The role of regulatory adaptive status in determining the
 effectiveness of bisoprololum and sotalolum in patients with hypertensive disease and paroxysmal atrial fibrillation

Abstract

A rise in mortality from cardiovascular causes, systemic thromboembolism, and congestive heart failure, in the frequency of hospitalization and deterioration of the quality of life is associated with atrial fibrillation (AF). Essential hypertension (EH) and ischemic heart disease (IHD) are the most common causes of AF. To prevent recurrence of AF in patients with hypertension or IHD, beta-blockers (BAB) can be used. Taking into account the possible effect of multidirectional BAB on the functional state of the body, it is advisable to apply the quantitative assessment of the regulatory-adaptive status (RAS), in order to determine the effectiveness of therapy. Aim. To compare the effectiveness of treatment with bisoprololum or sotalolum in patients with paroxysmal AF associated with EH and/or IHD taking into account the quantitative evaluation of the regulatory adaptive status (RAS). Material and methods. 60 patients with paroxysmal AF , stage II-III EH and/or IHD took part in the study; they were randomized into two groups for the treatment with bisoprololum (6,7±1,6 mg/day n=30) or sotalolum (156,0±35,2 mg/day n=30). As part of combined therapy, the patients were administered lisinoprilum (12,9±3,8 mg/day and 13,3±4,0 mg/day) and, if required, atorvastatin (16,6±4,1 mg/day, n=12 and 16,3±4,9 mg/day, n=13) and acetylsalicylic acid (90,8±16,8 mg/day, n=13 и 91,7±14,4 mg/day, n=12), respectively. Initially and 6 months after therapy, the following was done: quantitative assessment of RAS (by cardio-respiratory synchronism test), echocardiography, triplex scanning of brachiocephalic arteries, treadmill test, six-minute walk test, all-day monitoring of blood pressure and electrocardiogram, subjective assessment of the quality of life. Results. Both drug regimens comparably improved structural and functional condition of the heart, increased exercise tolerance, controlled arterial hypertension, reduced symptoms of IHD, effectively suppressed paroxysms of AF, improved the quality of life. At the same time, sotalolum decreased the RAS to a lesser degree than bisoprololum. Conclusion. In patients with paroxysmal AF associated with stage II-III HD and/or IHD, the use of sotalolum as part of combined therapy may be preferable to bisoprololum due to its lower negative impact on the RAS.