ACTIVITY OF THE AUTONOMIC NERVOUS SYSTEM AND DIASTOLIC DYSFUNCTION OF THE LEFT VENTRICLE IN YOUNG HYPERTENSIVE PATIENTS
Abstract
Background. Activity of the autonomic nervous system has an important role in the development of arterial hypertension. Diastolic disfunction of the left ventricle is one of the earliest changes of heart in developing hypertension. In our study we tried to elucidate the relationship between the changing compliance of the left ventricle and the tone of the autonomic nervous system in young hypertensive patients.
Patients and methods. 91 hypertensive patients and 80 healthy subjects, who corresponded to demanded conditions were included in the study. All of them were clinically examined, including body weight and height, blood pressure and standard 12-channel ECG. Spectral analysis of heart rate variability (SA) was performed in supine and sitting position. The 2D guided M-mode echocardiogram was performed in order to measure systolic and diastolic dimensions of left ventricle. Pulse Doppler technique was used to obtain peak velocity flow through mitral valve in early and atrial phase (i.e. E and A wave).
Results. SA results showed significant lower value of high frequency (0.15 to 0.4 Hz)/low frequency (0.04 to 0.15 Hz) (HF/ LF) area ratio in hypertensive patients than in healthy subjects (41.4 ± 6.8, 44.3 ± 7.2; p = 0.01). Using our criteria (mean value of ratio in healthy subjects ± SD), 26.2% of hypertensive patients had significant lower value of this ratio. E/A ratio, measured with pulsed Doppler technique, was significantly lower in hypertensive patients comparing to healthy subjects (1.28 ± 0.42, 1.52 ± 0.44; p < 0.001). According to our own criteria (mean value of E/A ratio in healthy subjects ± SD), 39,7% of hypertensive patients had significantly lower value of E/A ratio. Using our own criteria, 12.5% of hypertensive patients had in the same time significantly lower E/A and HF/ LF ratio.
Conclusions. The results of our study indicated a high percentage of significantly changed E/A ratio in young hypertensive patients, but at the same time the percentage of hypertensive patients with a significantly changed activity of the autonomic nervous system (HF/LF ratio) is rather small. This suggests the hypothesis that changes of diastolic function of the left ventricle follow the changes in sympathovagal balance with a delay. Comparison of low frequency (0.04 to 0.15 Hz) and very low frequency (0.01 to 0.04 Hz) properties show different influence of sympathetic nervous system. We suggest that very low frequency area is better indicator of sympathetic nervous activity than low frequency area. In further studies we will try to improve the spectral analysis in very low frequency area.
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