Zeng Weiwei, Tomlinson Brian
Department of Pharmacy, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China.
Faculty of Medicine, Macau University of Science and Technology, Taipa, Macau, China.
Ann Transl Med. 2021 Jun;9(11):923. doi: 10.21037/atm-21-1796.
Anti-hypertensive drugs are widely used to control blood pressure, yet their effects on haemodynamics, especially in Chinese populations, and the potential for non-invasive methods to monitor these changes, are poorly understood. This study aimed to determine the early and late effects of bisoprolol treatment on blood pressure, cardiac output (CO), stroke volume (SV), heart rate (HR), systematic vascular resistance (SVR), and inotropy measured in Chinese patients with hypertension.
Twelve Chinese subjects (median age: 55 years, interquartile range: 52-58 years; 33% male) with uncontrolled hypertension were recruited at the Prince of Wales Hospital in Hong Kong and haemodynamic measurements were assessed using a non-invasive Ultrasonic Cardiac Output Monitor (USCOM). Seven hourly measurements were taken before and after bisoprolol 2.5 mg on day 1 (T0 to T6), and in nine patients this was repeated six weeks later (TF0 to TF6). Any BP change of 5 mmHg was considered clinically significant and P<0.05 was considered statistically significant.
On day 1 (N=12), there was a significant drop in median CO [4.9 (4.7-5.6) 3.8 (3.3-4.7) L/m, P<0.0001] associated with a compensatory increase in SVR [1,698.1 (1,584.6-1,894.3) 2,222.6 (1,777.4-2,712.5) d·s·cm, P<0.0001] at T2. The median dBP {92 [87-95] 86 [79-89] mmHg, P=0.0002} and MAP {110 [104-114] 104 [101-109] mmHg, P=0.038} reduced significantly 6 hours after bisoprolol treatment. Except for HR, all other measured haemodynamics returned to baseline at T6. On week 6 (N=9), SVR was generally reduced, but major parallel swings in CO and SVR were still evident. All patients showed a trend to lower blood pressure, SVR, and inotropy (P<0.05), but HR, SV, and CO returned to baseline values after 6 weeks treatment (P>0.05).
The acute haemodynamic changes between 6 hours of the first dose and the dose after 6 weeks of bisoprolol treatment are similar. Long-term therapy can effectively reduce blood pressure by reducing SVR.
抗高血压药物被广泛用于控制血压，然而其对血流动力学的影响，尤其是在中国人群中的影响，以及非侵入性方法监测这些变化的潜力，目前仍知之甚少。本研究旨在确定比索洛尔治疗对中国高血压患者血压、心输出量（CO）、每搏输出量（SV）、心率（HR）、全身血管阻力（SVR）和心肌收缩力的早期和晚期影响。
在香港威尔士亲王医院招募了12名血压控制不佳的中国受试者（中位年龄：55岁，四分位间距：52 - 58岁；33%为男性），并使用非侵入性超声心输出量监测仪（USCOM）评估血流动力学指标。在第1天给予2.5 mg比索洛尔前后（T0至T6）每小时测量一次，共测量7次，其中9名患者在6周后重复测量（TF0至TF6）。血压变化5 mmHg被认为具有临床意义，P<0.05被认为具有统计学意义。
在第1天（N = 12），T2时中位CO显著下降[4.9（4.7 - 5.6）对3.8（3.3 - 4.7）L/m，P<0.0001]，同时SVR代偿性增加[1,698.1（1,584.6 - 1,894.3）对2,222.6（1,777.4 - 2,712.5）d·s·cm，P<0.0001]。比索洛尔治疗6小时后，中位舒张压{92 [87 - 95]对86 [79 - 89] mmHg，P = 0.0002}和平均动脉压{110 [104 - 114]对104 [101 - 109] mmHg，P = 0.038}显著降低。除HR外，所有其他测量的血流动力学指标在T6时恢复至基线水平。在第6周（N = 9），SVR总体下降，但CO和SVR的主要平行波动仍然明显。所有患者的血压、SVR和心肌收缩力均有下降趋势（P<0.05），但治疗6周后HR、SV和CO恢复至基线值（P>0.05）。
比索洛尔治疗第1剂后6小时至6周后剂量之间的急性血流动力学变化相似。长期治疗可通过降低SVR有效降低血压。
