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Effects of antihypertensive treatment on cardiovascular autonomic control: a prospective study

Anton R Kiselev1, Vladimir I Gridnev, Mikhail D Prokhorov

  • 1Centre of New Cardiological Informational, Saratov Research Institute of Cardiology, Saratov-Russia. antonkis@list.ru.

Anadolu Kardiyoloji Dergisi : AKD = the Anatolian Journal of Cardiology
|September 5, 2014
PubMed

Insights

This study introduces a method to personalize antihypertensive treatment for arterial hypertension patients by analyzing heart rate variability and heart rate/photoplethysmogram synchronization. This approach helps tailor medication choices for better autonomic dysfunction control.

Area of Science:

  • Cardiology
  • Autonomic Nervous System Research
  • Hypertension Management

Background:

  • Autonomic dysfunction is a key factor in cardiovascular system (CVS) regulation, particularly in patients with arterial hypertension (AH).
  • Current antihypertensive treatment (AT) strategies may not fully address individual autonomic dysfunction patterns.
  • Personalized medicine approaches are needed to optimize AT based on specific patient physiological markers.

Purpose of the Study:

  • To propose an approach for controlling autonomic dysfunction dynamics in the cardiovascular system (CVS) during antihypertensive treatment (AT) for arterial hypertension (AH) patients.
  • To utilize individual synchronization features of 0.1-Hz rhythms in heart rate (HR) and photoplethysmogram (PPG), alongside heart rate variability (HRV) spectral indices, for treatment guidance.
  • To compare the efficacy of HRV spectral indices and a synchronization index (S) in guiding AT with ACE inhibitors and beta-blockers.

Main Methods:

  • Prospective cohort diagnostic accuracy study involving 105 AH patients over 8 weeks.
  • Assessment of HRV spectral indices and synchronization index (S) between 0.1-Hz rhythms in HR and PPG during a tilt test.
  • Application of Shapiro-Wilk, Mann-Whitney U, and Wilcoxon tests for statistical analysis.

Main Results:

  • The power of the low-frequency (LF) band in HRV and index S serve as initial assessment criteria for autonomic regulation in AH patients.
  • Specific thresholds for LF and S values during tilt tests indicate the need for ACE inhibitors or beta-blockers.
  • Certain patient profiles (e.g., S>25% and LF>250 ms² in horizontal position) may not require ACE-Is or beta-blockers, while others benefit from either drug class.

Conclusions:

  • Antihypertensive treatment (AT) control in arterial hypertension (AH) patients can be effectively managed by considering individual autonomic dysfunction characteristics.
  • The proposed approach demonstrated a sensitivity of 65% and specificity of 73% in guiding treatment decisions.
  • Personalized AT based on autonomic markers offers a more refined strategy for managing AH and associated autonomic dysregulation.
Abstract

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