Effect of isosorbide dinitrate on sinoatrial node pacemaker activity in patients with stable angina pectoris of III and IV functional classes associated with hypertension

Aim. To study the effect of isosorbide dinitrate on heart rate variability in patients with III and IV functional classes of stable angina and concomitant essential hypertension. Methods. The study involved 122 patients with III and IV functional classes of stable angina and concomitant essential hypertension, mean age 58.4±5.8 years. All patients underwent electrocardiography, Doppler echocardiography, 24-hour ECG monitoring. Rhythmocardiography was performed in the morning before the drug intake (acetylsalycilic acid, beta-blockers, statins, angiotensin-converting enzyme inhibitors) and 1.5 hours after 10 mg isosorbide dinitrate intake. Results. There was a statistically significant increase in overall heart rate variability at Valsalva’s maneuver and active postural test in patients with III and IV functional classes of stable angina and concomitant essential hypertension, which was most likely due to the amplitude of humoral-metabolic waves. The amplitude of the sympathetic pacing fluctuations increased in all samples, while the parasympathetic pacing fluctuation amplitude decreased at Valsalva’s maneuver, Ashner’s test and while lying flat. There was a vegetative spectrum shift towards the humoral-metabolic effect in sympathetic active postural test, sympathetic shift in all tests except for sympathetic active postural test, and significant decrease in parasympathetic effect at Ashner’s test, sympathetic active postural test and while lying flat. Conclusion. In patients with III and IV functional classes of stable angina and concomitant essential hypertension there was an increase in the overall heart rate variability mainly due to the humoral-metabolic and sympathetic waves amplitude increase and parasympathetic amplitude decrease. Isosorbide dinitrate intake resulted in vegetative spectrum redistribution towards humoral and sympathetic metabolic regulation patterns and decrease of parasympathetic regulation pattern, which normally prevails.

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Assessing the impact of isosorbide mononitrate on sinoatrial node pacemaker activity in patients with III and IV functional class of stable angina

Kazan medical journal ◽

10.17816/kmj1581 ◽

2013 ◽

Vol 94 (2) ◽

pp. 163-168

Author(s):

E A Safronova ◽

I M Shadrina

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Arterial Hypertension ◽

Stable Angina ◽

Sinoatrial Node ◽

Wave Structure ◽

Isosorbide Mononitrate ◽

Pacemaker Activity ◽

Functional Classes ◽

The Impact

Aim. To evaluate the peripheral autonomic effects of isosorbide mononitrate on sinoatrial node pacemaker activity using wave structure analysis by rhythmocardiography. Methods. The study included 162 patients with III and IV functional classes of stable angina, among them 122 - with hypertension. The control group consisted of 42 healthy volunteers. In addition to standard techniques (electrocardiography, echocardiography, bicycle ergometry, electrocardiogram daily monitoring), high-resolution rhythmocardiography using a KAP-RK-01-«Mikor» diagnostic complex with time and spectral analysis of the sinus rhythm wave structure was performed. The method is based on the evaluation of peripheral autonomic regulation in the sinoatrial pacemaker and influence of humoral and metabolic environment on it. Results. In all patients with III and IV functional classes of stable angina regardless of the concomitant arterial hypertension heart rate variability, as well as Valsalva maneuver response increased in a number of patients taking isosorbide mononitrate. Negative events related to isosorbide mononitrate intake were reduced parasympathetic fluctuations in a number of cases, humoral-metabolic regulation growth, and increase of sympathetic regulation role in patients with concomitant arterial hypertension. Rhythmocardiography allowed to access the influence of isosorbide mononitrate on heart rate variability in patients with ischemic heart disease. Conclusion. Both positive (increased heart rate variability) and negative (spectral features redistribution with humoral, metabolic and sympathetic components increase and parasympathetic component decrease) effects were associated with isosorbide mononitrate intake with lesser sinoatrial node dysregulation in patients with concomitant arterial hypertension.

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Leptinemia, parameters of heart rate variability, and prognosis in patients with essential arterial hypertension with obesity

Bukovinian Medical Herald ◽

10.24061/2413-0737.xviii.4.72.2014.208 ◽

2014 ◽

Vol 18 (4 (72)) ◽

Author(s):

O. Radchenko ◽

N. Bek ◽

V. Potapov

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Essential Hypertension ◽

Arterial Hypertension ◽

Cardiovascular Events ◽

Serum Leptin ◽

Ventricular Systole ◽

Essential Arterial Hypertension

An examination of 103 patients with essential hypertension and obesity showed the dependence of autonomic cardioregulation, electrical ventricular systole, and prediction of adverse cardiovascular events on the serum leptin concentration (hyper-, normo – or hypoleptinemia).

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