Lopatin Yuri M, Vitale Cristiana
Volgograd Medical University, Cardiology Centre, Volgograd, Russian Federation.
Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy.
Int J Cardiol. 2016 Dec 1;224:145-148. doi: 10.1016/j.ijcard.2016.09.054. Epub 2016 Sep 16.
Treatment of hypertensive patients with beta-blockers decreases central blood pressure (CBP) less than other antihypertensive drugs, which is believed to account for their lesser cardiovascular protection in this setting. Some authors have suggested that decreasing heart rate (HR) with beta-blockers would increase CBP. In contrast to beta-blockers, the anti-anginal agent ivabradine reduces HR without other hemodynamic effects, and represents an attractive tool for exploring the direct relationship between HR and CBP. Here, we review the available clinical data assessing the effect of selective HR reduction with ivabradine on CBP in patients with stable coronary artery disease (CAD). We collected data from five studies which report either increase, decrease, or neutral effects of ivabradine on CBP. Further studies are needed to clarify the exact role of ivabradine on CBP. However, as supported by its pharmacodynamic effect in patients with stable CAD, available evidence to date suggests that ivabradine does not negatively impact CBP when associated with beta-blocker. HR reduction with both beta-blockers and ivabradine remains well-established treatments for the symptomatic treatment of angina patients.
与其他抗高血压药物相比，使用β受体阻滞剂治疗高血压患者降低中心血压（CBP）的效果较差，这被认为是其在这种情况下心血管保护作用较小的原因。一些作者认为，β受体阻滞剂降低心率（HR）会升高CBP。与β受体阻滞剂不同，抗心绞痛药物伊伐布雷定可降低心率而无其他血流动力学影响，是探索心率与CBP之间直接关系的有吸引力的工具。在此，我们回顾了评估伊伐布雷定选择性降低心率对稳定型冠状动脉疾病（CAD）患者CBP影响的现有临床数据。我们收集了五项研究的数据，这些研究报告了伊伐布雷定对CBP的升高、降低或中性影响。需要进一步研究以阐明伊伐布雷定对CBP的确切作用。然而，正如其在稳定型CAD患者中的药效学作用所支持的那样，迄今为止的现有证据表明，伊伐布雷定与β受体阻滞剂联用时不会对CBP产生负面影响。β受体阻滞剂和伊伐布雷定降低心率仍然是心绞痛患者症状性治疗的成熟方法。
