Alekseeva Iu M, Malkina T A, Sokolov S F
Kardiologiia. 2007;47(12):24-34.
Beta-blocking agents (BB) decrease mortality particularly sudden in post-myocardial infarction patients and in patients with chronic heart failure that is closely related to heart rate (HR) lowering at rest. The hypothesis exists that BB decrease mortality due to increase of cardiac vagal activity.
To evaluate the relation between HR changes on therapy with BB and changes in heart rate variability (HRV).
Sixty patients with arterial hypertension randomized in three groups were studied before and after treatment with atenolol (AT), acebutolol (AC) or talinolol (TL) until doses of 100, 600 and 300 mg/d correspondingly were reached or resting HR was decreased by 10 bpm. 24-hour Holter monitoring was used to measure HR and HRV indexes.
Arterial blood pressure decreased significantly in every group. HR max, min and average decreased significantly on AT. AC and TL lowered HR max and AT average but did not change HR min. AT did not change SDNN, SDANN, TotP and ULFP, but AC and NL decreased them significantly (p < 0.001). AT increased SDNNind, VLFP (p < 0.002), rMSSD, pNNSO and HFP (p < 0.003), but did not change LFP. AC and TL did not change these indexes. Changes of HRV indexes were closely related to changes of HR particularly HR min (r=0.53 - 0.84). Linear regressions of these relations did not differ between three drugs except for low frequency indexes of HRV between AC and TL. According to the equations the differences in HRV indexes between the drugs were well explained by the differences in HR changes. When all patients were evaluated together statistical significance of increase in rMSSD, pNN50 and HFP was not reached until HR average decreased by 10 bpm or more. The effect of TL on HR and HRV is very similar to AC what suggests its intrinsic sympathomimetic activity or anticholinergic properties.
β受体阻滞剂（BB）可降低死亡率，尤其是心肌梗死后患者以及慢性心力衰竭患者的猝死率，这与静息心率（HR）降低密切相关。有一种假说认为，BB通过增加心脏迷走神经活动来降低死亡率。
评估使用BB治疗时HR变化与心率变异性（HRV）变化之间的关系。
将60例动脉高血压患者随机分为三组，在使用阿替洛尔（AT）、醋丁洛尔（AC）或他林洛尔（TL）治疗前及治疗至相应剂量分别达到100、600和300mg/d或静息HR降低10次/分钟之前和之后进行研究。使用24小时动态心电图监测来测量HR和HRV指标。
每组动脉血压均显著降低。AT组的HR最大值、最小值和平均值显著降低。AC和TL降低了HR最大值，AT降低了HR平均值，但未改变HR最小值。AT未改变SDNN、SDANN、总功率（TotP）和超低频功率（ULFP），但AC和TL显著降低了它们（p<0.001）。AT增加了SDNN指数、极低频功率（VLFP）（p<0.002）、rMSSD、pNN50和高频功率（HFP）（p<0.003），但未改变低频功率（LFP）。AC和TL未改变这些指标。HRV指标的变化与HR变化密切相关，尤其是HR最小值（r=0.53 - 0.84）。除AC和TL之间HRV的低频指标外，三种药物之间这些关系的线性回归无差异。根据这些方程，药物之间HRV指标的差异可以通过HR变化的差异得到很好的解释。当对所有患者进行综合评估时，直到HR平均值降低10次/分钟或更多时，rMSSD、pNN50和HFP增加的统计学意义才达到。TL对HR和HRV的作用与AC非常相似，这表明其具有内在拟交感活性或抗胆碱能特性。
