Abstract:Aim To investigate the therapeutic effect of Danshen Chuanxiongqin injection combined with metoprolol in the treatment of acute coronary syndrome (ACS) and its improvement effect on blood lipid and cardiac function.Methods 124 patients with ACS admitted to Nanyang Central Hospital were selected from January 2016 to January 2019, and according to the random number table method, the patients were divided into two groups:monotherapy group and combined group, 62 cases in each group. The monotherapy group was treated with metoprolol, while the combined group was treated with Danshen Chuanxiongqin injection and metoprolol. The levels of blood lipids were measured by enzyme colorimetry, including low density lipoprotein cholesterol (LDLC), high density lipoprotein cholesterol (HDLC), triglyceride (TG) and total cholesterol (TC). Echocardiography was used to detect cardiac function indexes:left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF). The level of plasma cardiac troponin I (cTnI) was detected by chemiluminescence. Results The total effective rate of combined group and monotherapy group was 98.39% and 87.10%, respectively, and the difference between the two groups was statistically significant (χ2＝5.871, P＝0.015). After treatment, the levels of LDLC, TG and TC in the two groups were significantly lower than those before treatment, and HDLC was significantly higher than that before treatment (P＜0.05); the levels of LDLC, TG and TC in the combined group were lower than those in the monotherapy group, and HDLC was higher than that in the monotherapy group (P＜0.05). After treatment, LVESV and LVEDV in the two groups were significantly smaller than those before treatment, LVEF was significantly higher than that before treatment, cTnI was significantly lower than that before treatment (P＜0.05); LVESV and LVEDV in the combined group were much smaller than those in the monotherapy group, LVEF was much higher than that in the monotherapy group, cTnI was much lower than that in the monotherapy group (P＜0.05). Conclusion Danshen Chuanxiongqin injection combined with metoprolol has a satisfactory therapeutic effect on ACS patients, which is beneficial to the improvement of blood lipid level and cardiac function, and is worthy of clinical application.

Abstract:Aim To investigate the effects of metoprolol succinate sustained-release tablets on heart rate turbulence(HRT) and heart rate variability(HRV) to silent ischemia with coronary heart disease. Methods The changes of heart rate turbulence and heart rate variability to silent ischemia with coronary heart disease in treatment with metoprolol were investigated. Results The TS and TO in treatment group were both lower than those of control group(P<0.05).The TS and TO after treatment were higher than those of before treatment.SDNN,SDANN and SDNNindex before treatment in treatment group except rMSSD and PNN50 were lower than those of control group(P<0.05).SDNN,SDANN and SDNNindex after treatment in treatment group were increased significantly(P<0.05). Conclusion HRT and HRV in the patients of silent ischemia with coronary heart disease is abnormal and metoprolol can improve the heart autonomic nerves function.

Abstract:Aim To investigate whether antihypertensive efficacy in patients with hyprtension was impacted by polymorphism and methylation of β1-adrenoreceptor (β1-AR) gene. Methods Three hundred hypertensive patients enrolled began taking metoprolol by the same dose;the genotype of their β1-AR gene by PCR-RFLP was tested to compare the antihypertensive efficacy among patients with different genotype.The methylation state in β1-AR gene detected by methylation specific PCR(MSP) from peripheral blood of patients with the same genotype was controlled by the subjects with normal blood pressure,to make a inquiry into the relationship between the modification and the antihypertensive response to metoprolol. Results Patients with Arg389Arg genotype got significant greater decrease in diastolic blood pressure as compared with Gly389Arg and Gly389Gly(8.0%±1.3% vs 4.0%±1.5% and 3.0%±1.1%,P<0.05);and the β1-AR gene from peripheral blood of all subjects was methylated. Conclusions Polymorphism at Gly389Arg of β1-AR gene was associated with antihypertensive response to metoprolol;the methylated modification on β1-AR gene from human peripheral blood was not found to be related to the response.

Abstract:Aim To investigate the influence of ralated factors to different antihypertensive effective rate of metoprolol with the same genotypes of CYP2D6 and β1-adrenergic receptor (β1-AR). Methods 63 cases of 1 or 2 grade essential hypertension patients with the *10*10 of CYP2D6*10 genotype and Arg/Arg of β1-AR Gly389Arg genotype were chosen and administrated with metoprolol 100 mg/d. Indexes, such as blood pressure and heart rate, were collected every two weeks during the follow-up visit. After 8 weeks, the relationships between the related factors, such as age, baseline blood pressure, body mass index (BMI), hyperlipidemia and smoking, and antihypertensive effective rate of metoprolol were analysed. Results According to antihypertensive efficacy, 40 patients were effective to metoprolol, while 23 were ineffective. The effective rate was 63.5%. Monofactorial analysis indicated that patients with higher baseline systolic blood pressure and normal BMI had greater effective rate than the others (P<0.05). Furthermore, multifactoring regression analysis also claimed that baseline systolic blood pressure showed the significant effect to metoprolol. Conclusion Baseline blood pressure and BMI are related to the different antihypertensive effective rate of metoprolol.

Abstract:Aim To determine whether obesity and glucolipide metabolism could influence the antihypertensive effect of selective β1 adrenergic receptor blocker, metoprolol. Methods 300 Patients with 1 or 2 grade essential hypertension were enrolled and treated with metoprolol for 8 weeks, with analysis of the relationship between total effective rate rate and obesity or centre obesity, diabetes mellitus and hyperlipoidemia. Results Patients with normal body mass index had greater effective rate of metoprolol treatment than patients who were overweight or obesity, patients without centre obesity had greater effective rate than the ones with centre obesity, and sex difference existed in the influence of diabetes mellitus and hyperlipoidemia to metoprolol treatment (p<0.05). Body mass index were the most influential factors to effect of metoprolol through Logistic analysis. Conclusion Obesity or centre obesity, diabetes mellitus and hyperlipoidemia were related with antihypertensive treatment of metoprolol, specifically in men.

Abstract:Aim To evaluate the efficacy and safety of intravenous diltiazem and metoprolol for treatment of rapid ventricular rate in elderly heart failure (HF) patients with rapid atrial fibrillation. Methods A single-blind, randomized study on 72 elderly HF patients with rapid atrial fibrillation was conducted by comparing intravenous diltiazem and metoprolol. Results The efficacy was 94.6% in the diltiazem group,and the ventricular rate decreased from 149±26 bpm to 97±19 bpm, with a mean decrease by 35% 120 min after treatment;Simultaneously, the efficacacy was 97.1% in the metoprolol group,and the ventricular rate decreased from 150±27 bpm to 95±18 bpm, with a mean decrease by 35%. 3 and 2 patients developed asymptomatic hypotension respectively. No patient developed worsening of HF due to diltiazem, but one patient developed worsening of HF in metoprolol group. Conclusions Diltiazem and metoprolol are all efficacious and relatively safe to control the rapid ventricular rate in elderly HF patients with rapid atrial fibrillation.