| Objective: Essential hypertension is the clinical syndrome in which theblood pressure in arteries is elevated. Sustained high blood pressure leads totarget organ damage, in which heart damage is the main complication, such asmyocardial infarction, arrhythmia. In the mechanisms of hypertension, theautonomic nerve function is closely associated with the fluctuation of bloodpressure. Currently some researchers considered that the autonomic nervedysfunction is the important factor of elevation of blood pressure. Heart ratevariability (HRV) is a physiological phenomenon where the time intervalbetween heart beats varies, which is an important index to reflect autonomicnerve function. Therefore HRV, as a quantitative non-invasive examination ofthe autonomic nerve activity and regulation, has the vital value to evaluate theautonomic nerve change in the process of cardiovascular disease. Now the useof anti-hypertensive drugs are considered not only the effect ofanti-hypertension agent, but also whether or not improve autonomic nervefunction. Bisoprolol fumarate is a new generation of the selective type β1adrenergic receptor blocker, which can be reduce sympathetic output, canmake the sensitivity of the pressure sensor remodeling, and suppress thehormone over-release and the activation of RAAS to protect thecardiovascular system. This study is that determine improvement ofautonomic nerve function and effect of anti-hypertension and anti-arrhythmiawith bisoprolol fumarate treatment.Methods:54patients with essential hypertension were selected fromMar.2010to Dec.2011year in our hospital, including32slight hypertension,36moderate hypertension,36males,18females, mean age is52.00±4.26years old. All patients are diagnosed hypertension according to guidelines for prevention and treatment of hypertension in China (2005). Excludingsecondary hypertension, sinus bradycardia, acute left heart failure and chroniccongestive heart failure, second degree and above the block, sick sinussyndrome, hypotension, shock, electrolyte disorders, diabetes, asthma, chronicobstructive pulmonary disease, severe liver and renal insufficiency, severewater and sodium retention etc.. According to the dynamic electrocardiogramresults before taking the medicine,54patients were divided into two groups:the arrhythmia group of20cases and normal rhythm group of34cases. And inthe arrhythmia group, there were23cases of supraventricular arrhythmia and11cases of ventricular arrhythmia.Patients have been stooped other antihypertensive drugs and drugs ofinfluence to autonomic nerve function, such as ACEI for5half-life, digitalis,calcium channel blockers and antiarrhythmic drugs, then are given bisoprololfumarate5mg, once daily, for4weeks. Patients were taken examination ofambulatory blood pressure monitoring and dynamic synchronouselectrocardiogram before and of the trial.The examination index of24hours ambulatory blood pressure include24hours systolic blood pressure mean differences (24h SBP),24hour diastolicpressure mean differences (24h DBP); The day systolic blood pressure(dSBP), the mean duration of diastolic blood pressure (dDBP); The nightmean systolic blood pressure and diastolic (nSBP) mean differences (nDBP);R/P ratio.The related HRV index of24hours of dynamic electrocardiogramindex:1)The indexes of time domain:(1) SDNN: standard deviation (SD) ofall normal sinus heartbeat R-R intervals;(2) SDANN: SD of mean value ofR-R intervals every five minutes in24hours;(3) RMSSD: mean square rootof difference value of adjacent R-R intervals;(4) PNN50: the percentage ofheart beat greater than50ms of the difference value of sinus adjacent R-R inthe total workforce.2) The indexes of frequency domain:(1) high frequencypower (HF): frequency band at0.15-0.40HZ,(2) low frequency power (LF):0.04-0.15HZ,(3) LH/HF ratio: the normal range1.5-2.0. All data are presented as mean±standared error of mean. T test analysis ofvariance was used to determine the significant differences between groups;where appropriate, data were analyzed using paired t test for before and aftermedication treatment. p <0.05was accepted as significance.Results:154mild-moderate hypertensive in this study,36males,18females, mean ageis52.00±4.26years old. The antihypertensive effect of all of the patients whohas taken bisoprolol fumarate for4weeks as follows:14cases (25.92%) weremarkedly effective,34cases (62.92%) were effective, the total effective caseswere48, the total effective rate was88.89%.2All patients were measured with24-hour ambulatory blood pressureelectrocardiogram joint monitor before and after4-weeks treatment, and theresults are as follows:24h SBP,24h DBP, dSBP, dDBP, nSBP, and nDBPare decreased significantly (p <0.01) in the treatment group compared withcontrol group. Through24h ambulatory blood pressure monitor, R/P ratio ofsystolic blood pressure was56.2%, R/P ratio of diastolic pressure was69.1%.The results indicated that bisoprolol fumarate can lower blood pressurecontinuously in24hours.3All patients were determined liver and kidney function, blood fat, fastingblood glucose before and after treatment. The difference had no significant(p>0.05).4Adverse reactions: in the processing of treatment, dizzy3cases, headache4cases, languor3cases, but all the patients endured bisoprolol fumaratetreatment until the trial was over.5The indexes of heart rate variability in arrhythmia group, includingSDNN,SDANN,RMSSD,PNN50and HF were significantly reduced comparedwith a non-arrhythmia group (p<0.01); while LF and LF/HF were increased inarrhythmia group compared with a non-arrhythmia group (p<0.01). These datahad shown that bisoprolol fumarate can improve heart rate variability inmild-moderate hypertension. 6In comparison with24hours dynamic electrocardiogram before and aftertreatment in the arrhythmia group, the total number of supraventriculararrhythmia and ventricular arrhythmia were reduced than before. Theefficiency of bisoprolol fumarate in treatment to mild-moderate hypertensionand arrhythmia patients was85.29%, in which10cases were markedlyeffective (29.41%),19cases were effective (55.88%).Conclusion: Bisoprolol fumarate has good antihypertensive effect intreatment of f mild-moderate hypertension, once a day, oral administration, tobe available to reduce blood pressure, minor side effect, and superiortolerability. This study suggested that bisoprolol fumarate can improve theautonomic nerve function, and then effectively prevent cardiac events, such asmalignant arrhythmia and stroke. |
PDF Full Text Request