Influence of arotinolol hydrochloride on heart rate spectrum in hypertensive subjects

[To understand blood pressure and heart rate variability]

OBJECTIVES

To review current data on the heart rate and blood pressure variability.

DATA SOURCES

Search through Medline databases of articles in french or english.

DATA SELECTION

Original articles and case reports were selected according to their quality and main advances. The articles were analysed in order to obtain current data about the methods of study and clinical application of blood pressure and heart rate variability.

DATA SYNTHESIS

Various regulatory systems in the cardiovascular system play crucial roles in controlling and assuring adequate perfusion of the peripheral tissues. Among them the baroreceptor reflex is the most important regulatory mechanism in the short-term control of the heart rate and blood pressure, and operates through the autonomic nervous system. The gain of the cardiac baroreflex further referred to, as baroreflex sensitivity is an interesting way to study this system. Unfortunately, with our current knowledge, it is not possible to predict the instantaneous output of the baroreceptor in response to instantaneous changes in input within a frequency range of physiological importance. The fast Fourier transform can describe variables as the sum of elementary oscillatory components and it has been established as practical clinical methods for detecting abnormalities in cardiovascular control. A time-frequency distribution provides an indication of how the spectral energy distribution varies with time and it is an interesting tool in non-stationary data. One of the major motivations behind spectral analysis is the hope that the combination of time-domain and frequency-domain analyses will provide dynamical informations about the relation between blood pressure and heart rate.

Clinical trial of arotinolol in the treatment of hypertension: dippers vs. non-dippers

To compare the effects of an alpha, beta blocker, arotinolol, in the treatment of essential hypertension between patients with a dipper and those with a non-dipper profile by means of 24-h ambulatory blood pressure monitoring (ABPM), a multicenter single blind parallel trial was carried out in five clinical centers. After a one-week single blind placebo run-in period, the patients underwent ABPM if their clinic diastolic blood pressure (DBP) ranged from 90-109 mmHg and their clinic systolic blood pressure (SBP) was <180 mmHg. They were divided into two groups according to the absence (non-dipper group, 24 cases) or presence (dipper group, 23 cases) of nocturnal BP reduction > or =10% of daytime BP. ABPM was measured again at the end of the active treatment phase. All patients were given Arotinolol 10-20 mg twice daily for 4 weeks. Twenty four-hour systolic and diastolic average BPs (MSBP, MDBP), 24-h systolic and diastolic blood pressure load (LS BP, LDBP), daytime systolic and diastolic average BPs (dMSBP, dMDBP), daytime systolic and diastolic blood pressure load (dLSBP, dLDBP), nighttime systolic and diastolic average BPs (nMSBP, nMDBP) and nighttime systolic and diastolic blood pressure load (nLSBP, nLDBP) were calculated. Arotinolol was effective in 78.2% of dippers and 54.2% of non-dippers, but the difference in effectiveness between these groups was not statistically significant. After treatment, SBP and DBP-including 24-h, daytime and nighttime systolic and diastolic BPs- were significantly reduced in both groups. During the daytime period, the systolic and diastolic blood pressures were significantly reduced in both dippers and non-dippers, while nighttime systolic and diastolic blood pressures were significantly reduced only in the non-dipper group. No significant changes were found in the dipper group over this period. In conclusion, Arotinolol, which can be dosed twice daily, is an effective antihypertensive agent which effectively lowers blood pressure during the day while reducing nighttime blood pressure more in non-dippers than in dippers, without excessive lowering blood pressure in the latter.

Acute effects of bisoprolol on respiratory sinus arrhythmia

Respiratory sinus arrhythmia (RSA) is often quantified by computing the spectra of heart period (HP) or of its reciprocal heart rate (HR) at the respiratory frequency. This study was undertaken to describe the effect of an acute beta-blockade achieved with bisoprolol on RSA, obtained during a calibrated breathing (breathing frequency 0.25 Hz, tidal volume VT 500 or 700 mL) in 15 normal volunteers, using a double-blind, placebo-controlled, cross-over method. The two heart signals were computed and the RSA values were compared to the individual estimates of vagal tone obtained using an additional atropine injection. The difference between the HP (or HR) value obtained after beta-blockade and the HP (or HR) value observed following the double blockade (bisoprolol plus atropine) was taken as an index of cardiac vagal tone. Bisoprolol administration resulted in a significant reduction in HR reaching 60.3 +/- 1.4 bpm at VT of 500 mL (compared to 70.5 +/- 1.8 bpm with placebo, P < 0.001). Changes in HP were also significant with an increase in HP reaching 1004.5 +/- 22.2 msec at this controlled VT (compared to 860.3 +/- 21.5 msec with placebo, P < 0.001). Similar changes were observed at a VT of 700 mL. The relationship between RSA in bpm and vagal tone was not significant for HR while a significant positive relationship was observed between RSA in msec and vagal tone for the two respiratory patterns (r = 0.65 for a tidal volume of 500 mL, P < 0.01, and r = 0.62 for 700 mL, P < 0.05). This demonstrates that the detection of the variability effect highly depends upon the unit. The parallelism between vagal tone and RSA supports the view that the HF component of HRV in msec quantifies the vagal tone. The increased RSA during beta-blockade could well reflect this vagotonic effect of this class of drugs.

Estimation of arterial blood pressure variability by spectral analysis: comparison between Finapres and invasive measurements

In order to assess the accuracy of spectral analysis of beat-by-beat arterial blood pressure fluctuations recorded by the finger technique we analysed simultaneous ipsilateral resting sequences (180 s) of systolic blood pressure (SP) and diastolic blood pressure (DP) obtained by brachial artery cannulation and by the Finapres device in 26 post-myocardial infarction (post-MI) and 24 chronic heart failure (CHF) patients. We estimated: (i) the total variability and the power in the bands 0.01-0.04 Hz (band 1), 0.04-0.07 Hz (band I), 0.07-0.15 Hz (band III) and 0.15-0.45 Hz (band IV); and (ii) the group-average transfer function between the invasive and non-invasive channel. The total variability of intra-arterial SP was greatly enhanced by the Finapres device in both populations (p < 0.01) mainly due to the increase of power in bands I and II (mean percentage errors 157 and 111% in post-MI and 368 and 245% in CHF patients respectively). The power in band IV was significantly reduced in post-MI (p < 0.001) but not in CHF patients. The total DP variability increased in post-MI patients (p < 0.001) due to the increase in bands I and II (mean percentage errors 62 and 43% respectively). No significant difference was found in bands III and IV of the same group and in the overall variability of CHF. Linear system analysis showed that intra-arterial SP oscillations in both groups are amplified by the Finapres device in bands I and II, with a higher gain in CHF patients, whereas they are attenuated in band IV. Band III acts as a transition band. DP oscillations recorded non-invasively are slightly amplified in bands I and II of post-MI patients only and are attenuated in band IV of both groups. A substantial fraction (approximately 30%) of the non-invasive SP variability in band I cannot be explained as a pure linear transformation (amplification) of the invasive signal. A phase delay in the range 7 degrees-10 degrees relates the non-invasive signal to the invasive one in the region 0.025-0.17 Hz and approaches zero elsewhere. Several mechanisms were examined as potential causes of the invasive-non-invasive differences. We argue that these differences are mainly due to the complex rhythmic behaviour of peripheral resistance vessels.