Abstract
Objective: Decrease of heart rate variability (HRV) (decrease of SDANN < 100 ms) and left ventricular (LV) hypertrophy can be independent risk factors for future cardiovascular complications. The purpose of this study was to determine relation between humoral factors (plasma renin activity -PRA, plasma aldosterone – pALD, 24 hour urinary metanephrines – uMET), myocardial remodeling and HRV in resistant hypertensive (RH) patients (pts). Design and method: 24 h Holter ECG monitoring has been recorded in 20 true RH pts (20pts by mean age 51.0 ± 2.8yrs) using Meditech EC-GO System. The analysis of HRV included time parameters (SDNN, SDANN, SDNN-I, pNN50%, RMSSD). Echocardiography of all patients has been carried out. The level of PRA, pALD, uMET has been determined by standard methods. Results: The analysis of HRV in 20 RH pts showed initial state HRV – SDNN - 105,5 ± 4,2mc, SDANN - 97,5 ± 5,03mc, SDNN-I - 38,6 ± 3,04mc, RMSSD - 42,9 ± 6,7mc, pNN50% - 8,8 ± 1,4. The significant linear relation was found between level of uMET and time parameters of HRV (SDNN-I, RMSSD): with SDNN-I r = 0,564, p < 0,05, RMSSD r = 0,502, p < 0,05 in these pts. No significant difference was established between parameters of myocardial remodeling (PWT, IVST, RWT, LVID, LVMI) in pts with SDANN<100mc and pts with SDANN>100mc. In comparison, pts with SDANN<100mc showed positive correlation of time parameter SDNN with PWT (r = 0,652, p < 0,05), IVST (r = 0,651, p < 0,05), LVMI (r = 0,661, p < 0,05), and time parameter RMSSD with IVST and LVMI and its absence in pts with SDANN>100mc and in the general group of pts. The analysis of humoral factors in pts with SDANN>100mc showed linear relation between level of uMET and SDANN (r = 0,727, p < 0,05). In comparison, in pts with SDANN<100mc inverse relation between level of uMET and SDANN (r = −0,729, p < 0,05) and linear relation with SDNN-I (r = 0,750, p < 0,05) were revealed. Conclusions: These findings indicate that decrease of heart rate variability in resistant hypertensive pts is closely associated with left ventricular hypertrophy and level metanephrines.
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