PARAMETERS OF SPECTRAL AND TEMPORAL ANALYSIS OF HEART RATE VARIABILITY IN THE CONDITIONS OF DISREGULATION OF APOPTOTIC ACTIVITY IN BRONCHOPULMONARY PATHOLOGY AND COMORBIDITY WITH ARTERIAL HYPERTENSION

Abstract

According to numerous reports, the prevalence rate of systemic arterial hypertension in patients with chronic pulmonary diseases varies from 0.4 to 27.7%. The number of authors have shown a decrease in heart rate variability against the background of hypertension, mainly due to the SDNN (the standard deviation of the normal-to-normal RR intervals) and RMSSD (the root mean square of successive RR-interval differences), indicating a decrease in parasympathetic effects on the heart rhythm and a relative increase in sympathetic tone.
 Objective: to study changes in heart rate variability parameters depending on the level of apoptotic processes in patients with arterial hypertension against the background of chronic obstructive pulmonary disease.
 Materials and methods. We examined 25 men with a diagnosis of arterial hypertension stage II and chronic obstructive pulmonary disease stage II without clinically significant comorbidities, whose average age was 51.72±1.22; more than 80% of them were active smokers, pack-years index was 17.06±2.41, the harmful professional factor were indicated by 1/4 people.
 The verification of arterial hypertension was carried out in accordance with the Order of the Ministry of Health of Ukraine dated May 24, 2012 № 384. All patients were diagnosed with stage II of hypertension. Arterial hypertension degree was diagnosed in 12% patients – first, in 28% patients – second and in 60% patients, respectively, third. Participants expressed their willingness to be included in medical research.
 Results. Index SDNN statistically significantly (p<0.05) in parallel with the elevation of the values ​​of the marker of apoposis of caspase-9 decreased by 13.68%, comparing between groups of patients less and more than IV quartile according to the values ​​of caspase-9. The LF (Low Frequency power: frequency activity in the 0.04 - 0.15Hz range) value in patients with a cohort of less and more than IV quartile according to the values ​​of caspase-9 showed a statistically significant decrease by 32.67% (p <0.05). HF (High Frequency power: frequency activity in the 0.15 - 0.40Hz range) with an increase in the activity of apoptosis processes according to the values ​​of caspase-9 decreased most significantly significant, by 48.92% (p <0.05).
 To assess the direction, the tightness and the nature of the relationship between the indices between the studied variables, a regression analysis was conducted to construct a functional dependence. As independent argument (X) considered the level of caspase-9 activity, and as a dependent variable (Y) considered the indicator LF / HF (LF/HF Ratio: A ratio of Low Frequency to High Frequency). The obtained data indicated that the correlation between numerical variables in patients with caspase-9 level less than 4 quartiles had an unreliable character, while in patients with high expression of this cysteine ​​protease the correlation obtained with a high degree of accuracy and adequacy was approximated by the model of exponential form, and namely: Y = 4,0578 * exp (0,0901 * X) at R = 0,547, R2 = 0,30, normalized R2 = 0,29, p = 0,0083).
 Conclusion. Elevation of the state of the sympathetic part of the autonomic nervous system and a decrease in the activity of the parasympathetic part of the autonomic support, which can potentially be associated with an increased risk of serious cardiovascular cases in patients with this comorbidity, were found in patients with chronic obstructive pulmonary disease against the background of arterial hypertension.