RESUMO
INTRODUCTION AND OBJECTIVES: The effect of the treatment of arterial hypertension with angiotensin inhibitors on the autonomic response to orthostatism was studied. PATIENTS AND METHOD: In 20 hypertensive patients, enalapril (10 to 20 mg) was administered daily for four weeks. Then, irbesartan (150 to 300 mg) was given for four weeks. Finally, 10 mg of enalapril combined with 150 mg of irbesartan was prescribed for another four weeks. Heart rate variability at rest and during the head-up tilt test with controlled respiration was assessed at the beginning and end of each period. RESULTS: Mean arterial pressure showed a similar reduction in the three treatment periods. There were no changes in heart rate. Heart rate variability at rest showed differences in the spectral high-frequency component between the control and the treatment periods (p = 0.10). There was an increase in the high-frequency component between the control and the third (p = 0.047) and the fourth periods (p = 0.03). In the head-up tilt test there was a decrease in total spectral high-frequency power. CONCLUSIONS: There was no increase in orthostatic intolerance with these drugs in hypertensive patients. The absence of changes in heart rate in spite of a decrease in blood pressure suggests resetting of the baroreflex function. The long-term control of hypertension with these drugs may have a favorable effect on heart rate variability, with an increase in parasympathetic activity.
Assuntos
Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Enalapril/uso terapêutico , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Adulto , Idoso , Sistema Nervoso Autônomo/efeitos dos fármacos , Sistema Nervoso Autônomo/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PosturaRESUMO
Introducción y objetivos. El presente trabajo se llevó a cabo para estudiar el efecto del control de la presión arterial por inhibición de angiotensina en la respuesta autonómica al ortostatismo en pacientes hipertensos. Pacientes y método. En 20 pacientes hipertensos se administró enalapril, 10 o 20 mg diarios, durante 4 semanas. Después se usó irbesartán, 150 o 300 mg, durante otras 4 semanas. Finalmente, se prescribieron 10 mg de enalapril y 150 de irbesartán durante otras 4 semanas. Al principio y al final de cada etapa se midió la variabilidad de la frecuencia cardíaca en reposo y en ortostatismo pasivo con mesa basculante con respiración controlada. Resultados. La presión arterial media disminuyó de manera similar en las 3 etapas. No se observaron cambios significativos en la frecuencia cardíaca. La variabilidad de la frecuencia cardíaca en reposo reveló diferencias en potencia espectral del componente de frecuencias altas sin tratamiento, comparada con los períodos con tratamiento (p = 0,10). El componente de alta frecuencia aumentó entre el primero, tercero (p = 0,047) y el cuarto períodos (p = 0,03). En la prueba de inclinación, la densidad de potencia espectral total disminuyó el componente de alta frecuencia. Conclusiones. No se observó un incremento de la intolerancia ortostática de los pacientes con los fármacos utilizados. El hecho de que la frecuencia cardíaca no se modificara pese a la disminución de la presión sugiere un reajuste de la función barorrefleja. El control sostenido de las cifras de presión en pacientes hipertensos con estos fármacos puede tener un efecto favorable en la variabilidad de la frecuencia cardíaca, con un aumento de la actividad parasimpática (AU)
Assuntos
Pessoa de Meia-Idade , Idoso , Adulto , Masculino , Feminino , Humanos , Postura , Sistema Nervoso Autônomo , Inibidores da Enzima Conversora de Angiotensina , Hipertensão , EnalaprilRESUMO
We present the case of a woman with familial antecedents of a brother who died suddenly at the age of 39 years, and an other with Brugada syndrome. The ECG had not shown the typical pattern of the Brugada syndrome. Based on these antecedents, we decided to perform a pharmacological test with endovenous propafenone, which revealed the electrocardiographic alterations at 10 min after the administration. This is the first case in our knowledge in which endovenous propafenone manifested a concealed Brugada syndrome.
Assuntos
Cardiopatias/diagnóstico , Propafenona , Adulto , Arritmias Cardíacas/etiologia , Morte Súbita Cardíaca/etiologia , Eletrocardiografia , Feminino , Cardiopatias/complicações , Cardiopatias/fisiopatologia , Humanos , Injeções Intravenosas , Propafenona/administração & dosagem , SíndromeRESUMO
We present the case of a woman with familial antecedents of a brother who died suddenly at the age of 39 years, and an other with Brugada syndrome. The ECG had not shown the typical pattern of the Brugada syndrome. Based on these antecedents, we decided to perform a pharmacological test with endovenous propafenone, which revealed the electrocardiographic alterations at 10 min after the administration. This is the first case in our knowledge in which endovenous propafenone manifested a concealed Brugada syndrome.