Jackson G, Atkinson L, Oram S
Br Med J. 1975 Sep 13;3(5984):616-8. doi: 10.1136/bmj.3.5984.616.
Twenty-one patients with angina pectoris were treated with adrenergic beta-receptor antagonists. Previously the resting heart rate had been used as a guide to treatment, a reduction in the rate to 55-60 beats/min without symptomatic improvement indicating failure of medical treatment. These patients were re-evaluated before coronary arteriography using the peak-exercise heart rate as an index of adrenergic beta-receptor antagonism. The dose of beta-blocking drugs was increased to produce a peak-exercise heart rate of less than 100 beats/min or a consistent rate of 100-125 beats/min which would not lessen in spite of progressive dose increments. The resting heart rate was ignored. On these criteria 15 patients previously considered to have responded inadequately to beta-blockade responded satisfactorily and were therefore removed from the waiting list for coronary arteriography. They all remained well up to two years later. Six patients failed to respond and had coronary arteriography with a view to surgical treatment. Reliance on the resting heart rate as the index of optimum adrenergic beta-receptor antagonism is likely to lead to premature or unnecessary referral for surgery; the failure of beta-blockade in the treatment of angina pectoris can be determined simply and accurately by using peak-exercise heart rate.
21例心绞痛患者接受了肾上腺素能β受体拮抗剂治疗。以前，静息心率被用作治疗的指导指标，心率降至55 - 60次/分钟但无症状改善表明药物治疗失败。在冠状动脉造影之前，使用运动高峰心率作为肾上腺素能β受体拮抗作用的指标对这些患者进行了重新评估。增加β受体阻滞剂的剂量，以使运动高峰心率低于100次/分钟，或使心率稳定在100 - 125次/分钟，即使剂量逐渐增加，心率也不会降低。静息心率被忽略不计。根据这些标准，15例先前被认为对β受体阻滞剂反应不佳的患者反应令人满意，因此被从冠状动脉造影的等待名单中剔除。直到两年后，他们都状况良好。6例患者反应不佳，接受了冠状动脉造影以考虑手术治疗。将静息心率作为最佳肾上腺素能β受体拮抗作用的指标可能会导致过早或不必要的手术转诊；通过使用运动高峰心率，可以简单而准确地确定β受体阻滞剂在治疗心绞痛时是否失败。
