Nodari Savina, Metra Marco, Dei Cas Livio
Cattedra di Cardiologia, Università di Brescia, c/o Spedali Civili, Piazza Spedali Civili, 25100 Brescia, Italy.
Eur J Heart Fail. 2003 Oct;5(5):621-7. doi: 10.1016/s1388-9842(03)00054-0.
We compared the effects of 6 months administration of atenolol or nebivolol on resting and exercise hemodynamic parameters and maximal exercise capacity, in 26 patients with hypertension and left ventricular (LV) diastolic dysfunction (ejection fraction >50%, end-diastolic diameter <60 mm and increased pulmonary wedge pressure at rest and/or at peak exercise). Both atenolol and nebivolol administration was associated with a significant decrease in the resting and peak exercise heart rate and blood pressure and in LV mass, with an increase in the E/A ratio. This latter effect was greater with nebivolol. Nebivolol was associated with an increase in the peak VO(2), VO(2) at the anaerobic threshold and with a decrease in the VE/VCO(2) ratio. With regards to the hemodynamic parameters, compared to patients on atenolol, those on nebivolol showed a lower reduction in the cardiac index, a greater increase in the stroke volume index and a decline in the mean pulmonary artery pressure and pulmonary wedge pressure, both at rest and peak exercise. Thus, although the two beta-blockers have a similar antihypertensive action, nebivolol administration was associated with a greater hemodynamic improvement, compared to atenolol.
我们比较了阿替洛尔或奈必洛尔6个月给药对26例高血压合并左心室（LV）舒张功能障碍患者（射血分数>50%，舒张末期直径<60 mm，静息和/或运动峰值时肺楔压升高）静息和运动血流动力学参数及最大运动能力的影响。阿替洛尔和奈必洛尔给药均与静息和运动峰值心率、血压及左心室质量显著降低相关，E/A比值升高。奈必洛尔对后者的作用更大。奈必洛尔与峰值VO₂、无氧阈时的VO₂增加及VE/VCO₂比值降低相关。关于血流动力学参数，与服用阿替洛尔的患者相比，服用奈必洛尔的患者在静息和运动峰值时心脏指数降低幅度较小，每搏量指数增加幅度更大，平均肺动脉压和肺楔压下降。因此，尽管两种β受体阻滞剂具有相似的降压作用，但与阿替洛尔相比，奈必洛尔给药与更大的血流动力学改善相关。
