ABSTRACT
The aim of the work was to elucidate peculiarities of neurovegetative mechanisms underlying cardiovascular regulation in patients with metabolic syndrome (MS) compared with healthy subjects and patients with arterial hypertension (AH). 46 patients presented with AH without obesity and metabolic disturbances, 42 with MS. 24-hour AD and ECG monitoring was performed and cardiac rhythm variability indices (CVI) were calculated. AH patients showed lowered CVI in association with decreased high-frequency vagal effects compared with healthy subjects. MS patients had smaller CVI than healthy and AH ones due to much poorer involvement of both parasympathetic and sympathetic divisions of vegetative nervous system. Vegetative balance index remained normal. It is concluded that the use of LF/HF ratio alone is insufficient for the evaluation of sympatovagal index in MS patients due to markedly decreased CVI; a complex analysis of all CVI temporal and spectral characteristics is needed.
Subject(s)
Autonomic Nervous System Diseases/complications , Autonomic Nervous System/physiopathology , Heart Rate/physiology , Metabolic Syndrome/etiology , Adult , Autonomic Nervous System Diseases/diagnosis , Autonomic Nervous System Diseases/physiopathology , Disease Progression , Electrocardiography, Ambulatory , Female , Follow-Up Studies , Humans , Male , Metabolic Syndrome/physiopathology , Middle Aged , Prospective Studies , Young AdultABSTRACT
In the recent years the problem of heart remodeling under drugs in patients with arterial hypertension (AH) have been extensively discussed. The beta-blocker of the third generation nebivolol is known as a good antihypertensive agent. The aim of our study was to evaluate effects of nebivolol on structural and functional parameters of cardiac remodeling in patients with AH without heart failure. We examined 28 patients with AH aged 49.99 +/- 5.26 years, with average arterial pressure 154.42 +/- 94.37 mm Hg and ejection fraction (EF) > 60%. All of them underwent routine clinical examination and echocardiography (EchoCG) with calculation of additional indexes, and than were given nebivolol 5 mg. After 3 months and 1 year of treatment with nebivolol we assessed antihypertensive effect and the state of cardiac hemodynamics using EchoCG with calculation of remodeling indexes. After 3 months of therapy myocardial stresses (systolic - MSs and diastolic - MSd) were reduced (from 154.28 +/- 11.65 to 132.77 +/- 11.37 U, p < 0.02, and from 184.17 +/- 14.1 to 159.87 +/- 13.34 U, p < 0.02, respectively), and diastolic function improved. After 1 year of antihypertensive treatment LV diastolic function remained normal, while thickness of LV wall decreased (from 0.41 +/- 0.03 to 0.37 +/- 0.02 U, p=0.01). MS continued to decrease with high degree of significance. At the end of the first year we revealed decrease of MSs/ESVI from 9.66 +/- 1.77 at the start of treatment to 6.1 +/- 0.69 (p < 0.005) and MSd/EDVI from 3.21 +/- 0.4 to 2.57 +/- 0.38 (p < 0,005). Increase of EF/MSs (from 0.47 +/- 0.05 to 0.61 +/- 0.07, p < 0.02) was also revealed after 1 year treatment with nebivolol. There were 32% individuals in the studied group, who had concentric type of LV remodeling at the beginning, after 3 months this number decreased to 16%, and at the end of first year no patients had this type of remodeling. Thus, it was shown that nebivolol is able to interfere with the processes of structural and functional rearrangement of the myocardium, preventing development of systolic and diastolic dysfunction of the heart.
