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目的探讨坎地沙坦对高血压并阵发性心房颤动患者心率变异性(HRV)、P波离散度(Pd)的影响。方法将高血压并阵发性心房颤动患者160例随机分为治疗组(n=80)和对照组(n=80)。治疗组给予坎地沙坦4mg/d,对照组给予非洛地平5mg/d,疗程20周,并在治疗前后行24h动态心电图(Holter)及普通心电图检查,对比观察治疗前后HRV、P波最大时限(Pmax)和Pd的变化。结果治疗后两组血压均较治疗前明显降低[对照组(133.8±8.9)/(74.4±7.1)比治疗前(157.2±10.6)/(87.6±10.4)mmHg;治疗组(134.6±7.5)/(76.3±6.9)比治疗前(158.9±8.3)/(85.6±10.2)mmHg;均P<0.01];治疗后两组血压之间无明显差异(P>0.05)。治疗组心房颤动复发率(56.3%比对照组63.8%)、发作持续时间[(16.9±5.7)比对照组(23.8±5.1)h]、发作时心室率[(105.5±11.4)比对照组(118.0±17.0)次/min]均较对照组明显改善(均P<0.05);治疗组HRV较治疗前明显改善(均P<0.05),Pmax、Pd明显减小(均P<0.01);治疗20周后与对照组比较,治疗组HRV[SDNN(170.3±51.7)比对照组(146.6±36.6)ms;SDANN(145.1±43.2)比对照组(118.3±29.1)ms;高频(201.6±71.3)比对照组(167.4±67.3)ms2;低频(346.6±120.5)比对照组(440.9±181.5)ms2;低频/高频(2.0±1.2)比对照组(3.8±1.0)、Pmax(116.4±16.6)比对照组(125.4±19.0)ms]和Pd[(31.8±8.3)比对照组(37.2±12.7)ms]改善有明显差异(均P<0.05)。结论坎地沙坦在降压的同时可改善高血压并阵发性心房颤动患者的HRV、Pmax、Pd,并可能减少阵发性心房颤动的发作。
Objective To investigate the effect of candesartan on heart rate variability (HRV) and P wave dispersion (Pd) in patients with hypertension and paroxysmal atrial fibrillation. Methods 160 patients with hypertension and paroxysmal atrial fibrillation were randomly divided into treatment group (n = 80) and control group (n = 80). The treatment group was given candesartan 4mg / d, the control group was given felodipine 5mg / d, the course of treatment was 20 weeks, and 24h before and after treatment dynamic Holter (Holter) and general electrocardiogram, compared and observed before and after treatment HRV, P wave maximum Time (Pmax) and Pd changes. Results After treatment, the blood pressure in both groups was significantly lower than that before treatment (133.8 ± 8.9 / 74.4 ± 7.1 vs 157.2 ± 10.6 / 87.6 ± 10.4 mmHg before treatment and 134.6 ± 7.5 / (76.3 ± 6.9) than before treatment (158.9 ± 8.3) / (85.6 ± 10.2) mmHg respectively; all P <0.01]. There was no significant difference between the two groups after treatment (P> 0.05). The recurrence rate of atrial fibrillation in treatment group (56.3% vs control group 63.8%), duration of attack [(16.9 ± 5.7) vs control group (23.8 ± 5.1 h), and ventricular rate at onset (105.5 ± 11.4) 118.0 ± 17.0) times / min were significantly higher than those in the control group (all P <0.05). The HRV in the treatment group was significantly improved (all P <0.05) and Pmax and Pd were significantly decreased (all P <0.01) After 20 weeks, HRV [SDNN (170.3 ± 51.7) ms vs 146.6 ± 36.6 ms; SDANN (145.1 ± 43.2) vs control (118.3 ± 29.1 ms); high frequency ) Was lower than that of control group (167.4 ± 67.3) ms2; low frequency (346.6 ± 120.5) vs control group (440.9 ± 181.5) ms2; low and high frequency (2.0 ± 1.2) ) (125.4 ± 19.0 ms vs Pd (31.8 ± 8.3) vs 37.2 ± 12.7 ms (P <0.05), respectively). Conclusions Candesartan can reduce HRV, Pmax, Pd and reduce the incidence of paroxysmal atrial fibrillation in patients with hypertension and paroxysmal atrial fibrillation.