COMPARISON OF FOSINOPRIL AND ATENOLOL EFFECT ON HEART 0.1 HZ-RHYTHMS SYNCHRONIZATION AND BLOOD MICROCIRCULATION IN PATIENTS WITH ARTERIAL HYPERTENSION

Aim. To compare the effect of fosinopril and atenolol on synchronization of heart 0.1 Hz-rhythms and blood microcirculatory.

Material and methods. 63 patients at the age of 47±8 with hypertension (HT) of grade 1-2 were enrolled in the study. 0.1 Hz-oscillations in heart rate variability (HRV) and in filling of microcirculatory bed were registered during passive tilt test under spontaneous breathing. The duration of each stage of test was 10 min. Synchronization was estimated as a phase difference between 0.1 Hz-rhythms of heart rate and filling of microcirculatory bed. Frequency values of HRV spectrum in LF- and HF-ranges were also assessed.

Results. Fosinopril and atenolol showed comparable effect on blood pressure (BP) reduction. Atenolol decreased in heart rate significantly. Treatment with either fosinopril or atenolol in patients with significant vegetative dysfunction resulted in repair of functional interaction between heart 0.1 Hz-regulation and microcirculatory bed. Functional dissociation of 0.1 Hz-regulation mechanisms was observed under the treatment with fosinopril or atenolol in patients with initially sufficient interaction.

Conclusions. Fosinopril and atenolol influenced similarly on heart 0.1 Hz-mechanisms and microcirculation autonomic regulation in patients with HT. Atenolol is a drug of choice in patients with sympathicotony. Both drugs should be administered in according with an individual level of 0.1-Hz rhythms synchronization assessed before start of the treatment.

1. De Boer R.W., Karemaker J.M., Strackee J. Relationships between short-term blood pressure fluctuations and heart variability in resting subjects. I: A spectral analysis approach. Med Biol Eng Comput 1985; 23(4): 352-358.

2. De Boer R.W., Karemaker J.M., Strackee J. Relationships between short-term blood pressure fluctuations and heart variability in resting subjects. II: A simple model. Med Biol Eng Comput 1985; 23(4): 359-364.

3. Ringwood J.V., Malpas S.C. Slow oscillations in blood pressure via a nonlinearfeedback model. Am J Physiol Regul Integr Comp Physiol 2001;280(4):R1105-15.

4. Whittam A.M., Claytont R.H., Lord S.W. et al.Heartrate and blood pressure variability in normal subjects compared with data from beat-to-beat models developed from de Boer's model of the cardiovascular system. Physiol Meas 2000; 21(2): 305-318.

5. Madwed J.B., Albrecht P., Mark R.G., Cohen R.J. Low-frequency oscillation in arterial pressure and heart-rate: a simple computer model. Am J Physiol 1989;256(6 Pt 2):H1573-9.

6. Kiselev A.R., Posnenkova O.M., Gridnev V.I. et al. Internal synchronization of the main 0.1- hz rhythms in the autonomic control of the cardiovascular system.Human Physiology 2007; 33(2): 188-193. Russian (Киселев А.Р., Посненкова О.М., Гриднев В.И. и соавт. Внутренняя синхронизация основных 0,1 Гц-частотных ритмов в системе вегетативного управления сердечно-сосудистой системой. Физиология человека 2007; 33(2): 188- 193).

7. Janson N.B., Balanov A.G., Anishchenko V.S., McClintock P.V. Phase relationships between two or more interacting processes from one-dimensional time series. II. Application to heartrate-variability data. Phys Rev E Stat Nonlin Soft Matter Phys 2002;65(3 Pt 2A):036212.

8. Glass L. Synchronization and rhythmic processes in physiology. Nature 2001; 410(6825): 277-284.

9. Karavaev A.S., Prokhorov M.D., Ponomarenko V.I. et al. Synchronization of low-frequency oscillations in the human cardiovascular system. Chaos 2009; 19(3): 033112.

10. National guidelines for diagnosis and treatment of hypertension. The Experts Committee of RMSAH and RSSC. Kardiovaskulyarnaya terapiya i profilaktika 2008; 7(6) prilozhenie 2:1-32. Russian (Диагностика и лечение артериальной гипертензии. Рекомендации экспертов ВНОК. Кардиоваскулярная терапия и профилактика 2008; 7(6) приложение 2: 1-32).

11. Kiselyov A.R., Gridnev V.I., Shevchenko O.V. et al. Comparison of ACE inhibitor (fosinopril) and β-adrenoblocker (atenolol) effects on autonomic regulation of the heart in patients with arterial hypertension. Rational Pharmacother Card 2008; 1: 10-13. Russian (Киселев А.Р., Гриднев В.И.,Шевченко О.В. и соавт. Сравнительная оценка влияния и АПФ (фозиноприл) и β-адреноблокатора (атенолол) на вегетативную регуляцию сердца у больных артериальной гипертонией. РФК 2008;1:10-13).

12. Preobrazhenskiy D.V., Marenich A.V., Romanova N.E. et al. Microalbuminuria: diagnostic, clinical and prognostic significance (Part I). Rossiyskiy kardiologicheskiy zhurnal 2000; 3: 56-59. Russian (Преображенский Д.В., Маренич А.В., Романова Н.Е. и соавт. Микроальбуминурия: диагностическое, клиническое и прогностическое значение (часть первая). Российский кардиологический журнал 2000; 3: 56-59).

13. Pikovsky A.S., Rosenblum M.G., Osipov G.V., Kurths J. Phase synchronization of chaotic oscillators by external driving. Physica D 1997; 104(3-4): 219-238.

14. Tass P., Rosenblum M.G., Weule J. et al. Detection of n:m phase locking from noisy data: Application to magnetoencephalography. Phys Rev Lett 1998; 81: 3291–3294

15. Baevskiy R.M., Ivanov G.G., Chireykin L.V. et al. Analysis of heart rate variability using different ECG systems (guidelines). Vestnik aritmologii 2002; 24: 65-86. Russian (Баевский Р.М., Иванов Г.Г., Чирейкин Л.В. и соавт. Анализ вариабельности сердечного ритма при использовании различных электрокардиографических систем (методические рекомендации). Вестник аритмологии 2002; 24: 65-86).