Verdecchia P, Brignole M, Delfino G, Queirolo C, De Marchi G, Bertulla A
Hypertension. 1983 Jan-Feb;5(1):140-6. doi: 10.1161/01.hyp.5.1.140.
Systolic time intervals (STI) were recorded at rest and during isometric exercise (IHG) in 20 hypertensive outpatients, WHO Stage 1 or 2. In a double-blind crossover study, slow-release metoprolol 200 mg once daily and matched placebo were given for 4 weeks each, at the end of a 2-week placebo washout. Blood pressure and STI were taken in the last day of washout and of either crossover period. Treatment decreased blood pressure and heart rate values at rest and on peak IHG; it didn't modify preejection period index (PEPI), left ventricular ejection time index (LVETI), and their ratio at rest, but decreased the ratio between diastolic blood pressure and PEPI (DBP/PEPI ratio) at rest and on peak IHG and lengthened the PEPI at peak IHG. Resting PEPI values on placebo treatment showed a negative correlation with systolic (r = -0.72) as well as diastolic (r = -0.80) pressure reduction on slow-release metoprolol as compared with placebo treatment. The PEP/LVET ratio at rest on placebo treatment showed a negative correlation with systolic (r = -0.78) as well as diastolic (r = -0.82) pressure reduction at rest on metoprolol compared with placebo treatment. Patients with a resting PEP/LVET ratio less than 0.43 showed a reduction in both systolic and diastolic pressure approximating or exceeding 20 mm Hg, whereas patients with a PEP/LVET ratio greater than 0.47 showed a decrease in systolic and diastolic blood pressure of less than 10 mm Hg. In patients with a PEP/LVET ratio of 0.43 to 0.47 (50% of the trial population), STI didn't show any correlation with the pressure response to beta-blockade. A positive correlation was found between the DBP/PEPI ratio at rest on placebo treatment and systolic (r = 0.56) as well as diastolic (r = 0.76) pressure reduction at rest on slow-release metoprolol compared with placebo treatment. Thus, STI appeared as promising predictors of the magnitude of blood pressure response to sustained beta-blocking therapy in mild-to-moderate essential hypertension, mostly in patients with a resting PEP/LVET ratio less then 0.43 or greater then 0.47.
在20例世界卫生组织1期或2期高血压门诊患者中，记录静息状态和等长运动（IHG）期间的收缩期时间间期（STI）。在一项双盲交叉研究中，在为期2周的安慰剂洗脱期结束后，分别给予每日一次200mg缓释美托洛尔和匹配的安慰剂，各治疗4周。在洗脱期以及任一交叉期的最后一天测量血压和STI。治疗降低了静息状态和IHG峰值时的血压和心率值；它没有改变静息状态下的射血前期指数（PEPI）、左心室射血时间指数（LVETI）及其比值，但降低了静息状态和IHG峰值时舒张压与PEPI的比值（DBP/PEPI比值），并延长了IHG峰值时的PEPI。与安慰剂治疗相比，安慰剂治疗时的静息PEPI值与缓释美托洛尔治疗时的收缩压降低（r = -0.72）以及舒张压降低（r = -0.80）呈负相关。与安慰剂治疗相比，安慰剂治疗时静息状态下的PEP/LVET比值与美托洛尔治疗时静息状态下的收缩压降低（r = -0.78）以及舒张压降低（r = -0.82）呈负相关。静息PEP/LVET比值小于0.43的患者收缩压和舒张压降低幅度接近或超过20mmHg，而PEP/LVET比值大于0.47的患者收缩压和舒张压降低幅度小于10mmHg。在PEP/LVET比值为0.43至0.47的患者（占试验人群的50%）中，STI与β受体阻滞剂的血压反应无任何相关性。与安慰剂治疗相比，安慰剂治疗时静息状态下的DBP/PEPI比值与缓释美托洛尔治疗时静息状态下的收缩压降低（r = 0.56）以及舒张压降低（r = 0.76）呈正相关。因此，在轻度至中度原发性高血压中，STI似乎有望成为持续β受体阻滞剂治疗血压反应幅度的预测指标，主要适用于静息PEP/LVET比值小于0.43或大于0.47的患者。
