Fletcher Janine, Buch Ashesh N, Routledge Helen C, Chowdhary Saqib, Coote John H, Townend Jonathan N
Department of Physiology, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
J Am Coll Cardiol. 2004 Apr 7;43(7):1270-5. doi: 10.1016/j.jacc.2003.10.058.
We have examined the acute effects (<45 min) of aldosterone antagonism on heart rate variability and baroreflex sensitivity, markers of cardiac vagal control, in 13 healthy subjects.
Evidence for the beneficial effects of aldosterone antagonists comes from studies showing increased survival rates following their addition to standard heart failure therapy. Many mechanisms have been suggested for this action, including effects upon the autonomic nervous system.
Heart rate variability and baroreflex sensitivity were examined 30 min following the administration of potassium canrenoate (intravenous) (aldosterone antagonist) or saline (control).
Active treatment reduced resting heart rate (-6 +/- 1 beats/min [mean +/- standard error mean]) compared to control (0 +/- 1 beat/min) (p < 0.001) and increased measures of high frequency (HF) heart rate variability. Root mean square of successive RR interval differences increased by 21 +/- 5 ms versus -6 +/- 5 ms control (p < 0.001); HF power increased by 1,369 +/- 674 ms(2)with aldosterone antagonism compared to -255 +/- 431 ms(2) following saline infusion (p < 0.01). Baroreflex sensitivity (alpha-HF) was increased after active treatment (+4 +/- 2 ms/mm Hg vs. 0 +/- 1 ms/mm Hg control [p < 0.05]). No changes in plasma potassium levels were observed.
These results provide evidence that aldosterone antagonists acutely improve cardiac vagal control, irrespective of any diuretic effects, and may in part explain their beneficial effects in treatment of heart failure.
我们研究了13名健康受试者中醛固酮拮抗作用（<45分钟）对心率变异性和压力反射敏感性（心脏迷走神经控制的标志物）的急性影响。
醛固酮拮抗剂有益作用的证据来自于在标准心力衰竭治疗中添加该药物后生存率提高的研究。对于这种作用提出了许多机制，包括对自主神经系统的影响。
在静脉注射坎利酸钾（醛固酮拮抗剂）或生理盐水（对照）30分钟后，检测心率变异性和压力反射敏感性。
与对照组（0±1次/分钟）相比，积极治疗降低了静息心率（-6±1次/分钟[平均值±标准误平均值]）（p<0.001），并增加了高频（HF）心率变异性的测量值。连续RR间期差值的均方根增加了21±5毫秒，而对照组为-6±5毫秒（p<0.001）；与盐水输注后-255±431毫秒²相比，醛固酮拮抗作用使HF功率增加了1369±674毫秒²（p<0.01）。积极治疗后压力反射敏感性（α-HF）增加（+4±2毫秒/毫米汞柱对对照组0±1毫秒/毫米汞柱[p<0.05]）。未观察到血浆钾水平的变化。
这些结果提供了证据，表明醛固酮拮抗剂可急性改善心脏迷走神经控制，而与任何利尿作用无关，并且可能部分解释了它们在治疗心力衰竭中的有益作用。
