Ades P A, Gunther P G, Meacham C P, Handy M A, LeWinter M M
University of Vermont School of Medicine.
Ann Intern Med. 1988 Oct 15;109(8):629-34. doi: 10.7326/0003-4819-109-8-629.
To determine whether beta-adrenergic blocking agents affect exercise tolerance, exercise conditioning response, and blood pressure response to conditioning in hypertensive patients.
Randomized, double-blinded, placebo-controlled trial with a 10-week exercise period.
Outpatient, monitored exercise program at a community-based, university-sponsored cardiac rehabilitation facility.
Thirty adults with mean resting blood pressure of 145 mm Hg or greater (systolic), 95 mm Hg or greater (diastolic), or a combined systolic and diastolic pressure of 140/90 mm Hg or greater. Mean systolic pressure of 170 mm Hg or more or mean diastolic pressure of 105 mm Hg or more was exclusionary. Mean blood pressure was 145/95 mm Hg; mean age was 46.5 years.
The beta-1-nonselective blocker was propranolol, 80 mg twice daily. The beta-1-selective blocker was metoprolol, 100 mg twice daily, compared with placebo. All patients did exercise conditioning consisting of 40 sessions of aerobic exercise with heart rate monitoring.
Resting systolic blood pressure measured without drug therapy was lowered markedly after exercise conditioning on placebo (146 to 135 mm Hg) and on metoprolol (144 to 133 mm Hg) (P less than 0.05), but not on propranolol (no change). Acutely, propranolol decreased both maximal oxygen consumption (VO2max) and exercise duration compared with metoprolol and placebo. Chronically, VO2max increased 24% (95% CI, 8 to 40) in response to training on placebo and 8% on metoprolol (95% CI, 3 to 14); it did not increase on propranolol (95% CI, -10 to 15).
If an exercise program is to be recommended as an adjunct to pharmacologic beta-blockade for hypertension, blood-pressure-lowering effects are preserved and exercise capacity is less affected with a beta-1-selective agent than with a beta-1-nonselective agent. Antihypertensive medications may be avoided altogether for selected patients who sustain an aerobic exercise program.
确定β-肾上腺素能阻滞剂是否会影响高血压患者的运动耐量、运动适应性反应以及运动适应性过程中的血压反应。
为期10周运动期的随机、双盲、安慰剂对照试验。
在一所大学资助的社区心脏康复机构进行的门诊监测运动项目。
30名成年人，静息血压平均收缩压为145毫米汞柱或更高，舒张压为95毫米汞柱或更高，或收缩压与舒张压之和为140/90毫米汞柱或更高。收缩压平均170毫米汞柱或更高或舒张压平均105毫米汞柱或更高者被排除。平均血压为145/95毫米汞柱；平均年龄为46.5岁。
β1非选择性阻滞剂为普萘洛尔，每日两次，每次80毫克。β1选择性阻滞剂为美托洛尔，每日两次，每次100毫克，与安慰剂作比较。所有患者均进行了40次有氧运动并监测心率的运动适应性训练。
在安慰剂组（从146降至135毫米汞柱）和美托洛尔组（从144降至133毫米汞柱）进行运动适应性训练后，未进行药物治疗时测量的静息收缩压显著降低（P<0.05），但普萘洛尔组无变化。急性情况下，与美托洛尔和安慰剂相比，普萘洛尔降低了最大耗氧量（VO2max）和运动持续时间。长期来看，安慰剂组训练后VO2max增加24%（95%置信区间，8%至40%），美托洛尔组增加8%（95%置信区间，3%至14%）；普萘洛尔组未增加（95%置信区间，-10%至15%）。
如果推荐将运动项目作为高血压药物β受体阻滞剂治疗的辅助手段，β1选择性药物比β1非选择性药物在降低血压效果得以保留的同时，对运动能力的影响更小。对于坚持有氧运动项目的特定患者，可能完全无需使用抗高血压药物。
