Cardiovascular Department, The First Affiliated Hospital, Harbin Medical University, Harbin, People's Republic of China.
Institute of Metabolic Disease, Heilongjiang Academy of Medical Science, Harbin, People's Republic of China.
Sleep Breath. 2019 Mar;23(1):227-233. doi: 10.1007/s11325-018-1688-5. Epub 2018 Jun 27.
β-Blocker use has been controversial for a long time in the management of hypertensive patients with obstructive sleep apnea (OSA). The aim of present study was to compare the effects of metoprolol on BP lowering with amlodipine in hypertensive OSA patients.
Hypertensive subjects with OSA were randomly assigned to metoprolol and amlodipine groups, receiving 12 weeks of oral either metoprolol (47.5 mg once daily) or amlodipine (5 mg once daily) treatment. At baseline and after the 12-week treatment period, 24-h ambulatory blood pressure monitoring was performed in both groups.
Both of metoprolol and amlodipine treatments significantly lowered 24-h blood pressure (BP) (from 143/88 to 132.3/81.6 mmHg; from 141.3/84.5 to 133.7/80.8 mmHg), daytime BP (from 146/90.2 to 136.4/84.6 mmHg; from 145.1/87.6 to 138.2/84.1 mmHg), and nighttime BP (from 139.1/83.9 to 125.7/76.2 mmHg; from 134.5/78.5 to 125.8/74.1 mmHg) (all P < 0.05). But there were no significant differences between the groups in BP variability (P > 0.05). Besides, metoprolol significantly reduced daytime heart rate (HR) (P < 0.05), while 24-h and nighttime HR values had no remarkable changes compared with baseline (P > 0.05).
Metoprolol had similar therapeutic effects on BP lowering as amlodipine and could not decrease HR during the nighttime in hypertensive patients with OSA.
β受体阻滞剂在合并阻塞性睡眠呼吸暂停(OSA)的高血压患者的治疗中一直存在争议。本研究旨在比较美托洛尔和氨氯地平对高血压合并 OSA 患者降压的影响。
将 OSA 合并高血压的患者随机分为美托洛尔组和氨氯地平组,分别接受为期 12 周的口服美托洛尔(47.5mg 每日 1 次)或氨氯地平(5mg 每日 1 次)治疗。在基线和 12 周治疗后,两组均进行 24 小时动态血压监测。
美托洛尔和氨氯地平治疗均可显著降低 24 小时血压(BP)(从 143/88mmHg 降至 132.3/81.6mmHg;从 141.3/84.5mmHg 降至 133.7/80.8mmHg)、白天 BP(从 146/90.2mmHg 降至 136.4/84.6mmHg;从 145.1/87.6mmHg 降至 138.2/84.1mmHg)和夜间 BP(从 139.1/83.9mmHg 降至 125.7/76.2mmHg;从 134.5/78.5mmHg 降至 125.8/74.1mmHg)(均 P<0.05)。但两组间 BP 变异性无显著差异(P>0.05)。此外,美托洛尔可显著降低白天心率(HR)(P<0.05),而 24 小时和夜间 HR 与基线相比无明显变化(P>0.05)。
美托洛尔对降低高血压合并 OSA 患者的血压具有与氨氯地平相似的疗效,且不能降低夜间的心率。