Frattola A, Parati G, Castiglioni P, Paleari F, Ulian L, Rovaris G, Mauri G, Di Rienzo M, Mancia G
Clinica Medica, University of Milano-Bicocca and Ospedale S. Gerardo, Monza, Italy.
Hypertension. 2000 Oct;36(4):622-8. doi: 10.1161/01.hyp.36.4.622.
The aim of our study was to assess the effects of lacidipine, a long-acting calcium antagonist, on 24-hour average blood pressure, blood pressure variability, and baroreflex sensitivity. In 10 mildly to moderately hypertensive patients with type II diabetes mellitus (aged 18 to 65 years), 24-hour ambulatory blood pressure was continuously monitored noninvasively (Portapres device) after a 3-week pretreatment with placebo and a subsequent 4-week once daily lacidipine (4 mg) or placebo treatment (double-blind crossover design). Systolic blood pressure, diastolic blood pressure, and heart rate means were computed each hour for 24 hours (day and night) at the end of each treatment period. Similar assessments were also made for blood pressure and heart rate variability (standard deviation and variation coefficient) and for 24-hour baroreflex sensitivity, which was quantified (1) in the time domain by the slope of the spontaneous sequences characterized by progressive increases or reductions of systolic blood pressure and RR interval and (2) in the frequency domain by the squared ratio of RR interval and systolic blood pressure spectral power approximately 0.1 and 0.3 Hz over the 24 hours. Compared with placebo, lacidipine reduced the 24-hour, daytime, and nighttime systolic and diastolic blood pressure (P<0.05) with no significant change in heart rate. It also reduced 24-hour, daytime, and nighttime standard deviation (-19.6%, -14.4%, and -24.0%, respectively; P<0.05) and their variation coefficient. The 24-hour average slope of all sequences (7.7+/-1.7 ms/mm Hg) seen during placebo was significantly increased by lacidipine (8.7+/-1.8 ms/mm Hg, P<0.01), with a significant increase being obtained also for the 24-hour average alpha coefficient at 0.1 Hz (from 5.7+/-1.5 to 6.4+/-1.3 ms/mm Hg, P<0.01). Thus, in diabetic hypertensive patients, lacidipine reduced not only 24-hour blood pressure means but also blood pressure variability. This reduction was accompanied by an improvement of baroreflex sensitivity. Computer analysis of beat-to-beat 24-hour noninvasive blood pressure monitoring may offer valuable information about the effects of antihypertensive drugs on hemodynamic and autonomic parameters in daily life.
我们研究的目的是评估长效钙拮抗剂拉西地平对24小时平均血压、血压变异性和压力反射敏感性的影响。在10例轻度至中度高血压的II型糖尿病患者（年龄18至65岁）中，先用安慰剂进行3周预处理，随后进行为期4周的每日一次拉西地平（4mg）或安慰剂治疗（双盲交叉设计），之后使用无创设备（Portapres装置）连续监测24小时动态血压。在每个治疗期结束时，计算24小时（白天和晚上）每小时的收缩压、舒张压和心率平均值。还对血压和心率变异性（标准差和变异系数）以及24小时压力反射敏感性进行了类似评估，压力反射敏感性在时域中通过以收缩压和RR间期逐渐增加或减少为特征的自发序列斜率进行量化，在频域中通过24小时内RR间期和收缩压频谱功率在约0.1和0.3Hz处的平方比进行量化。与安慰剂相比，拉西地平降低了24小时、白天和夜间的收缩压和舒张压（P<0.05），心率无显著变化。它还降低了24小时、白天和夜间的标准差（分别为-19.6%、-14.4%和-24.0%；P<0.05）及其变异系数。拉西地平使安慰剂期间观察到的所有序列的24小时平均斜率（7.7±1.7ms/mm Hg）显著增加（8.7±1.8ms/mm Hg，P<0.01），24小时平均α系数在0.1Hz处也显著增加（从5.7±1.5增加到6.4±1.3ms/mm Hg，P<0.01）。因此，在糖尿病高血压患者中，拉西地平不仅降低了24小时血压平均值，还降低了血压变异性。这种降低伴随着压力反射敏感性的改善。对逐搏24小时无创血压监测进行计算机分析，可能会提供有关抗高血压药物对日常生活中血流动力学和自主神经参数影响的有价值信息。
