Circadian heart rate variability in patients with primary arterial hypertension.

INTRODUCTION

Abnormalities of autonomic nervous system function (ANS) exist in patients with hypertension and have been considered as one of the important factors in developing of essential hypertension. However the information about the effect of antihypertensive treatment (angiotensin-converting enzyme inhibitors--ACEI) on cardiac ANS activity is scarce. The main aim of our study was to evaluate circadian heart rate variability changes in primary hypertension treated with ACE inhibitors.

METHODS

Fourteen patients with essential hypertension with night/day differences of mean blood pressure of more than 10% (dippers) aged 26 to 61 years (mean 52.9 +/- 9.2) and 14 healthy volunteers, 14 healthy volunteers were recruited and matched for age and gender. Ambulatory 24 hour arterial blood pressure measurement using HolCARD (Aspel, Poland) recorder with simultaneous ECG monitoring using the Mediarc-Premier IV Holter Monitoring System (DRG-International) undertaken in both groups of patients. The hypertensive patients were tested before and after one year of the enalapril treatment. The HRV analysis was performed according to a standard Fast Fourier Transformation (FFT). The time and spectral analysis parameters were compared within the examined groups of patients during day and night.

RESULTS

The results obtained in the control group showed the great circadian fluctuations in sympathetic and parasympathetic activity. A simultaneous circadian HRV evaluation showed also significant increases in night RMSSD, TP, VLF, LF and HF mean values (p < 0.05) with significantly decreased night LF/HF ratio (p < 0.05) in comparison to the day time recordings. After one year of ACE inhibitors treatment, we noted the following circadian changes: Significant increase of RMSSD, pNN50 (p < 0.05), TP, VLF, LF and HF (p < 0.05) parameters with non-significant increases in LF/HF ratio during night recording. A comparison between daily HRV parameters, before and after 1 year of ACEI treatment, presented significant increases in pNN50 and RMSSD mean values (p = 0.01) and decreases in LF/HF ratio, with simultaneous withdrawal of spectral parameters. However, no significant changes in comparison of night HRV parameters before and after ACEI intake were observed.

CONCLUSIONS

Our observations support an attenuation of night vagal activity as an important factor in the pathogenesis of essential hypertension. The lack of effect of ACEI treatment on circadian heart rate variability parameters in patients with essential hypertension, despite long-term normalisation of blood pressure, suggests persistent circadian cardiac autonomic dysfunction in the "dippers" subgroup of patients.