[Heart rate variability dynamics during treatment of arterial hypertension].

UNLABELLED: Investigation of the dynamics of heart rate variability (HRV) in anti-hypertension therapy can facilitate the evaluation of the effectiveness of treatment. AIM OF INVESTIGATION: to compare anti-hypertension effect of monotherapy with nebivolol and dilatrend with dynamics of HRV and the estimation of the state of patients with mild arterial hypertension (AH) and metabolic syndrome (MS). MATERIAL AND METHODS: HRV was studied in 42 patients with mild AH and MS at the age of 32-60. Eighteen of them were treated with 5 mg of nebivolol during 24 weeks, and twenty-four with 25-50 mg of dilatrend during 16 weeks. All the patients were subjected to 24-hour ECG monitoring with analysis of HRV and arterial pressure (AP) before and after treatment. The main feature of HRV analysis was investigation of dependence of sinus arrhythmia on the mean value of heart rate (HR) RESULTS: With nebivolol treatment AP decreased in 11 patients, HRV became better in 9 patients. 7 cases manifested coincidence of AP reduction and HRV improvement. In 6 cases out of 7 when AP did not decrease, HRV did not change. Worsened HRV was observed in 3 cases: in one case with growing AP and in 2 cases with decreasing AP. All the patients, except one, regarded their state as improved. With dilatrend treatment AP lowered in 16 cases. In 9 cases HRV became better, in 11 cases it remained the same, and in 4 cases it became worse. Positive HRV dynamics in 7 cases out of 9 was accompanied by lowering of AP, while negative dynamics was observed in one case with rise of AP and in three cases with very low AP or in the absence of AP dynamics. 14 patients felt better, 6 of them manifested better level both of AP and HRV. CONCLUSION: The method of 24-hour HRV analysis based on assessment of dependence of the value of sinus arrhythmia on HR is useful in evaluating the effectiveness of anti-hypertension therapy. As a rule, an effective decrease in AP is accompanied with improvement of HRV. The absence of improvement of deterioration of HRV in anti-hypertension therapy is a factor which should be taken into consideration when choosing the mode of therapy.

[Changes in ST segment on ECG of hypertensive patients].

AIM: To evaluate ST depression in hypertensive patients with electrocardiographic signs of left ventricular hypertrophy (LVH), correlation of ST segment changes with heart rate (HR) and blood pressure (BP) during Holter monitoring (HM) and bi-functional ECG and BP monitoring (BFM), and to compare ST depression and local left ventricular contractility during stress-echocardiography in hypertensive patients with unaffected coronary arteries according to the data of coronary angiography. MATERIAL AND METHODS: We examined 344 hypertensive patients without clinical signs of ischemic heart disease. Correlation between ST segment depression and ECG signs of LVH was evaluated in 192 patients. 180 patients underwent HM, 122--BFM and 30 hypertensive patients with normal coronary arteries according to the data of coronary angiography underwent stress-echocardiography. RESULTS: According to the data of 12 lead ECG 40 cases of ST depression were found, with LVH signs in 26 (65%) of these patients. During HM in 34 of 180 patients 2 types of ST depression were found: type 1--short periods of transient ST depression without persistent ST depression was fond in 8 patients; type 2--persistent ST depression more than 1 mm during the whole time of recording--in 26 patients. In 7 of 8 cases of type 1 and in 5 of 26 cases of type 2 ST depression had rhythm-dependent character. During BFM in 9 cases ST depression during HR or BP increase was found. In 2 cases ST depression during BP increase was unrelated to HR increase which may be consequence of systolic myocardial strain syndrome. In 7 of 30 hypertensive patients with normal coronary arteries and without local myocardial contractility disturbances according to the data of stress-echocardiography positive criteria of ischemia were found. CONCLUSION: The cause of ST segment depression in hypertensive patients more often are secondary disturbances of repolarizaion processes related with LVH development. In some cases such patients during HM show rhythm-dependent valuable ST depressions. In BFM cases of left ventricular myocardial strain syndrome are found, similar cases are also seen in stress-echocardiography. However, in some cases one fails to define the reason of ST changes even approximately. One of the factors leading to disturbances of repolarization processes in hypertensive patients may be disturbances of microcirculation at the level of prearteriols and capillaries.

[The effect of different factors on cardiac rhythm variability in patients with arterial hypertension]. / Vliianie razlichnykh faktorov na variabel'nost' ritma serdtsa u bol'nykh arterial'noi gipertoniei.

The purpose of this study was to evaluate the influence of different factors, among them left ventricular hypertrophy (LVH) on long-term heart rate variability (HRV) in patients with hypertension. 38 patients with arterial hypertension of different genesis were included in the study. Ischemia was excluded in all the patients by the data of clinical and instrumental methods of investigation. LVH data obtained from HRV of 20 healthy subjects was used as control. HRV was evaluated by estimating variations for short intervals of a rhythmogram (VSI). A HRV decrease did not depend on sex, but essentially depended on patients'a age, disease duration and the form of hypertension. A marked tendency leading to the rate variability decrease was observed only in moderate LVH. In cases of original LVH variability data did not differ from those in patients without signs of LVH. Low or marginal HRV was more often observed in patients with essential hypertension and in those with hypertension of endocrine genesis. As far as renal hypertension is concerned low variability was less frequent. There were a lot of factors which affect the change of HRV. The more significant of them were the patients' age, hypertension genesis and form of hypertension. Factors leading to the rate variability decrease were the following age above 40, endocrine or essential hypertension and moderate form of hypertension.