Glasser S P, Frishman W, White W B, Stone P, Johnson M F
University of Minnesota, Minneapolis, USA.
Clin Cardiol. 2000 Jul;23(7):524-9. doi: 10.1002/clc.4960230711.
Changes in heart rate (HR) may contribute to the higher incidence of cardiovascular events in the morning.
The objectives of this analysis were to assess HR patterns in two populations (patients with chronic stable angina or stage I to III hypertension) and to compare the effects of various antianginal and antihypertensive treatments on HR.
This was a retrospective analysis of HR data from two clinical trials evaluating the efficacy of controlled-onset, extended-release (COER)-verapamil. The effects of COER-verapamil were compared with placebo, nifedipine gastrointestinal therapeutic system (GITS), amlodipine, and the combination of amlodipine and atenolol.
In patients with angina (n = 498), the change from baseline in HR following 4 weeks of treatment was -6.7 +/- 10.5 beats/min in the COER-verapamil group, -10.8 +/- 10.8 beats/min in the amlodipine/atenolol group, + 2.5 +/- 9.1 beats/ min in the amlodipine monotherapy group, and -1.3 +/- 10.5 beats/min in the placebo group (p<0.001). Data were stratified based on whether patients experienced asymptomatic ischemia during baseline ambulatory electrocardiographic monitoring. The circadian HR pattern was morphologically similar in all groups; however, differences in the magnitude of HR response were evident. In the subset of patients with asymptomatic ischemia (n = 101), treatment with amlodipine monotherapy increased HR compared with placebo. In this same subset of patients, HR reductions were achieved with COER-verapamil and amlodipine/atenolol. In patients with hypertension (n = 557), the change in HR following 10 weeks of treatment was -3.3 beats/min for patients treated with COER-verapamil compared with + 2.0 beats/min for patients treated with nifedipine GITS (p < 0.0001, between-group differences).
This analysis demonstrates that morphologically similar circadian patterns of HR occur in both hypertensive patients and those with angina. In addition, significant variation exists among antianginal and antihypertensive agents regarding HR effects.
心率（HR）变化可能是导致早晨心血管事件发生率较高的原因。
本分析的目的是评估两个人群（慢性稳定型心绞痛患者或I至III期高血压患者）的心率模式，并比较各种抗心绞痛和抗高血压治疗对心率的影响。
这是一项对两项评估控释维拉帕米疗效的临床试验中的心率数据进行的回顾性分析。将控释维拉帕米的效果与安慰剂、硝苯地平胃肠道治疗系统（GITS）、氨氯地平和氨氯地平和阿替洛尔的联合用药进行比较。
在心绞痛患者（n = 498）中，控释维拉帕米组治疗4周后心率相对于基线的变化为-6.7±10.5次/分钟，氨氯地平/阿替洛尔组为-10.8±10.8次/分钟，氨氯地平单药治疗组为+2.5±9.1次/分钟，安慰剂组为-1.3±10.5次/分钟（p<0.001）。根据患者在基线动态心电图监测期间是否经历无症状性心肌缺血对数据进行分层。所有组的昼夜心率模式在形态上相似；然而，心率反应幅度的差异很明显。在无症状性心肌缺血患者亚组（n = 101）中，与安慰剂相比，氨氯地平单药治疗使心率增加。在同一亚组患者中，控释维拉帕米和氨氯地平/阿替洛尔可降低心率。在高血压患者（n = 557）中，控释维拉帕米治疗10周后的心率变化为-3.3次/分钟，而硝苯地平GITS治疗的患者为+2.0次/分钟（组间差异，p < 0.0001）。
本分析表明，高血压患者和心绞痛患者的心率昼夜模式在形态上相似。此外，抗心绞痛和抗高血压药物在心率影响方面存在显著差异。
