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目的探讨帕罗西汀对原发性高血压(EH)伴焦虑抑郁(AD)患者降压疗效和心率变异性(HRV)的影响。方法83例EH伴AD情绪患者,随机分为实验组(常规降压+抗AD剂:帕罗西汀)和对照组(常规降压+安慰剂),并随访6周,观察两组治疗前、后焦虑和抑郁评定(SAS、SDS)、动态心电图、坐位血压、动态血压及血压昼夜节律变化情况,并对两组结果加以比较。结果实验组治疗后SAS、SDS评分明显降低(P<0.01),而对照组无明显变化(P>0.05);两组治疗后HRV时域指标明显提高(P<0.05),但实验组较对照组提高更为明显;实验组降压总有效率明显高于对照组(P<0.01);两组治疗后24h平均血压、白昼平均血压、夜间平均血压均较治疗前降低(P<0.05),但实验组较对照组更为明显(P<0.05);并且尤以实验组夜间平均血压降低更为明显(P<0.001);两组治疗后非勺型的血压昼夜节律发生率明显降低(P<0.05),但实验组较对照组更为明显(P<0.01)。结论抗AD剂帕罗西汀有利于EH伴AD患者AD情绪、血压及HRV的控制,提高降压疗效,改善自主神经功能,改善血压昼夜节律。
Objective To investigate the effect of paroxetine on antihypertensive effect and heart rate variability (HRV) in patients with essential hypertension (EH) and anxiety and depression (AD). Methods Eighty-three patients with EH accompanied with mood disorder were randomly divided into experimental group (conventional antihypertensive + anti-AD agent: paroxetine) and control group (conventional antihypertensive + placebo) for 6 weeks. Anxiety and depression (SAS, SDS), ambulatory electrocardiogram, sitting blood pressure, ambulatory blood pressure and circadian rhythm of blood pressure were compared, and the results of two groups were compared. Results The scores of SAS and SDS in the experimental group were significantly decreased (P <0.01), but there was no significant change in the control group (P> 0.05). The time domain index of HRV in both groups were significantly increased (P <0.05) (P <0.01). The average blood pressure, mean daytime blood pressure and nighttime mean blood pressure of the two groups after treatment were lower than those before treatment (P <0.05), and the total effective rate of the experimental group was significantly higher than that of the control group However, the experimental group was more obvious than the control group (P <0.05), and the mean nocturnal mean blood pressure decreased more significantly in the experimental group (P <0.001). The incidence of non-dipper blood pressure circadian rhythm was significantly decreased in both groups (P <0.05), but the experimental group was more obvious than the control group (P <0.01). Conclusion Paroxetine, an anti-AD agent, is beneficial to the control of AD mood, blood pressure and HRV in patients with EH accompanied with AD, improving antihypertensive efficacy, improving autonomic nervous function and improving circadian rhythm of blood pressure.