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美托洛尔的作用与功能主治与用量美托洛尔是一种选择性β1受体阻滞剂，主要用于治疗高血压、心绞痛和心律失常等心血管疾病。
它通过阻断β1受体，降低心脏的收缩力和心率，从而减少心脏的氧耗和负荷，达到降低血压和治疗心脏病的作用。
主治美托洛尔常用于以下心血管疾病的治疗：1.高血压：美托洛尔作为一种高血压的治疗药物，通过降低心率和血压，减少心脏的负荷，从而达到降低血压的效果。
2.心绞痛：美托洛尔可减少心脏对氧的需求，缓解心绞痛的症状，改善心脏供血，并预防心绞痛的发作。
3.心律失常：美托洛尔可以减慢心脏的频率，稳定心律，治疗心律失常。
用量美托洛尔的用量根据疾病的严重程度和个体情况而定。
一般建议的剂量如下：1.高血压：–起始剂量：美托洛尔每日50mg-100mg，分为1-2次口服。
–维持剂量：根据血压控制情况逐渐调整，一般为每日100mg-200mg，分为2次口服。
在个别病例可能需要更高的剂量。
2.心绞痛：–起始剂量：美托洛尔每日50mg，分为1-2次口服。
–维持剂量：根据症状和心电图的改善情况逐渐调整，一般为每日100mg-200mg，分为2次口服。
3.心律失常：–起始剂量：美托洛尔每日50mg-100mg，分为1-2次口服。
–维持剂量：根据心律失常的情况逐渐调整，一般为每日100mg-200mg，分为2次口服。
注意：美托洛尔的用量应根据医生的建议和个体情况来确定，切勿自行调整剂量。
常见的不良反应美托洛尔在治疗过程中可能会出现一些不良反应，但并不是每个人都会出现。
常见的不良反应包括：1.疲倦或乏力2.阻塞感或胸闷3.低血压4.心悸或心率减慢5.呼吸困难如果出现以上不良反应，应立即咨询医生，并根据医生的指导进行处理。
注意事项在使用美托洛尔期间，需要注意以下事项：1.遵循医嘱：请按照医生的指导和处方使用美托洛尔，并不要自行调整剂量。
2.定期复诊：定期回访医生，根据病情调整治疗方案。
3.避免停药：如需停药，请在医生的指导下逐渐减少剂量，避免突然停药引起的反弹效应。
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。
地尔硫卓联合美托洛尔对不稳定型心绞痛患者的影响张俊俊① 吴美善① 何健① 【摘要】 目的：研究地尔硫卓联合美托洛尔对不稳定型心绞痛患者的影响。
方法：选取2022年1—8月深圳市人民医院龙华分院收治的146例不稳定型心绞痛患者为研究对象。
根据随机数表法将其分为观察组及对照组，各73例。
两组均给予常规治疗，对照组在此基础上予以酒石酸美托洛尔片，观察组则在对照组基础上增加盐酸地尔硫卓片。
比较两组临床疗效，治疗前后心功能指标、运动耐力相关指标及不良反应。
结果：观察组总有效率高于对照组，差异有统计学意义（P<0.05）。
治疗后，观察组左室舒张末期内径（LVEDD）及左室收缩末期内径（LVESD）均短于对照组，左室射血分数（LVEF）高于对照组，差异有统计学意义（P<0.05）。
治疗后，观察组6分钟步行试验（6MWT）距离长于对照组，改良英国医学研究委员会呼吸困难量表（mMRC问卷）评分低于对照组，差异有统计学意义（P<0.05）。
两组不良反应发生率比较，差异无统计学意义（P>0.05）。
结论：地尔硫卓联合美托洛尔治疗不稳定型心绞痛患者的效果较好，还可提升其运动耐力，改善心功能指标，安全性较好。
【关键词】 地尔硫卓 美托洛尔 冠心病 不稳定型心绞痛 doi：10.14033/ki.cfmr.2023.21.037 文献标识码 B 文章编号 1674-6805（2023）21-0146-04 Effect of Diltiazem Combined with Metoprolol on Patients with Unstable Angina/ZHANG Junjun, WU Meishan, HE Jian. //Chinese and Foreign Medical Research, 2023, 21(21): 146-149 [Abstract] Objective: To study the effect of Diltiazem combined with Metoprolol on patients with unstable angina. Method: A total of 146 patients with unstable angina treated in Longhua Branch of Shenzhen People's Hospital from January to August 2022 were selected as study objects. They were divided into observation group and control group according to random number table method, with 73 cases in each group. Both groups were given conventional treatment, the control group was given Metoprolol Tartrate Tablets on this basis, the observation group was given Diltiazem Hydrochloride Tablets on the basis of the control group. The clinical efficacy, cardiac function indexes, exercise endurance related indexes before and after treatment and adverse reactions were compared between the two groups. Result: The total effective rate of the observation group was higher than that of the control group, and the difference was statistically significant (P<0.05). After treatment, left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) in the observation group were shorter than those in control group, and left ventricular ejection fraction (LVEF) was higher than that in control group, the differences were statistically significant (P<0.05). After treatment, the 6 min walking test (6MWT) distance of the observation group was longer than that of the control group, and the score of the modified British Medical Research Council dyspnea (mMRC questionnaire) was lower than that of the control group, the differences were statistically significant (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: Diltiazem combined with Metoprolol in the treatment of patients with unstable angina has a good effect, can also improve their exercise endurance, improve cardiac function indexes, and has good safety. [Key words] Diltiazem Metoprolol Coronary heart disease Unstable angina First-author's address: Longhua Branch of Shenzhen People's Hospital, Shenzhen 518110, China 临床认为，不稳定型心绞痛冠心病致病因素较多，机体内部的血小板聚集及血栓的产生等均可能导致心肌细胞发生急性的缺血和缺氧症状，从而引发心绞痛[1-2]。
心律失常诊治流程一、快速性心律失常(一)快速性室上性心律失常:1、狭义室上性心动过速（阵发性室上性心动过速）：阵发性房性心动过速、阵发性房室折返性心动过速（预激）、阵发性房室结折返性心动过速。
2、广义室上性心动过速:阵发性室上性心动过速+窦性心动过速、心房颤动、心房扑动。
(二)快速性室性心律失常室性心动过速、心室扑动、心室颤动二、缓慢性心律失常1、病态窦房结综合征：窦性心动过缓、窦性停搏、窦房阻滞、以及各种类型的快速性心律失常2、房室传导阻滞：Ⅱ度Ⅱ型、Ⅲ度房室阻滞3、心脏骤停、室性自主心律三、心律失常对血流动力学的影响1频率：心脏代偿范围：40bpm ～150bpm心脏代偿机制障碍：＜40bpm，＞150bpm2 有无器质性心脏病3 心律失常整齐与否4 持续时间长短5 房室同步性房室同步心房辅助泵：20％～45％双室同步QRS波群宽度室内激动顺序是否正常阵发性室上性心动过速的急诊处理一、阵发性室上性心动过速的分类：（1）阵发性房性心动过速：①多见于老年人；②多有器质性心脏病，如肺心病、冠心病；③异位起源点位于心房，可分为自律性房速和折返性房速；又可分为单形性房速和多形性房速；④房速的频率150bpm～250bpm；⑤刺激迷走神经不能终止；⑥当出现血流动力学障碍时提示危重，如血压下降、呼吸困难、心绞痛及晕厥；发作时室率＞200bpm；老年患者或有心脑血管器质性疾病者。
（2）阵发性房室折返性心动过速（预激）：①多见于无器质性心脏病的中青年；②心电图特点是，突发突止，QRS波群形态正常（隐匿型预激）或宽大畸形（显性预激或合并有束支阻滞；心率范围多在150bpm～250bpm；③刺激迷走神经常可终止。
④当出现血流动力学障碍时提示危重，此外发作时室率＞200bpm时也提示危重。
（3）阵发性房室结折返性心动过速：①多见于无器质性心脏病的中青年；②心电图特点是，突发突止，QRS波群形态正常，除非有束支阻滞，心率范围多在150bpm～250bpm，平均180bpm；③迷走神经刺激常可终止心动过速；④当出现血流动力学障碍时提示危重。
家庭医药 2017.0838对于高血压患者来说，使用降压药物能够有效降低血压，保护靶器官，减少心脑血管事件的风险。
然而，降压药是一个大家族，成员众多，在选择降压药物时既要重视其作用机制及合理使用，也要充分认识到该药物的注意事项，才能真正做到安全有效地控制血压。
本期专家评药，我们聚焦β受体阻断剂类降压药当中的代表药物之一——美托洛尔，为您详解该药的选择和使用。
指导专家：上海交通大学医学院附属瑞金医院高血压科副主任医师 陶 波 上海长征医院心血管内科主任医师、教授 任雨笙河南中医药大学第一附属医院心脏中心主任医师、教授 麻京豫整 理：杨春霞美托洛尔：降压又护心基础篇问1：美托洛尔是一种什么样的降压药？答：说美托洛尔之前，先简单介绍一下什么是β受体。
β受体在心血管系统各个部位均存在，β受体兴奋时可使心率加快、血压升高、加重心脏负荷，对心血管系统是一个无形的打击。
所以就需要及时阻断β受体的兴奋！美托洛尔，作为β受体阻滞剂中的一种，可阻滞β受体持续兴奋，起到稳定血压、减少心绞痛和心衰引起的心脏性猝死的几率。
美托洛尔主要有酒石酸美托洛尔片、酒石酸美托洛尔胶囊、琥珀酸美托洛尔缓释片、注射用酒石酸美托洛尔等剂型。
患者最常见的是口服的片剂和胶囊剂，既有国产药也有进口药，常见的倍他乐克是总部在英国伦敦的阿斯利康制药有限公司生产的酒石酸美托洛尔片和琥珀酸美托洛尔缓释片的商品名。
有研究认为，国产和进口的疗效差不多，但国产的美托洛尔（如蒙得康）更经济实惠。
具体如何选择，可根据患者的经济情况进行选择。
问2：有哪些与美托洛尔是同类药？ 答：通用名字中带有“洛尔”两个字的，大都属于β受体阻滞剂，是美托洛尔的同类药，如普萘洛尔、比索洛尔、阿替洛尔。
另外，卡维地洛也属于β受体阻滞剂。
问3：酒石酸美托洛尔片和琥珀酸美托洛尔缓释片有什么区别？两者可以互换吗？答：酒石酸美托洛尔片是平片，属于短效药，而琥珀酸美托洛尔缓释片属于长效药物，两种药物的制作工艺不同，用来填充药物的辅料也不同。
美托洛尔与地尔硫卓治疗心肌反复梗塞效果的比较
朱元州;冯义柏;姚晋涛
【期刊名称】《心血管康复医学杂志》
【年(卷),期】2008(017)004
【摘要】目的:比较美托洛尔与地尔硫卓治疗心肌反复梗塞病人的疗效.方法:44 例急性心肌反复梗塞患者随机分成两组,一组给予美托洛尔6.25mg,口服,1次/d,另一组给地尔硫卓30 mg,口服,1次/d.疗程均为1个月.结果:两组患者短期死亡率没有明显差别(P>0.05),美托洛尔组的疼痛症状缓解,疼痛再发和心衰的减少均显著优于地尔硫卓组(P<0.05).结论:小剂量美托洛尔选择性阻断a1受体,降低心肌的耗氧量,有对抗儿茶酚胺的心脏毒性作用,在防止心肌梗塞的面积扩大和改善症状方面优于地硫尔卓,其长期效果仍需继续观察.
【总页数】3页(P376-378)
【作者】朱元州;冯义柏;姚晋涛
【作者单位】武汉科技大学附属医院心内科,湖北,武汉,430064;华中科技大学同济医学院附属协和医院;武汉市石化医院
【正文语种】中文
【中图分类】R542.22
【相关文献】
1.美托洛尔与地尔硫卓治疗反复心肌梗塞的临床对比分析 [J], 刘海燕
2.酒石酸美托洛尔与琥珀酸美托洛尔治疗扩张型心肌病效果比较 [J], 王倩英
3.美托洛尔与地尔硫卓治疗心肌反复梗死患者的疗效比较 [J], 王维成;康改平
4.分析对比美托洛尔与地尔硫卓治疗反复心肌梗塞的临床疗效 [J], 贾世豪
5.静脉应用地尔硫卓和美托洛尔治疗老年心功能衰竭伴心房颤动快速心室率的疗效和安全性比较 [J], 叶显华;袁洪;凌峰;王宁夫;张邢炜
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健康域用药冠心病比较常见，国内现患人数庞大，且呈增长趋势。
冠心病患者常伴UAP。
如冠心病UAP患者无法得到及时、恰当的救治，易诱发不良事件（常见急性心肌梗死），增加患者死亡风险。
现阶段临床仍以药物治疗为主，以期为患者赢得更多抢救时间，达到治病目的。
美托洛尔为β1肾上腺素受体阻滞剂，是心绞痛常用治疗药物。
经证实，其能明显降低心肌耗氧量、心率，进而控制心绞痛[1]。
地尔硫卓是钙拮抗剂，此药物除了能扩张冠状动脉、外周血管外，还能够促使心肌需氧量降低，对心功能改善颇为有益[2]。
本研究拟联合用药（地尔硫卓+美托洛尔），用于治疗冠心病UAP。
报告如下。
1资料与方法1.1资料2020年4月~2021年4月，共选取98例冠心病UAP患者（均在本院就诊）。
分组依据随机数字表法，分为2组。
对照组（n=49）中，男27例，女22例，年龄41~69（52.25±4.98）岁；研究组（n=49）中，男30例，女19例，年龄40~68（52.01±4.89）岁。
经统计学分析，组间比较，P均＞0.05。
1.2纳入与排除标准纳入标准：（1）冠心病确诊；（2）UAP确诊；（3）心功能评估，介于I~Ⅲ级；（4）视、听、言测试，均正常；（5）知情同意。
排除标准：（1）精神疾患；（2）需紧急手术；（3）急性心肌梗死；（4）严重心力衰竭；（5）肝、肾功能障碍，或心胸手术史；（6）恶性肿瘤；（7）过敏体质，或药物滥用。
1.3方法2组冠心病UAP患者入院给予心电监护、吸氧、常规抗心绞痛药物等。
其中，抗心绞痛药物治疗包含：（1）阿司匹林：（方法）po，（剂量）100mg/次，（频次）qd；（2）LMWH-NA：（方法）iH，（剂量）4200 U/次，（频次）q12h；（3）ISDN：（方法）po，（剂量）60 mg/次，（频次）qd；（4）冠心病UAP患者如处于急性发作状态，要求患者含服0.5g硝酸甘油。
对照组：美托洛尔，po，25mg/次，bid。
地尔硫卓联合美托洛尔治疗冠心病不稳定型心绞痛的效果以及对血脂和运动耐力的影响?发布时间：2022-09-22T06:54:40.391Z 来源：《医师在线》2022年6月11期作者：田志胜[导读]地尔硫卓联合美托洛尔治疗冠心病不稳定型心绞痛的效果以及对血脂和运动耐力的影响?田志胜（芦潮港社区卫生服务中心全科门诊；上海201308）摘要：目的：分析对于冠心病不稳定型心绞痛（UAP）患者合用地尔硫卓、美托洛尔的治疗价值。
方法：对照组为美托洛尔治疗，观察组合用地尔硫卓、美托洛尔进行治疗。
结果：治疗总有效率观察组、对照组分别为97.30%、83.78% ，P＜0.05；治疗前2组血脂4项、6MWT相比差异小P＞0.05，治疗后TC、TG、LDL-C观察组低于对照组，HDL-C、6MWT观察组高于对照组P＜0.05。
结论：对UAP患者通过合用地尔硫卓、美托洛尔进行治疗其效果较为满意，并可有效改善血脂水平及提升运动耐力。
关键词：冠心病；不稳定型心绞痛；地尔硫卓；美托洛尔UAP为近年来的高发慢性心血管疾病，患者冠脉供血减少，引起心肌细胞缺血和缺氧，该疾病也是冠心病患者比较常见的心脏急性事件，若未能妥善给予治疗容易转变为急性心梗，增加了患者的猝死风险。
科学用药来改善其临床症状，避免心肌受损加重意义重大[1]。
美托洛尔有利于降低患者的心肌耗氧量，帮助调低心率水平。
地尔硫卓为钙离子通道阻滞剂，有助于扩张冠脉、调低血压以及改善心功能。
以下将分析对UAP患者合用地尔硫卓与美托洛尔治疗的效果，并观察其血脂水平和运动耐力的改善情况。
1资料与方法1.1常规资料病例选取自2021年1月～2022年1月我院均确诊为UAP，共计74例，随机数字表法予以平均分组，均为37例，观察组男、女分别为19例、18例；年龄分布于56～83岁，均数（62.6±2.5）岁；病程1～9年，均数（3.8±0.5）年。
对照组男、女分别为20例、17例；年龄分布于55～85岁，均数（62.7±2.4）岁；病程1～8年，均数（3.7±0.6）年。
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 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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。
