[Dynamics of electrophysiological parameters of the heart in hypertensive patients depending on a 24-h profile of arterial pressure, left ventricular geometry and metabolic disorders].

AIM: To examine conduction system and repolarization in the ventricles and heart rate variability in hypertensive patients with consideration of 24-h blood pressure profile, left ventricular (LV) geometry and metabolic disorders. MATERIAL AND METHODS: 24-h monitoring of blood pressure, diagnostic transesophageal electrostimulation of the left ventricle, echocardiography were made and duration and dispersion of QT interval, variability of the intervals R-R (SDNN) were assessed in 73 untreated patients aged 42 to 57 years with essential hypertension of the second degree. RESULTS: It is shown that hypertensive patients having left ventricular hypertrophy (LVH), metabolic syndrome (MS) and pathologic 24-h blood pressure profile have also a depressed function of the sinus-atrial node and atrioventricular conduction, marked electric instability of the atria and ventricles. Such patients are at high risk to develop arrhythmia (3-5 times higher than patients without LVH, MS, with normal circadian blood pressure rhythm). CONCLUSION: Electric heart remodeling associated with LVH, MS and disturbances of circadian blood pressure pattern enhances electric instability and risk to develop cardiac arrhythmia.

[Evaluation of hypotensive and antiischemic effects of a combination of dihydropyridine and non-dihydropyridine calcium antagonists in patients suffering from coronary artery disease with arterial hypertension].

The hypotensive and antiischemic activity of combined therapy with dihydropyridine group (amlodipine) and non-dihydropyridine group (verapamil retard) calcium antagonists (CA) as well as tolerance to this therapy were studied in 43 patients suffering from coronary heart disease (CAD) with II-III functional class exertional angina and II degree essential hypertension during 24 weeks. Twenty-four-hour ECG and blood pressure (BP) monitoring and Doppler EchoCG were done. The combination of amlodipine and verapamil retard in different day doses made it possible to achieve target BP levels in 86% of cases, improved circadian BP pattern and decreased left ventricular myocardial mass index (18.5% on the average; p < 0.01). The study also demonstrated prominent antiischemic and antianginal effects of the therapy, including patients with left ventricular hypertrophy. A decrease in myocardial ischemic (both painful and painless) episode frequency and the total duration of ST segment depression were the most pronounced changes. The combination of amlodipine and verapamil retard had a substantially lower rate of adverse effects compared with that of each of the component when used separately thanks to mutual neutralization of their side-effects or a possibility to lower their doses. Thus, the combination of CA from different groups possesses high hypotensive and antiischemic activity and good tolerance, which allows recommending it for treatment of patients suffering from CAD with arterial hypertension.

[Assessment of coronary reserve in patients with hypertensive disease and without hypertrophy left ventricular].

AIM: To study relationship between coronary reserve and left ventricular geometry. METHOD AND MATERIAL: Transesophageal cardiac pacing was carried out in 53 patients with hypertensive disease. Thirty five patients (66%) had left ventricular hypertrophy which was eccentric in 16 and concentric in 19. RESULTS: Myocardial ischemia was induced during pacing in 79.2% of patients; it was painful in 45.2 and painless -- in 54.8% of patients. Test with esophageal pacing was positive in 91.4 and 55.6% of patients with and without left ventricular hypertrophy, respectively. In patients with concentric hypertrophy frequency of positive tests was higher and level of coronary reserve lower than in patients with eccentric left ventricular hypertrophy. There was negative correlation between pacing rate at myocardial ischemia induction and left ventricular myocardial mass index. Painless ischemia was more frequent among patients with left ventricular hypertrophy. Twelve of 42 patients (28.3%) with positive result of pacing had no clinical signs of ischemic heart disease. CONCLUSION: Left ventricular hypertrophy limits coronary reserve, increases prevalence of painless myocardial ischemia. Transesophageal pacing enables detection of preclinical signs of lowered coronary reserve.

[The incidence and pattern of cardiac rhythm and conduction disturbances in patients with different clinical and pathogenetic types of hypertensive disease]. / Chastota i kharakter narushenii ritma i provodimosti serdtsa u bol'nykh s razlichnymi kliniko-patogeneticheskimi variantami gipertonicheskoi bolezni.

In 237 patients with grades I-III hypertensive disease, the incidence and pattern of cardiac rhythm and conduction disturbances were studied in various clinical and pathogenetic types of the disease. By taking into account the known clinical, laboratory, and hemodynamic criteria, the patients were profiled by the following types: 62 (26.2%) patients with a hyperadrenergic type, 61 (25.7%) with a hyperhydration types, 60 (25.3%) with a hyperrenin type, and 54 (22.8%) with a calcium-dependent type. Bicycle ergometric exercise test, daily ECG monitoring, and a transesophageal electrophysiological study of the heart were performed to detect latent, routine ECG-unverified cardiac rhythm and conduction disturbances. In the total group of patients, cardiac arrhythmia and block occurred in 55.3% of the cases, including in 55.7% they are latent. Cardiac rhythm disturbances were most frequently detected in the hyperadrenergic and hyperrenin variants of the disease (50.0 and 43.3%, respectively). Premature beats and paroxysmal supraventricular tachyarrhythmias were predominantly diagnosed in the hyperadrenergic type of HD; intraventricular conduction disturbances and extrasystolic arrhythmia were in the hyperhydration type; the sick sinus syndrome and atrioventricular blocks were in the hyperrenin type. The above cardiac rhythm and conduction disturbances were equally characteristic for the calcium-dependent type of the disease. There was a direct correlation between the detection rate of cardiac arrhythmia and block and the degree of a risk for cardiac and cerebral events, as well as left ventricular hypertrophy. Thus, the study of the incidence and pattern of cardiac arrhythmias associated with hypertensive disease is of importance for choosing an effective and safe treatment; and their existence should be borne in mind to stratify a risk of prognosis.