舍曲林对高血压伴焦虑抑郁患者血压昼夜节律及心率变异性的影响

摘要

Objective To investigate the effects of sertraline on antihypertensine therapy and circadian rhythm of ambulatory blood pressure and heart rate variability(HRV) in essential hypertensive patients with anxiety and depression.Methods A total of 61 essential hypertensive patients with anxiety and depression were enrolled in this study from June 2009 to May 2010.All patients were randomly divided into two groups: experimental group(routine antihypertensive drugs and anti-anxiety-depression drug: sertraline) and control group(routine antihypertensive drugs and placebo), and the follow-up was eight weeks.The observation items included the scores of SAS/SDS, the blood pressure at base line in sitting position, ambulatory blood pressure monitoring (ABPM) and circadian rhythm of ambulatory blood pressure and Holter ECG monitoring in comparison between experimental group and control groups.Results ①The SAS and SDS of experimental group decreased in post-treatment( P ＜0.01) ,but control group showed no sighificant change( P ＞0.05).There was statistical significance between two groups in post-treatment( P ＜0.01).②Indexes for ambulatory blood pressure in experimental group after treatment decreased more significantly than those of control group ( P ＜0.05).Non-dipper day-night rhythm incidence of experimental group decreased obviously in post-treatment,but control group did no change.There was statistical significance between two groups in posttreatment(64.5 ％ vs 36.7 ％, x2 = 4.731, P ＜ 0.05 ).③ The HRV index ( SDNN, SDANN, RMSSD, PNN50) inexperimental group were all higher than those of control group.There was statistical significance between two groups in post-treatment ( P ＜ 0.01 ).Conclusion The anti-anxiety-depression drug sertraline has effect on antihypertensive therapy and circadian rhythm of ambulatory blood pressure in essential hypertensive patients with anxiety and depression,and the drug can improve day-night circadian rhythm and HRV.%目的 探讨舍曲林对伴焦虑抑郁原发性高血压(essential hypertension,EH)患者血压昼夜节律及心率变异性(heart tate variability,HRV)的影响.方法 选择2009年6月至2010年5月我院收治的EH伴焦虑抑郁患者61例,随机分为实验组(卡托普利+舍曲林)和对照组(卡托普利+安慰剂),并随访8周,观察2组治疗前后焦虑自评量表(SAS)和抑郁自评量表(SDS)评分,坐位血压,动态血压,血压昼夜节律及动态心电图的情况.结果 ①实验组治疗后SAS、SDS评分明显降低(P＜0.01),而对照组无明显变化,两组治疗后相比差异有统计学意义;②治疗后实验组动态血压各项指标均较对照组降低更加明显(P＜0.05).实验组非勺型血压昼夜节律发生率明显降低,而对照组无明显变化,对照组与实验组治疗后相比差异有统计学意义(64.5%vs 36.7%,x2=4.731,P＜0.05).③治疗后实验组HRV时域指标(SDNN、SDANN、RMSSN、PNN5 0)明显高于对照组(P＜0.01).结论 抗焦虑抑郁剂舍曲林能有效缓解伴焦虑抑郁EH患者的焦虑抑郁情绪,可提高降压疗效,改善血压昼夜节律及HRV.