Bangalore Sripal, Sawhney Sabrina, Messerli Franz H
Department of Medicine, Division of Cardiology, St Luke's Roosevelt Hospital, Columbia University College of Physicians and Surgeons, New York, New York 10019, USA.
J Am Coll Cardiol. 2008 Oct 28;52(18):1482-9. doi: 10.1016/j.jacc.2008.06.048.
The purpose of this study was to evaluate the role of heart rate reduction with beta-blockers on the risk of cardiovascular events in patients with hypertension.
Resting heart rate has been shown to be a risk factor for cardiovascular morbidity and mortality in the general population and in patients with heart disease such as hypertension, myocardial infarction, and heart failure. Conversely, pharmacological reduction of heart rate is beneficial for patients with heart disease. However, the role of pharmacological reduction of heart rate using beta-blockers in preventing cardiovascular events in patients with hypertension is not known.
We conducted a MEDLINE/EMBASE/CENTRAL database search of studies from 1966 to May 2008. We included randomized controlled trials that evaluated beta-blockers as first-line therapy for hypertension with follow-up for at least 1 year and with data on heart rate. We extracted the baseline characteristics, the blood pressure response, heart rate at the baseline and end of trial, and cardiovascular outcomes from each trial.
Of 22 randomized controlled trials evaluating beta-blockers for hypertension, 9 studies reported heart rate data. The 9 studies evaluated 34,096 patients taking beta-blockers against 30,139 patients taking other antihypertensive agents and 3,987 patients receiving placebo. Paradoxically, a lower heart rate (as attained in the beta-blocker group at study end) was associated with a greater risk for the end points of all-cause mortality (r = -0.51; p < 0.0001), cardiovascular mortality (r = -0.61; p < 0.0001), myocardial infarction (r = -0.85; p < 0.0001), stroke (r = -0.20; p = 0.06), or heart failure (r = -0.64; p < 0.0001). The same was true when the heart rate difference between the 2 treatment modalities at the end of the study was compared with the relative risk reduction for cardiovascular events.
In contrast to patients with myocardial infarction and heart failure, beta-blocker-associated reduction in heart rate increased the risk of cardiovascular events and death for hypertensive patients.
本研究旨在评估β受体阻滞剂降低心率对高血压患者心血管事件风险的作用。
静息心率已被证明是普通人群以及患有高血压、心肌梗死和心力衰竭等心脏病患者心血管发病和死亡的危险因素。相反，药物降低心率对心脏病患者有益。然而，使用β受体阻滞剂药物降低心率在预防高血压患者心血管事件中的作用尚不清楚。
我们对1966年至2008年5月的研究进行了MEDLINE/EMBASE/CENTRAL数据库检索。我们纳入了评估β受体阻滞剂作为高血压一线治疗且随访至少1年并有心率数据的随机对照试验。我们从每个试验中提取了基线特征、血压反应、试验基线和结束时的心率以及心血管结局。
在22项评估β受体阻滞剂治疗高血压的随机对照试验中，9项研究报告了心率数据。这9项研究评估了34096例服用β受体阻滞剂的患者、30139例服用其他抗高血压药物的患者和3987例接受安慰剂的患者。矛盾的是，较低的心率（如研究结束时β受体阻滞剂组所达到的）与全因死亡率（r = -0.51；p < 0.0001）、心血管死亡率（r = -0.61；p < 0.0001）、心肌梗死（r = -0.85；p < 0.0001）、中风（r = -0.20；p = 0.06）或心力衰竭（r = -0.64；p < 0.0001）等终点的更高风险相关。当比较研究结束时两种治疗方式之间的心率差异与心血管事件的相对风险降低时，情况也是如此。
与心肌梗死和心力衰竭患者不同，β受体阻滞剂相关的心率降低增加了高血压患者心血管事件和死亡的风险。
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