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Effect of ramipril on heart rate variability in digitalis-treated patients with chronic heart failure
L Guedon-Moreau1, A Pinaud, R Logier
1Service de Pharmacologie Hospitaliere, Faculte de Medecine, Lille, France.
Insights
Ramipril, an ACE inhibitor, did not significantly alter heart rate variability in heart failure patients on digitalis. However, it did reduce ventricular tachycardia, suggesting variable effects of ACE inhibitors in chronic heart failure.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Heart failure (HF) management often involves multiple medications.
- Angiotensin-converting enzyme (ACE) inhibitors are standard HF therapy.
- The impact of ACE inhibitors on heart rate variability (HRV) in HF patients on digitalis is not fully understood.
Purpose of the Study:
- To evaluate the effect of ramipril on HRV in patients with chronic heart failure (CHF) treated with digitalis.
- To assess the impact of ramipril on arrhythmias in this patient population.
Main Methods:
- Multicentric, randomized, double-blind, placebo-controlled study.
- 50 patients with CHF (NYHA class II-III) received digoxin and diuretics.
- Patients were randomized to ramipril or placebo, with 24-hour ECGs and HRV spectral analysis at baseline, 8, and 24 weeks.
Main Results:
- Ramipril did not induce statistically significant differences in HRV (low-, high-, or total-frequency bands) during diurnal or nocturnal periods.
- Ramipril significantly decreased nonsustained ventricular tachycardia at 24 weeks (p = 0.01).
- Findings contrast with previous studies suggesting increased parasympathetic tone with ACE inhibitors.
Conclusions:
- Ramipril's effect on HRV in CHF patients on digitalis is variable.
- Concomitant treatments, like digoxin, may influence HRV response to ACE inhibitors.
- Further research is needed to clarify the complex interactions of ACE inhibitors, digitalis, and HRV in heart failure.
Abstract:
The aim of this study was to evaluate the effect of an angiotensin-converting enzyme (ACE) inhibitor, ramipril, on heart rate variability in patients with heart failure simultaneously treated with digitalis. This study was a multicentric, randomized, double-blind, placebo-controlled study including 50 patients with chronic heart failure (CHF). All patients were in NYHA functional class II and III. The etiology of CHF was mainly idiopathic dilated cardiomyopathy and ischemic heart disease. After a 4-week placebo run-in period with digoxin and diuretics, patients were randomized to receive additional ramipril or placebo. To assess heart rate variability (HRV) and arrhythmias, 24-hour ECGs were recorded at the end of the placebo run-in period, 8 and 24 weeks after randomization. Spectral analysis of HRV was performed during one diurnal and one nocturnal 5-minute time period. No statistically significant differences in HRV within low-, high-, and total-frequency bands were induced by ramipril in either the diurnal or nocturnal periods, both at 8 and 24 weeks after randomization. Ramipril produced a significant decrease in nonsustained ventricular tachycardia at 24 weeks of treatment (p = 0.01). These results run against previous observations showing an increase in parasympathetic tone with ACE inhibitors in heart failure. The present study thus suggests that the effects of ACE inhibitors in CHF are variable and depend on the patient and concomitant treatment that might influence HRV such as digoxin treatment.