Krantz D S, Contrada R J, Durel L A, Hill D R, Friedler E, Lazar J D
Department of Medical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4799.
Psychosom Med. 1988 Nov-Dec;50(6):615-26. doi: 10.1097/00006842-198811000-00008.
This study compared the effects of beta-blockers differing in degree of central nervous system penetration on Type A behavior and cardiovascular reactivity to mental stress. Forty-six male hypertensives were assigned randomly to receive either highly lipophilic and nonselective propranolol, hydrophilic and cardioselective atenolol, the diuretic hydrochlorothiazide, or placebo. Subjects were administered parallel forms of the Structured Interview (SI) and performed mental arithmetic and a cognitive task prior to and after 6 weeks of therapy. Results indicated that diuretic and placebo subjects (subsequently combined into a single control group) did not differ and that both beta-blockers reduced heart rate but not blood pressure reactivity to mental stress (p less than 0.02), an effect that was strongest during the mental arithmetic test. Analysis of SI components indicated a reduction only in explosive speech for beta-blockers versus controls (p less than 0.05). For global SI classifications, seven out of 12 subjects (58%) receiving propranolol, three of 12 (25%) receiving atenolol, and four of 22 control subjects (18%) became less Type A (p less than 0.05). These data do not replicate results of a prior study obtained with atenolol and suggest that only a subset of hypertensive individuals show reduced Type A behavior with propranolol. Central nervous system mechanisms may be important in producing these effects.
本研究比较了中枢神经系统渗透程度不同的β受体阻滞剂对A型行为以及对精神应激的心血管反应性的影响。46名男性高血压患者被随机分配接受高亲脂性非选择性普萘洛尔、亲水性心脏选择性阿替洛尔、利尿剂氢氯噻嗪或安慰剂。在治疗6周前后，受试者接受了平行形式的结构化访谈（SI），并进行了心算和认知任务。结果表明，利尿剂组和安慰剂组受试者（随后合并为一个单一对照组）没有差异，两种β受体阻滞剂均降低了心率，但未降低对精神应激的血压反应性（p<0.02），在心算测试期间这种效应最强。对SI各成分的分析表明，与对照组相比，β受体阻滞剂仅使爆发性言语减少（p<0.05）。对于SI的整体分类，接受普萘洛尔的12名受试者中有7名（58%）、接受阿替洛尔的12名受试者中有3名（25%）以及22名对照受试者中有4名（18%）的A型行为减弱（p<0.05）。这些数据未能重复先前使用阿替洛尔获得的研究结果，表明只有一部分高血压个体使用普萘洛尔后A型行为会减弱。中枢神经系统机制可能对产生这些效应很重要。
