Palatini P, Julius S
Clinica Medica 4, University of Padova, Italy.
Curr Hypertens Rep. 1999 Jun;1(3):219-24. doi: 10.1007/s11906-999-0024-7.
Numerous studies have shown that resting heart rate is closely correlated with blood pressure and that it is prospectively related to the development of hypertension. Moreover, there is mounting evidence to indicate that a high heart rate is associated with increased cardiovascular morbidity and mortality. In this respect, heart rate can be considered both as a marker of risk and as an independent factor in the induction of risk. Sympathetic overactivity seems to be responsible for the increase in blood pressure and hematocrit, and for the metabolic abnormalities often observed in subjects with tachycardia. Experimental studies in monkeys have shown that heart rate can also exert a direct atherogenic action on the arteries through increased wall stress. Furthermore, tachycardia can favor the occurrence of ventricular arrhythmias and sudden death. Reduction of heart rate appears to be a reasonable additional goal of antihypertensive therapy, especially in subjects with increased sympathetic tone. Nondihydropyridine calcium antagonists and drugs with agonistic properties at the I1-imidazoline receptors of the rostral ventrolateral medulla may be drugs of choice for this purpose, but whether they offer a significant morbidity-mortality advantage must be proven in prospective trials.
大量研究表明，静息心率与血压密切相关，且与高血压的发生呈前瞻性关联。此外，越来越多的证据表明，高心率与心血管疾病发病率和死亡率的增加有关。在这方面，心率既可以被视为风险标志物，也可以被视为诱发风险的独立因素。交感神经过度活跃似乎是导致血压和血细胞比容升高以及心动过速患者常出现的代谢异常的原因。对猴子的实验研究表明，心率还可通过增加血管壁应力对动脉产生直接的致动脉粥样硬化作用。此外，心动过速会增加室性心律失常和猝死的发生几率。降低心率似乎是抗高血压治疗的一个合理的额外目标，尤其是在交感神经张力增加的患者中。非二氢吡啶类钙拮抗剂和对延髓头端腹外侧I1-咪唑啉受体具有激动特性的药物可能是实现这一目标的首选药物，但它们是否能带来显著的发病率-死亡率优势，必须在前瞻性试验中得到证实。
