Milovanovic Branislav, Trifunovic D, Djuric D
Neurocardiology Laboratory, Department of Cardiology, University Clinical Hospital Center Bezanijska Kosa, Medical Faculty, University of Belgrade, Belgrade, Serbia.
Acta Physiol Hung. 2011 Mar;98(1):71-84. doi: 10.1556/APhysiol.98.2011.1.9.
Reduced baroreflex sensitivity (BRS), decreased heart rate variability (HRV) and increased blood pressure (BP) variability have serious consequences for target organ damage in patients with hypertension, beside the BP level. The study was aimed to evaluate acute and long-term effects of enalapril, on BRS and HRV in individuals with prehypertension and mild essential hypertension.
We enrolled in the study 85 patients (male 53%, age 42-67) with prehypertension and mild hypertension (systolic blood pressure ≥120 mmHg or diastolic blood pressure ≥80 mmHg). All patients were tested before, 30 minutes after first oral enalapril dose and three weeks after monotherapy with enalapril. The methodology included: beat to beat HRV analysis, BRS measurements with sequence technique, ECG with short term and 24-hour HRV analysis, 24-hour ambulatory blood pressure monitoring with systolic and diastolic BP variability analysis. Patients were divided into groups with sympathetic or vagal predominance based on Autonomic Nervous System Adjustment (ANSA) method.
Initial enalapril dose significantly reduced systolic BP and had beneficial effects on autonomic tone and baroreflex sensitivity. Chronic enalapril therapy effectively reduced BP without significant influence on BRS, but had significant autonomic effects on HRV when initial autonomic profile in each patient was analyzed by ANSA. Analyzed by ANSA method chronic enalapril therapy managed to retrieve disturbed sympathovagal balance and established autonomic equilibrium.
压力反射敏感性（BRS）降低、心率变异性（HRV）降低以及血压（BP）变异性增加，除血压水平外，对高血压患者的靶器官损害具有严重影响。本研究旨在评估依那普利对高血压前期和轻度原发性高血压个体的BRS和HRV的急性和长期影响。
我们纳入了85例高血压前期和轻度高血压患者（男性占53%，年龄42 - 67岁）（收缩压≥120 mmHg或舒张压≥80 mmHg）。所有患者在首次口服依那普利剂量前、服药后30分钟以及依那普利单药治疗三周后进行测试。方法包括：逐搏HRV分析、采用序列技术测量BRS、进行短期和24小时HRV分析的心电图、进行收缩压和舒张压变异性分析的24小时动态血压监测。根据自主神经系统调整（ANSA）方法将患者分为交感神经占优势或迷走神经占优势的组。
1）初始剂量依那普利给药30分钟后，收缩压显著有效降低，并向副交感神经占优势转变，表现为心率降低以及低频（LF）与高频（HF）比值（LF/HF比值）降低；2）依那普利长期治疗有效降低血压，包括收缩压、舒张压和脉压，对血压昼夜节律有积极影响，但未显著改变血压变异性；3）在整个患者组中，依那普利长期治疗未显著改变HRV，但在基础交感神经活动较高的患者中显著降低了LF（nu），在基础迷走神经活动较高的患者中显著增加了LF（nu）；依那普利在基础副交感神经活动较高的患者中也显著降低了HF（nu）；4）尽管依那普利使BRS的最大和最小斜率出现初始的、短暂的变化，但并未显著影响自发性压力反射激活的敏感性。
依那普利初始剂量显著降低收缩压，并对自主神经张力和压力反射敏感性产生有益影响。依那普利长期治疗有效降低血压，对BRS无显著影响，但当通过ANSA分析每位患者的初始自主神经特征时，对HRV有显著的自主神经效应。通过ANSA方法分析，依那普利长期治疗成功恢复了紊乱的交感 - 迷走平衡并建立了自主神经平衡。
