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静脉注射地尔硫卓、美托洛尔控制房颤快速心室率疗效和安全性比较的Meta分析杨青松;陈永恒;王爱玲;程宝山【摘要】目的比较静脉注射地尔硫卓、美托洛尔控制房颤快速心室率疗效和安全性.方法检索PubMed、EMbase、Cochrane Library、Web of Science、CNKI、VIP、CBM和万方数据库,收集所有比较地尔硫卓、美托洛尔治疗房颤快速心室率的随机对照试验(RCTs),检索时间均为各数据库建库时间至2015年10月.按照纳入和排除标准由2名评价者独立筛选并提取资料,采用Cochrane 5.1手册提供的偏倚风险评估方法,对纳入研究进行质量评价后,使用RevMan 5.3软件进行Meta分析.结果共纳入6项研究,共366例患者.Meta分析结果显示:①有效性方面:地尔硫卓控制房颤快速心室率与美托洛尔相比总有效率无明显差异[相对危险度(RR)=1.12,95％可信区间(CI):0.96 ～ 1.31,P=0.14],房颤心室率下降幅度地尔硫卓组优于美托洛尔组[加权均数差(MD)=10.01,95％ CI:3.95～16.07,P=0.001],平均起效时间两者无明显差别(MD=-0.50,95％ CI:-1.68 ～0.67,P=0.40);②安全性方面:不良反应(包括收缩压＜12.0 kPa、心室率＜60次/min)发生率两者相比差异无统计学意义[率差(RD)=-0.00,95％ CI:-0.04～0.04,P=0.89].结论现有研究显示,地尔硫卓与美托洛尔控制房颤快速心室率的总有效率、平均起效时间及安全性方面无差异,但地尔硫卓心室率下降幅度更大.因受纳入研究数量及部分研究质量限制,该结论尚需开展更多大样本、多中心的随机对照试验加以验证.【期刊名称】《安徽医科大学学报》【年(卷),期】2016(051)009【总页数】6页(P1297-1302)【关键词】地尔硫卓;美托洛尔;心房颤动;心室率控制;Meta分析【作者】杨青松;陈永恒;王爱玲;程宝山【作者单位】安徽医科大学第一附属医院心血管内科,合肥230022;安徽医科大学第一附属医院心血管内科,合肥230022;安徽医科大学第一附属医院心血管内科,合肥230022;安徽医科大学第一附属医院心血管内科,合肥230022【正文语种】中文【中图分类】R541.75;R971.94;R972.3心房颤动是临床上常见的心律失常，其发病率随着年龄的增长而逐渐增高。
美托洛尔联合尼卡地平控制急诊主动脉夹层患者血压和心率的疗效观察郑强; 李磊; 赵宏宇; 赵敏【期刊名称】《《中国全科医学》》【年(卷),期】2012(15)11【摘要】目的评价美托洛尔联合尼卡地平控制急性主动脉夹层患者的血压和心率的疗效。
方法 34例高血压急性主动脉夹层患者接受美托洛尔联合尼卡地平静脉注射治疗。
观察治疗后各时间段的血压和心率以及达到治疗目标值的患者例数。
结果美托洛尔联和尼卡地平治疗10 min后血压和心率即明显下降,治疗后各时间点收缩压、舒张压和心率与治疗前比较均有明显下降(P<0.05)。
治疗30 min后达标率为85.3%,治疗60 min后达标率为94.1%。
治疗前后患者肝、肾功能和尿量无明显变化。
出现脸红发热感1例,低血压1例,窦性心动过缓2例,在减慢用药速度后血压和心率恢复正常。
结论美托洛尔联合尼卡地平可以快速、有效、安全地控制急性主动脉夹层患者的血压和心率。
【总页数】3页(P1264-1266)【作者】郑强; 李磊; 赵宏宇; 赵敏【作者单位】110004 辽宁省沈阳市中国医科大学附属盛京医院急诊科【正文语种】中文【中图分类】R543.1【相关文献】1.艾司洛尔联合尼卡地平对主动脉夹层心率和血压的控制 [J], 孙存杰;潘孔寒2.美托洛尔与尼卡地平联合治疗原发性高血压的疗效观察 [J], 寇连华3.美托洛尔与伊伐布雷定联合控制心率对急诊PCI患者短期预后的影响 [J], 易日霞;李朋;李睿;邹永光;胡威;徐建辉;王丹丹4.美托洛尔与尼卡地平用于急诊主动脉夹层患者治疗中的临床效果 [J], 任光明;张菊红;虞勤清5.地尔硫卓与美托洛尔对急性主动脉夹层患者血压和心率的控制效果研究 [J], 庄熙晶;高洋;高峰;石磊;何学志因版权原因，仅展示原文概要，查看原文内容请购买。
高血药压物治疗高血压是最常见的心血管疾病之一，严重威胁着人类的健康如不加治疗，常引起脑、心、肾的损害，是导致充血性心力衰竭、、冠心病、肾功能衰竭等疾病。
高血压治疗的目的不仅仅是降低血压,更重要的是保护靶器官,降低心血管病的发生率、病死率和致残率,改善病人生活质量,延长患者寿命。
一．临床常用抗高血压药物目前临床用于高血压治疗的药物主要有利尿降压药、肾上腺素受体阻滞药、血管紧张素转换酶抑制剂和血管紧张素Ⅱ受体拮抗剂、长效钙拮抗剂。
1.利尿降压药利尿剂自50年代进入临床作为基础降压药至今仍为临床常用,如噻嗪类利尿药降压作用缓慢平稳,作用时间较长,能拮抗其他降压药物引起的水钠潴留,增加其降压效果。
尤其对盐敏感性高血压、合并肥胖和糖尿病及老年高血压患者有较好的降压效果。
吲哒帕胺作为非噻嗪类利尿药兼有钙拮抗作用,降压温和,疗效确切,对心脏有保护作用,且不影响糖、脂代谢,为一理想的长效降压药。
2.肾上腺素受体阻滞药β受体阻滞剂β受体阻滞剂通过减轻交感神经活性和全身血流自动调节机制降低血压。
该类药物可分为三代,第一代受体选择性差,以普萘洛尔(propranolol)为代表。
普萘洛尔是第一个用于临床的β受体阻滞剂。
第二代具选择性β1受体阻滞作用,以氨酰心安、美多心安为代表。
第三代兼有α1受体阻滞、β2受体兴奋和钙拮抗作用,如拉贝洛尔(labelalol)、、塞利洛尔（celiprolol）、卡维地尔（carvedilol）。
临床治疗高血压通常使用β1受体阻滞剂阿替洛尔、美托洛尔、比索洛尔或兼有α-受体阻滞作用的β-受体阻滞剂卡维地洛,降压作用起效快而强,主要用于交感神经活性增强、静息心率较快的中、青年高血压病人或合并心绞痛的患者。
该药不仅降低静息血压,而且能抑制应激和运动状态下血压的急剧升高。
α1受体阻断剂α1受体阻断剂能选择性阻断血管平滑肌突触后膜的α1受体,使血管扩张,致外周血管阻力下降及回心血量减少,从而降低收缩压和舒张压。
干货！降压药“洛尔”三代的区别展开全文阿替洛尔、美托洛尔、比索洛尔,面对这些“洛尔”,一些老病号总是一头雾水,不同“洛尔”有什么不一样?“洛尔”是β受体阻滞剂的英文译名,具有降低血压、减慢心率、改善心肌缺血、改善心功能的作用,被广泛用于治疗高血压、冠心病、心律失常、慢性心功能不全。
“洛尔”家族有很多成员,它们的作用机制有区别,临床应用也不同。
(一)分类:1)美托洛尔:选择性的β1受体阻滞剂,但是,美托洛尔剂量增大时,其对β1受体的选择性会降低。
美托洛尔无β受体激动作用,几乎没有膜稳定作用。
2)比索洛尔:一种高选择性的β1-肾上腺受体拮抗剂,无内在拟交感活性和膜稳定活性。
比索洛尔在超出治疗剂量时仍具有β1-受体选择性作用。
3)阿替洛尔:选择性β1肾上腺素受体阻滞药。
为心脏选择性β-受体阻断剂,其心脏选择性作用明显强于美托洛尔,而对血管及支气管平滑肌的β2受体抑制较弱。
无内源性拟交感活性,无膜稳定性,也无抑制心肌收缩力的作用。
4)普萘洛尔:非选择性β受体阻滞剂。
有明显的抗血小板聚集作用,这主要与药物的膜稳定作用及抑制血小板膜Ca+转运有关。
5)卡维地洛:兼有α1和非选择性β受体阻滞作用,无内在拟交感活性。
它具有膜稳定特性。
该药是一种强效抗氧化物和氧自由基清除剂。
试验证实本品及其代谢产物均具有抗氧化特性。
6)阿罗洛尔:β受体阻滞剂,兼有适度的α受体阻滞作用(二)t1/21)美托洛尔:3-5h2) 比索洛尔:口服比索洛尔3~4小时后达到最大效应。
由于半衰期为10~12小时,比索洛尔的效应可以持续24小时。
比索洛尔通常在2周后达到最大抗高血压效应。
t1/2:10-12h。
3) 阿替洛尔:口服吸收约为50%。
小剂量可通过血脑屏障。
蛋白结合率6-10%。
服后2-4小时作用达峰值,作用持续时间较久。
t1/2: 6-7h4)普萘洛尔:胃肠道吸收较完全,广泛地在肝内代谢,生物利用度约30%。
药后1-1.5小时达血药浓度峰值,血浆蛋白结合率90-95%。
琥珀酸美托洛尔缓释片在中青年舒张期高血压的降压观察摘要目的观察单纯舒张期高血压选择不同的治疗方案，根据其临床疗效观察，从而证明影响单纯舒张期血压值升高的可能因素。
方法60例已确诊为单纯舒张期高血压的男性患者，按体重是否偏胖、有无吸烟及情绪情况随机分为三组：A组：单纯运动，B组：运动联合口服氯沙坦钾片50 mg/d，C组：运动联合口服琥珀酸美托洛尔缓释片47.5 mg/d。
观察不同方案治疗后其舒张压值的前后变化。
结果C组患者效果明显优于A组和B组（P＜0.05）。
结论运动能改善血管循环中和血管壁内皮细胞的功能，促进小动脉重构，改善血管的弹性。
中青年高血压患者多数存在不同程度的交感神经张力过高、心率偏快，琥珀酸美托洛尔缓解片能降低心率，延长心脏舒张期从而降低舒张期小动脉血流量。
关键词中青年；舒张期高血压；降压观察摘要目的观察单纯舒张期高血压选择不同的治疗方案，根据其临床疗效观察，从而证明影响单纯舒张期血压值升高的可能因素。
方法60例已确诊为单纯舒张期高血压的男性患者，按体重是否偏胖、有无吸烟及情绪情况随机分为三组：A组：单纯运动，B组：运动联合口服氯沙坦钾片50 mg/d，C组：运动联合口服琥珀酸美托洛尔缓释片47.5 mg/d。
观察不同方案治疗后其舒张压值的前后变化。
结果C组患者效果明显优于A组和B组（P＜0.05）。
结论运动能改善血管循环中和血管壁内皮细胞的功能，促进小动脉重构，改善血管的弹性。
中青年高血压患者多数存在不同程度的交感神经张力过高、心率偏快，琥珀酸美托洛尔缓解片能降低心率，延长心脏舒张期从而降低舒张期小动脉血流量。
关键词中青年；舒张期高血压；降压观察单纯的舒张期高血压，越来越多见于中青年人，资料显示在小于40岁的中青年高血压人群中，单纯舒张期高血压占60%，且这类患者多无任何临床症状，因而很少就医，忽视了早期治疗。
本文对本科60例单纯舒张期高血压门诊患者的临床资料进行分析，分析影响舒张期血压增高的可能因素，为临床诊治提供依据。
Comparison of the effectiveness of intravenous diltiazem and metoprolol in the management of rapid ventricular rate in atrial fibrillationC Demircan,H I Cikriklar,Z Engindeniz,H Cebicci,N Atar,V Guler,E O Unlu,B Ozdemir ...............................................................................................................................See end of article for authors’affiliations ....................... Correspondence to:Dr C Demircan,Uludag Universitesi Tip Fakultesi,Ic Hastaliklari Anabilim Dali, Bursa—Turkey; demircan@.trAccepted for publication 26April2004 .......................Emerg Med J2005;22:411–414.doi:10.1136/emj.2003.012047 Objective:To compare the effectiveness of intravenous(IV)diltiazem and metoprolol in the management of rapid ventricular rate in atrial fibrillation(AF).Methods:This prospective,randomised study was conducted in the Emergency Department of the Uludag University Medical Faculty Hospital,Bursa,Turkey.Forty AF patients with a ventricular rate>120/minute and systolic blood pressure>95mm Hg were included and randomised to receive IV diltiazem0.25mg/ kg(maximum25mg)or metoprolol0.15mg/kg(maximum10mg)over2minutes.Blood pressures and heart rate were measured at2,5,10,15,and20minutes.Successful treatment was defined as fall in ventricular rate to below100/minute or decrease in ventricular rate by20%or return to sinus rhythm. Results:Between January2000and July2002,40patients(18men,22women)met the inclusion criteria. Of these20(8men,12women;mean age60.2years,range31–82)received diltiazem and20(10men, 10women;mean age64.0years,range31–82)received metoprolol.The success rate at20minutes for diltiazem and metoprolol was90%(n=18)and80%(n=16),respectively.The success rate at2minutes was higher in the diltiazem group.The percentage decrease in ventricular rate was higher in the diltiazem group at each time interval.None of the patients had hypotension.Conclusion:Both diltiazem and metoprolol were safe and effective for the management of rapid ventricular rate in AF.However,the rate control effect began earlier and the percentage decrease in ventricular rate was higher with diltiazem than with metoprolol.A trial fibrillation(AF)is the commonest chronicarrhythmia,and its prevalence increases with age.12AF is a potential risk factor for stroke by predisposing to thrombus formation,it may exacerbate heart failure due to loss of effective atrial contraction in compensated patients, and it may cause tachycardia induced cardiomyopathy when ventricular rate is not controlled.2–4The goals of treatment for AF are to maintain effective cardiac output either by conversion to sinus rhythm when appropriate or by control-ling ventricular rate and preventing embolic complications.56 Recent trials(the rate control versus electrical cardioversion for persistent atrial fibrillation(RACE)study and the atrial fibrillation follow-up investigation of rhythm management (AFFIRM)study)have demonstrated that therapies directed towards maintenance of sinus rhythm have no survival advantage over ventricular rate controlling strategies and that there is a lower risk of adverse drug effects with the rate control strategy.78The rapid ventricular rate increases the oxygen demand of the myocardium and may cause myocardial ischaemia and heart failure in the patients who have limited myocardial reserve.Symptoms including palpitation,angina,dyspnoea, and anxiety may be seen in patients with AF.To prevent complications and relieve the symptoms ventricular rate should be controlled in AF patients with a rapid ventricular rate. Digitalis,b blockers and calcium channel blockers(ver-apamil and diltiazem)are all used in the treatment of rapid ventricular rate in AF.569–11However,there has been no study comparing the effectiveness of these agents.Therefore,we conducted the present study to compare the effectiveness of intravenous(IV)diltiazem and metoprolol(the only par-enteral b blocker preparation available in Turkey)in the management of rapid ventricular rate in AF in an emergency department(ED)setting.METHODSThis prospective,double blind,randomised study wasplanned and conducted in the ED of the Uludag UniversityMedical Faculty Hospital,Bursa,Turkey.The mean numberof annual admissions to the ED is24000.We enrolledpatients.18years of age who had AF with a ventricular rate>120/minute and systolic blood pressure>95mm Hg.Patients were excluded if they had history of allergicreactions to diltiazem and metoprolol,congestive heartfailure(New York Heart Association Class IV),systolic bloodpressure,95mm Hg,sick sinus syndrome,atrioventricular(AV)block(2nd or3rd degree),pre-excitation syndromes,ventricular rate.220/min,QRS.0.08s,unstable anginapectoris,acute myocardial infarction,hyperthyroidism,temperature.38.0˚C,haemoglobin,11.0g/dl,bronchial asthma,chronic obstructive pulmonary disease,diabetesmellitus,peripheral vascular disease,pregnancy,history ofuse of diltiazem,verapamil,digoxin,b blockers,theophylline,or b mimetics within the last five days(these drugs arecleared from the body within this time).12–14All the enrolledpatients received information about the study and gave writteninformed consent.The study was conducted inaccordancewith the Declaration of Helsinki.All patients had a12-lead electrocardiogram at thebeginning of the trial.We recorded and monitored theirheart rate and blood pressures.The patients were randomlyassigned to IV diltiazem0.25mg/kg(maximum25mg)ormetoprolol0.15mg/kg(maximum10mg),which wasadministered by the nursing staff in the ED.12–15Forrandomisation,we used cards with‘‘metoprolol’’or‘‘diltia-zem’’put in sealed,opaque envelopes.The envelopes wereAbbreviations:AF,atrial fibrillation;ED,emergency department;IV, intravenous411shuffled to achieve randomisation.When an eligible patient was to be given treatment the top most envelope was opened by a nurse who was not taking part in the study.Then the drug was prepared by the nurse and the amount of the injection equalised with normal saline.The drug was administered to the patient in the presence of an observer (one of the authors)who was blinded to the contents of the injection.The patient’s heart rate(with a rhythm strip at least30s long)and blood pressures were measured and recorded by a blinded observer at2,5,10,15,and20minutes to evaluate the effect of the treatment.We defined successful treatment as achievement of a ventricular rate,100/min or a decrease in ventricular rate by 20%(,120/min at least)or conversion to sinus rhythm.13 Hypotension(systolic blood pressure,90mm Hg)wasaccepted as a complication of treatment.1314If the initial therapy was unsuccessful,an additional dose of IV diltiazem (0.35mg/kg in diltiazem group and0.25mg/kg in the metoprolol group)was given as rescue treatment at the end of the study period.At this time point the observer was not blinded.We analysed the data with SPSS for Windows(version 10.0).We used the t test for statistical comparisons of the differences between the two groups with regard to mean age, sex,pretreatment ventricular rate,systolic and diastolic blood pressures,treatment success ratios,and percentage decrease in ventricular rate.The paired t test was used for comparing within group changes at different time point.Differences in categorical variables were analysed with x2square test. RESULTSBetween January2000and July2002,of85patients who were initially evaluated,40(18men,22women;mean(SD) age62.1(12.9)years)met all the inclusion criteria and were enrolled in the study(fig1).Twenty patients were randomised to receive diltiazem(8men,12women;mean age60.2years,range31–82)and20to receive metoprolol(10 men,10women;mean age64.0years,range31–82).There was no significant difference between the groups as regards age and sex.Table1gives the changes in ventricular rate following treatment for all patients in both study groups.The changes in mean ventricular rate are shown in fig2and the percentage decrease in ventricular rate in relation to time in table2.The rate of success of the treatments at2,5,10,15, and20minutes are given in table3and table4shows the changes in blood pressure with time in both the study groups. There were no significant differences between the meanFigure1Flow chart of the numbers of patients at different time points in the study.Table1Ventricular rate at the different time points of the study for each patient in both treatment groupsTreatmentgroup andpatient no.Age SexMinutes after administration of treatmentResult025101520Diltiazem165F145112105102102100Successful272F1509675687276Successful370M14094103908580Successful441M17810194939599Successful550M1508590929896Successful664M14610510810810898Successful770F192132120118117118Successful856F174170132136138124Unsuccessful969M1281071031009698Successful1067F1246874728072Successful1173F146112949810098Successful1263F16013210410810698Successful1360M1604313910810598Successful1447F170154142124116112Successful1531M1581451241209596Successful1666F162122120118116115Successful1750F186130126130140130Unsuccessful 1882F16912110810410499Successful1968M14098969395103Successful2040F150105108928090SuccessfulMean156.4116.6108.2103.7102.4100Metoprolol162M166148144135138142Unsuccessful266F161121120118116112Successful364M13210811010210493Successful482M124120106989498Successful565F1509210211210498Successful664F12410090969096Successful774F156140132130129115Successful876F138118108106110107Successful940F130128128126128122Unsuccessful 1069M1411169810410498Successful1131F170120122122116118Successful1252M150150150130130128Unsuccessful 1373M14012611410410898Successful1470M16012811411211098Successful1556M1689792888990Successful1660M142122119656568Successful1780F150108941069490Successful1870F160141144132126114Successful1975M198183190185163150Unsuccessful 2052F180130140130128115SuccessfulMean152124.8120.8115112.3107.5412Demircan,Cikriklar,Engindeniz,et alventricular rate and the systolic and diastolic blood pressures of the two treatment groups before treatment.None of the patients achieved sinus rhythm.A significant decrease in the ventricular rate was observed in both treatment groups after at2minutes(p,0.01).The percen-tage decrease in ventricular rate was significantly higher in the diltiazem group than in the metoprolol group at2,5,10, 15,and20minutes.Diltiazem was found to have a significantly higher success rate at2minutes than metopro-lol.The success rate in the diltiazem group appeared to be higher than metoprolol group at each time interval,however, there was no statistically significant difference between the two groups at5,10,15,and20minutes.At20minutes,a mean decline of15.5/9.8mm Hg and 22.3/11.5mm Hg in the systolic/diastolic blood pressures was observed in the diltiazem and metoprolol groups,respec-tively.There was no significant difference between the decrease of blood pressure in the two treatment groups. None of the patients had hypotension.DISCUSSIONDiltiazem is a calcium channel blocker classified as a class IV antiarrhythmic in the Vaughan–Williams classification.It slows the conduction through the AV node and prolongs AV nodal refractoriness when the AV nodal conduction rates are high.Hence it is commonly used in supraventricular tachycardias.12–14In a study comparing the efficacy of diltiazem and digoxin in30patients with AF and atrial flutter with rapid ventricular rate,Schreck et al reported that the mean heart rate decreased significantly(from150/min to 111/min)after IV diltiazem at5minutes and that IV diltiazem was more effective than IV digoxin for emergent control of ventricular rate.14In an out-of-hospital study on43 patients(38AF,4atrial flatter,1supraventricular tachycar-dia),Wang et al reported that sinus rhythm returned in four patients,ventricular rate decreased to(100/min in20 patients,heart rate decreased.20%in11patients,and the overall success rate was81%with IV diltiazem.16Goldenberg et al,in a study of patients with AF,atrial flutter,and moderate to severe congestive heart failure,reported a high therapeutic response(83.7%with0.25mg/kg and97.3%with an additional0.35mg/kg)with IV diltiazem in controlling rapid ventricular rate.17In our study,successful ventricular rate control was achieved in18/20patients(90%)in the diltiazem group at 20minutes.The remaining two patients required an additional dose of0.35mg/kg diltiazem for rate control. Half of the patients had a rapid response to diltiazem at 2minutes.None of the patients had hypotension.b Blockers are class II antiarrhythmic drugs whose physiological effects are a result of their competitive inhibition of catecholamine binding to b-adrenoceptor sites. They slow AV nodal conduction and prolong AV nodal refractoriness,so they are useful in supraventricular tachy-arrhythmias.The effect of metoprolol,which is the only parenteral b blocker preparation available in Turkey,on ventricular rate has been proved in several studies.151819In a study on the patients with supraventricular tachyarrhyth-mias,Amsterdam et al reported that the mean heart rate decreased by more than15%in11of16patients(69%)(9of 11patients with AF(82%))with a mean dose of9.5mg metoprolol.Hypotension was observed in five patients.18In our study the desired ventricular rate control was achieved in16of20patients(80%)in the metoprolol group at20minutes.In the remaining four patients the therapeutic effect was achieved with IV diltiazem,0.25mg/kg(only one of these patients needed an additional dose of diltiazem, 0.35mg/kg).None of the patients had hypotension.In conclusion,our study showed both diltiazem and metoprolol were effective and safe in controlling rapid ventricular rate in AF.However,the rate control effect of diltiazem began earlier and the percentage decrease inTable3Treatment success ratios(%)in relation to timeTreatment groups Time(minutes after administration of treatment) 25101520Diltiazem5060759090Metoprolol1535606580p value p,0.05p.0.05p.0.05p.0.05p.0.05Table4Mean(SD)blood pressure in both treatment groups in relation to time.Valuesare mm HgTreatment group Time(minutes after administration of treatment)025101520DiltiazemSBP136.5(29.8)128.7(24.8)124.5(22.6)122(21.9)121(21.4)121(19.9)DBP86(15.1)81.7(12.9)78.5(12.2)77.5(11.3)76.5(11.2)76.2(11.3)MetoprololSBP143(22.5)134(22.2)129.2(19.0)125.5(19.9)124.2(18.0)81.5(10.1)DBP93(13.8)88(13.3)85(11.3)84(11.4)82(10.5)120.7(18.1)p value p.0.05p.0.05p.0.05p.0.05p.0.05p.0.05SBP,systolic blood pressure;DBP,diastolic blood pressure.Intravenous diltiazem and metoprolol in management of rapid ventricular rate in AF413ventricular rate at different time intervals in the diltiazem group was higher in the metoprolol group.Authors’affiliations.....................C Demircan,H I Cikriklar,Z Engindeniz,H Cebicci,N Atar,V Guler,E O Unlu,B Ozdemir,Uludag University Medical Faculty Hospital,Bursa,TurkeyCompeting interests:none declaredREFERENCES1Feinberg WM ,Blackshear JL,Laupacis A,et al.Prevalence,age distribution,and gender of patients with fibrillation.Analysis and implications.Arch Intern Med 1995;155:469–73.2Kannel WB ,Abbott RD,Savage DD,et al.Epidemiologic features of chronic atrial fibrillation:the Framingham Study.N Engl J Med 1982;306:1018–22.3Wolf PA ,Abbott RD,Kannel WB.Atrial fibrillation:a major contributor to stroke in the elderly.The Framingham Study.Arch Intern Med 1987;147:1561–4.4Wellens HJJ ,Rodriguez LM,Smeets LRM,et al.Tachycardiomyopathy in patients with supraventricular tachycardia with emphasis on atrial fibrillation.In:Olsson SB,Allessie MA,Campbell RWF,eds.Atrial Fibrillation:Mechanism and Therapeutic Strategies .New York:Futura Publishing Company,1994:333–42.5Zipes DP .Specific arrhythmias:diagnosis and treatment.In:Braunwald E,ed.Heart Disease:A Textbook of Cardiovascular Medicine .5th edn.Philadelphia:WB Saunders Company,1997:640–704.6Pritchett ELC .Management of atrial fibrillation.N Engl J Med 1992;326:1264–71.7Hagens VE ,Van Gelder IC,Crijns HJ.The RACE study in perspective of randomized studies on management of persistent atrial fibrillation.Card Electrophysiol Rev 2003;7:118–21.8Wyse DG ,Waldo AL,DiMarco JP,et al.A comparison of rate control and rhythm control in patients with atrial fibrillation.N Engl J Med 2002;347:1825–33.9Shettigar UR .Management of rapid ventricular rate in acute atrial fibrillation.Int J Clin Pharm Ther 1994;32:240–5.10Waldo AL ,Prystowsky EN.Drug treatment of atrial fibrillation in the managedcare era.Am J Cardiol 1998;81(5A):23C–29C.11Werko ¨L .Atrial fibrillation:Introduction.In:Olsson SB,Allessie MA,Campbell RWF,eds.Atrial Fibrillation:Mechanism and Therapeutic Strategies .New York:Futura Publishing Company,1994:1–13.12Phillips BG ,Gandhi AJ,Sanoski CA,et parison of intravenousdiltiazem and verapamil for the acute treatment of atrial fibrillation and atrial flutter.Pharmacotherapy 1997;17:1238–45.13Dias VC ,Weir SJ,Ellenbogen KA.Pharmacokinetic and pharmacodynamicsof intravenous diltiazem in patients with atrial fibrillation or atrial flutter.Circulation 1992;86:1421–8.14Schreck DM ,Rivera AR,Tricarico VJ.Emergency management of atrialfibrillation and flutter:intravenous diltiazem versus intravenous digoxin.Ann Emerg Med 1997;29:135–40.15Rizos I ,Senges J,Jauernig R,et al.Differential effects of sotalol andmetoprolol on induction of paroxysmal supraventricular tachycardia.Am J Cardiol 1984;53:1022–7.16Wang HE ,O’Connor RE,Megargel RE,et al.The use of diltiazem for treatingrapid atrial fibrillation in the out-of-hospital setting.Ann Emerg Med 2001;37:38–45.17Goldenberg IF ,Lewis WR,Dias VC,et al.Intravenous diltiazem for thetreatment of patients with atrial fibrillation or flatter and moderate to severe congestive heart failure.Am J Cardiol 1994;74:884–9.18Amsterdam EA ,Kulcyski J,Ridgeway MG.Efficacy of cardioselective beta-adrenergic blockade with intravenously administered metoprolol in the treatment of supraventricular tachyarrhythmias.J Clin Pharmacol 1991;31:714–18.19Hazard PB ,Burnett CR.Treatment of multifocal atrial tachycardia withmetoprolol .Crit Care Med 1987;15:20–5.bmjupdates +is a unique and free alerting service,designed to keep you up to date with the medical literature that is truly important to your practice.bmjupdates +will alert you to important new research and will provide you with the best new evidence concerning important advances in health care,tailored to your medical interests and time demands.Where does the information come from ?bmjupdates +applies an expert critical appraisal filter to over 100top medical journals A panel of over 2000physicians find the few ’must read’studies for each area of clinical interestSign up to receive your tailored email alerts,searching access and more…414Demircan,Cikriklar,Engindeniz,et al。
“洛尔”类降压药（受体阻滞剂），既降血压又减心率的降压药！前面已经介绍了四大类一线降压药（常用的利尿（降压）药有哪些？我们应该怎么用？，“地平”类降压药（钙拮抗剂），我国应用最普遍的降压药，“普利”和“沙坦”，降压治疗“一根藤上两只瓜”！，“普利”和“沙坦”，降压好“兄弟”，再说弟弟“沙坦”），今天来介绍第五大类，“洛尔”类降压药。
“洛尔”类降压药，学名叫做“β-受体阻滞剂”（全称β-肾上腺素能受体阻滞剂，简称β阻滞剂）。
因为英文名最后都是“lol”，译成“洛尔”。
要说“β-受体阻滞剂”，大家可能会觉得陌生，可是要说心得安（普萘洛尔）、氨酰心安（阿替洛尔）、倍他乐克（美托洛尔）、康忻或博苏（比索洛尔）、阿尔马尔（阿罗洛尔）、以及卡维地洛（达利全，金络）等，还有妊娠（孕妇）降压常用的拉贝洛尔（柳氨苄心定），很多人就会感到熟悉，都是治疗高血压、冠心病常用的药物。
注意，还有个索他洛尔，虽然也称“洛尔”，也有部分“洛尔”的（β阻滞）作用，但大类不归于洛尔类，可不要搞混了哦！“洛尔”类药的作用，从学名“β-受体阻滞剂”就能看出，是阻滞β-受体的。
我们人体内有个交感神经系统，这个系统兴奋对心血管的作用就是使心跳增快、心肌收缩力增强、血压升高，等等；交感神经兴奋起来还会指挥下面的肾素-血管紧张素-醛固酮系统兴奋，一起来升高血压。
交感神经怎样指挥下级？通过神经内分泌激素作用于组织器官上的受体——β受体、α受体。
如果阻断了这些受体，就阻断了交感神经和神经内分泌激素的发号施令。
β-受体阻滞剂就是负责阻滞β受体的。
交感神经在高血压发病中的作用β-受体阻滞剂发展到今天已经是三代了。
最早的β-受体阻滞剂是普萘洛尔（心得安）一类的，这类药对β受体没有选择性，一律阻断，就会同时阻断β1和β2受体（这是两种类型的β受体，分布和作用不一样），因为气管上主要是β2受体（管气管扩张的），所以心得安会引起严重的哮喘发作，现在这类药已不常用。
World Latest Medicne Information (Electronic Version) 2016 Vo1.16 No.79176·药物与临床·临床常用抗高血压药物及其不良反应与防治刘春雨（天津市武清区城关镇医院，天津 300000）摘要：在当今人们的生活中，随着人们的膳食环境，工作环境，出行环境等的改变，心血管疾病的发生呈逐年上升的的趋势，尤其是高血压疾病有向青少年发展的态势。
高血压造成的并发症较多，其致残、致死率较高，严重影响人们的生活质量，因此高血压药物的研究与应用受到了广大医务工作者和病患者的普遍重视，现就一些临床常用的高血压药物及其应用总结如下，以供参考。
关键词：抗高血压药物；不良反应与防治中图分类号：R972+.4 文献标识码：B dOI：10.3969/j.issn.1671-3141.2016.79.1470 引言高血压是指在静息状态下动脉收缩压和/或舒张压增高， 可伴有心脏、血管、脑和肾脏等器官功能性或器质性改变的全身性疾病， 它有原发性高血压和继发性高血压之分。
在绝大多数患者中， 高血压的病因不明， 称之为原发性高血压， 占总高血压的95 % 以上。
而继发性高血压是继发于其他疾病， 最常见的是由肾脏及肾上腺疾病所致以及内分泌性高血压[1]。
1 抗高血压药物分类目前，抗高血压药物按其作用可分为11类[2]，临床常用的有5类为：血管紧张素转化酶抑制剂（ACEI），血管紧张素II受体拮抗剂（ARB），钙通道阻滞药（CCB）， β受体阻滞剂，利尿降压药[3]。
同时还包括复合药物， 以及中成性药物[4]。
1.1 血管紧张素转化酶抑制剂（ ACEI） : ACEI（贝那普利片、依那普利片、卡托普利片、培垛普利片）对全身动脉及静脉具有扩张作用，能减少血管紧张素的生成和醛固酮的释放，从而降低血压。
ACEI 是唯一能够同时适应糖尿病、心力衰竭、冠心病、心肌梗死、慢性肾病和预防中风复发的一线抗高血压药物。
美托洛尔用法美托洛尔是一种广泛使用的药物，常见于治疗高血压、心绞痛和心律失常等心血管疾病。
它属于一种β受体阻滞剂，通过阻断肾上腺素能β受体的激活，降低心脏的负荷和耗氧量，从而达到降压和减少心脏负担的效果。
下面将针对美托洛尔的用法进行详细介绍。
一、美托洛尔的剂型和用法美托洛尔主要有口服剂和缓释剂两种剂型。
口服剂一般每次5-10mg，每日2-3次，常用于治疗高血压和心绞痛。
缓释剂则一般每次50-100mg，每日1-2次，用于长效降压和稳定心绞痛。
在使用美托洛尔之前，患者应该咨询医生并根据医嘱进行用药，不得擅自更改用药剂量和频次。
二、合理用药注意事项1.适宜症状：美托洛尔主要用于治疗高血压、心绞痛和心律失常等心血管疾病。
患者在使用美托洛尔前应先了解使用的适宜症状，确保使用时符合医生的处方用药意见。
2.肾功能不全：患有肾功能不全的患者在使用美托洛尔前，需要告知医生相关病史，医生会根据具体情况调整用药剂量，避免出现肾功能不全导致的药物蓄积。
3.肝功能不全：患有肝功能不全的患者在使用美托洛尔前，同样需要告知医生相关病史，医生会根据情况调整用药剂量，避免出现肝功能不全导致的药物代谢不良。
4.儿童用药：儿童在使用美托洛尔前，必须听从医生的建议，按照医生的指导进行用药，切勿擅自调整剂量或频次。
5.老年人用药：老年人在使用美托洛尔时，由于生理机能下降，药物代谢减慢，需要根据具体情况调整用药剂量，避免出现过度药物蓄积。
三、美托洛尔常见不良反应及处理方法1. 心血管方面：可能出现低血压、心动过缓、心律失常等不良反应，如果出现上述症状，可减少用药剂量或者暂时停药，必要时寻求医生治疗。
2. 消化系统方面：可能出现恶心、呕吐、腹泻等不良反应，患者在出现上述症状时，可以酌情调整饮食，减少脂肪、辛辣食物的摄入，同时保持充足的水分补充。
3. 中枢神经系统方面：可能出现头晕、头痛、疲乏等不良反应，患者在出现上述症状时，可以适当休息，保持充足睡眠，避免过度疲劳。
