Petretta M, Canonico V, Madrid A, Mickiewicz M, Spinelli L, Marciano F, Vetrano A, Signorini A, Bonaduce D
Institute of Internal Medicine, Cardiology and Heart Surgery, University of Naples Federico II, Italy.
J Hypertens. 1999 May;17(5):707-13. doi: 10.1097/00004872-199917050-00016.
We evaluated the effect of two calcium channel blockers, verapamil and felodipine, on heart rate variability in hypertensive patients.
Time and frequency domain measures of heart rate variability were obtained from 24 h Holter recording in 25 previously untreated hypertensive patients without left ventricular hypertrophy, before and after 3 months of verapamil slow-release treatment (240 mg once daily) or felodipine extended-release treatment (10 mg once daily).
Blood pressure values decreased with both drugs. Measures of heart rate variability, comparable at baseline in the two groups, were unchanged after felodipine. After verapamil, the average RR interval, the square root of the mean of the squared differences between all adjacent normal RR intervals (r-MSSD) and the percentage of differences between all adjacent normal RR intervals > 50 ms (pNN50), measures of vagal modulation of heart rate, increased (from 735 +/- 67 to 827 +/- 84 ms, P < 0.001; from 30 +/- 10 to 44 +/- 15 ms, P < 0.001; and from 3 +/- 2 to 7 +/- 6%, P < 0.01, respectively) and were higher than after felodipine. The coefficient of variation, a measure that compensates for heart rate effects, increased only after verapamil (from 5.8 +/- 1.3% to 6.6 +/- 1.0%; P < 0.05). High frequency power and its coefficient of component variance, both representing the vagal modulation of heart rate, increased after verapamil (from 5.33 +/- 0.29 to 5.80 +/- 0.27 In units, P < 0.001 and from 1.9 +/- 0.3 to 2.2 +/- 0.25%; P < 0.05). Finally, the low to high frequency power ratio, an indicator of sympathovagal balance, with a high value suggesting a sympathetic predominance, decreased after verapamil (from 2.16 +/- 0.41 to 1.36 +/- 0.35; P < 0.001), confirming the improvement in vagal modulation of heart rate.
In hypertensive patients, despite a comparable anti-hypertensive effect, verapamil, but not felodipine, has favourable effect on cardiac autonomic control.
我们评估了两种钙通道阻滞剂维拉帕米和非洛地平对高血压患者心率变异性的影响。
在25例既往未经治疗、无左心室肥厚的高血压患者中，于维拉帕米缓释片（每日一次，240毫克）或非洛地平缓释片（每日一次，10毫克）治疗3个月前后，通过24小时动态心电图记录获取心率变异性的时域和频域指标。
两种药物治疗后血压值均下降。两组患者基线时心率变异性指标相当，非洛地平治疗后这些指标无变化。维拉帕米治疗后，作为心率迷走神经调节指标的平均RR间期、所有相邻正常RR间期差值平方的均值的平方根（r-MSSD）以及所有相邻正常RR间期差值>50毫秒的百分比（pNN50）均增加（分别从735±67毫秒增至827±84毫秒，P<0.001；从30±10毫秒增至44±15毫秒，P<0.001；从3±2%增至7±6%，P<0.01），且高于非洛地平治疗后。变异系数是一项可补偿心率影响的指标，仅在维拉帕米治疗后增加（从5.8±1.3%增至6.6±1.0%；P<0.05）。代表心率迷走神经调节的高频功率及其成分方差系数在维拉帕米治疗后增加（分别从5.33±0.29增至5.80±0.27单位，P<0.001；从1.9±0.3%增至2.2±0.25%；P<0.05）。最后，作为交感神经-迷走神经平衡指标的低频与高频功率比值，其高值提示交感神经占优势，维拉帕米治疗后该比值下降（从2.16±0.41降至1.36±0.35；P<0.001），证实了心率迷走神经调节的改善。
在高血压患者中，尽管维拉帕米和非洛地平具有相当的降压效果，但维拉帕米对心脏自主神经控制有有益作用，而非洛地平则没有。
