时间：
2005-06-01
影响因子：
4.9
通讯作者：
de Champlain, J
中科院分区：
文献类型：
--
作者：
Karas, M;Lacourcière, Y;de Champlain, J
目的 确定氨氯地平、雷米普利或替米沙坦治疗 8 周对高血压患者在 24 小时内对自主神经系统的影响。 方法 在安慰剂磨合后，57 名患者被纳入前瞻性随机开放标签设计方案，接受氨氯地平（5 mg，持续 4 周，然后 10 mg，持续 4 周，n = 22）或雷米普利（2.5 mg，持续 1 周， 5.0 mg 持续 3 周，10 mg 持续 4 周，n = 17）或替米沙坦（80 mg 持续 8 周，n = 18）。通过去甲肾上腺素（NE）和肾上腺素（E）以及心率变异性（HRV）频谱分析来评估自主神经功能。结果24小时动态血压、血浆NE和HRV显示了高血压患者特征性的昼夜节律。白天的 SBP 和 DBP 以及 NE 水平以及频谱分析成分（低频带 (LF) 和低频/高频 (LF/HF) 比）值较高，而 HF 在夜间较高。在接受氨氯地平治疗的患者中，HF 在夜间显着降低，而 LF 和 LF/HF 比值在白天则随着 NE 的升高而升高。替米沙坦治疗确实增加了夜间和白天的 HF，而雷米普利并未影响夜间的所有 HRV 成分，但显着增加了 HF，并降低了白天的 LF/HF 比值。替米沙坦或雷米普利未观察到血浆 NE 变化，但氨氯地平治疗患者的 24 小时内 NE 水平增加了 50%。 结论 这些数据表明氨氯地平治疗后白天交感神经激活，夜间副交感神经活动减少，与血浆 NE 增加相关。相比之下，替米沙坦治疗显着增加了副交感神经活动，而夜间和白天的 NE 没有变化。雷米普利治疗仅在白天增加副交感神经活动。 (c) 2005 年利平科特·威廉姆斯和威尔金斯。
Objective To determine the effects of 8 weeks of therapy with amlodipine, ramipril or telmisartan on the autonomic system over 24 h in hypertensives.Methods After a placebo run-in, 57 patients were included in a prospective randomized open-label design protocol for therapy with amlodipine (5 mg for 4 weeks followed by 10 mg for 4 weeks, n = 22), or ramipril (2.5 mg for 1 week, 5.0 mg for 3 weeks and 10 mg for 4 weeks, n = 17) or telmisartan (80 mg for 8 weeks, n = 18). Autonomic functions were assessed by norepinephrine (NE) and epinephrine (E), as well as by the spectral analysis of heart rate variability (HRV).Results The 24-h ambulatory blood pressure, plasma NE and HRV demonstrated the characteristic day-night circadian rhythm in hypertensives. Higher values for SBP and DBP and for NE levels, as well as for spectral analysis components - low frequency band (LF) and low frequency/ high frequency (LF/HF) ratio - were found during the day, whereas the HF was higher during the night. In patients treated with amlodipine, the HF decreased significantly during the night, while the LF and the LF/HF ratio increased during the day in association with the rise in NE. The therapy with telmisartan did increase the HF during the night and the day, while ramipril did not influence all HRV components during the night but significantly increased the HF, and decreased the LF/HF ratio during the day. No changes were observed in plasma NE with telmisartan or ramipril, but a 50% increase in NE levels throughout the 24-h period was found in amlodipine-treated patients.Conclusion These data suggest a sympathetic activation during the day and a decrease in parasympathetic activity during the night after therapy with amlodipine, correlated with increases in plasma NE. In contrast, the therapy with telmisartan significantly increased parasympathetic activity without changes in NE during the night and day. The therapy with ramipril increased the parasympathetic activity only during the day. (c) 2005 Lippincott Williams & Wilkins.