EFFECT OF BETA-BLOCKADE ON BAROREFLEX SENSITIVITY AND CARDIOVASCULAR AUTONOMIC FUNCTION-TESTS IN PATIENTS WITH CORONARY-ARTERY DISEASE

被引:30
作者
AIRAKSINEN, KEJ [1 ]
NIEMELA, MJ [1 ]
HUIKURI, HV [1 ]
机构
[1] UNIV OULU, DEPT MED, DIV CARDIOL, OULU, FINLAND
基金
芬兰科学院;
关键词
AUTONOMIC NERVOUS FUNCTION; BAROREFLEXES; BETA-BLOCKERS; HEART RATE; DIABETIC NEUROPATHY;
D O I
10.1093/oxfordjournals.eurheartj.a060418
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
We wished to assess rite effects of beta-blockade on baroreflex sensitivity and standard rests of integrity of autonomic nervous function in patients with coronary artery disease, and to determine whether the effects of lipophilic (metoprolol) and hydrophilic (atenolol) beta-blockers differ. Beta-blocking drugs increase spontaneous heart rate variability in healthy subjects and in patients with coronary heart disease, but little is known about their effects on baroreflex sensitivity and heart-rate based tests of autonomic integrity. In a randomly allocated double-blind crossover study with three 2-week treatment periods, metoprolol CR 200 mg once a day, or atenolol 100 mg once a day, or placebo once a day, were administered to 18 male patients with stable coronary artery disease. Baroreflex sensitivity was determined from the natural baroreflex challenge of Valsalva strain. Heart rate reactions to standard stimuli were measured. No significant differences were found between the effects of atenolol and metoprolol. Beta-blockade did not significantly affect the baroreflex sensitivity, but it diminished the Valsalva ratio significantly (P<0.001). The difference between mnximum and minimum heart rate during hyperventilation was also significantly lower during beta-blockade. The heart rate response to standing up and the ratio of maximum to minimum heart rate during deep breathing were not influenced by beta-blockade. Discontinuation of beta-blockade seems to be unnecessary for reliable determination of baroreflex sensitivity in patients with coronary artery disease, when the natural pressure challenge of Valsalva strain is used. Both hydrophilic and lipophilic beta-blockers interfere with certain diagnostic tests of autonomic nervous function. These effects must be taken into account when using these tests in the diagnosis of autonomic dysfunction and neuropathy.
引用
收藏
页码:1482 / 1485
页数:4
相关论文
共 17 条
[1]   VALSALVA MANEUVER IN THE ASSESSMENT OF BAROREFLEX SENSITIVITY IN PATIENTS WITH CORONARY-ARTERY DISEASE [J].
AIRAKSINEN, KEJ ;
HARTIKAINEN, JEK ;
NIEMELA, MJ ;
HUIKURI, HV ;
MUSSALO, HM ;
TAHVANAINEN, KUO .
EUROPEAN HEART JOURNAL, 1993, 14 (11) :1519-1523
[2]   EFFECT OF CORONARY-ARTERY DISEASE ON PARASYMPATHETIC CARDIOVASCULAR REFLEXES IN NIDDM PATIENTS [J].
AIRAKSINEN, KEJ ;
KOISTINEN, MJ ;
IKAHEIMO, MJ ;
PIRTTIAHO, H ;
HUIKURI, HV ;
TAKKUNEN, JT .
DIABETES CARE, 1990, 13 (02) :83-86
[3]   POWER SPECTRUM ANALYSIS OF HEART-RATE FLUCTUATION - A QUANTITATIVE PROBE OF BEAT-TO-BEAT CARDIOVASCULAR CONTROL [J].
AKSELROD, S ;
GORDON, D ;
UBEL, FA ;
SHANNON, DC ;
BARGER, AC ;
COHEN, RJ .
SCIENCE, 1981, 213 (4504) :220-222
[4]   EFFECT OF ATENOLOL AND DILTIAZEM ON HEART PERIOD VARIABILITY IN NORMAL PERSONS [J].
COOK, JR ;
BIGGER, JT ;
KLEIGER, RE ;
FLEISS, JL ;
STEINMAN, RC ;
ROLNITZKY, LM .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1991, 17 (02) :480-484
[5]   MORTALITY IN DIABETIC AUTONOMIC NEUROPATHY [J].
EWING, DJ ;
CAMPBELL, IW ;
CLARKE, BF .
LANCET, 1976, 1 (7960) :601-603
[6]   DIAGNOSIS AND MANAGEMENT OF DIABETIC AUTONOMIC NEUROPATHY [J].
EWING, DJ ;
CLARKE, BF .
BRITISH MEDICAL JOURNAL, 1982, 285 (6346) :916-918
[7]  
FARRELL TG, 1992, BRIT HEART J, V67, P129
[8]   CONTINUOUS NON-INVASIVE BLOOD-PRESSURE MONITORING - RELIABILITY OF FINAPRES DEVICE DURING THE VALSALVA MANEUVER [J].
IMHOLZ, BPM ;
VANMONTFRANS, GA ;
SETTELS, JJ ;
VANDERHOEVEN, GMA ;
KAREMAKER, JM ;
WIELING, W .
CARDIOVASCULAR RESEARCH, 1988, 22 (06) :390-397
[9]   BAROREFLEX SENSITIVITY, CLINICAL CORRELATES, AND CARDIOVASCULAR MORTALITY AMONG PATIENTS WITH A 1ST MYOCARDIAL-INFARCTION - A PROSPECTIVE-STUDY [J].
LAROVERE, MT ;
SPECCHIA, G ;
MORTARA, A ;
SCHWARTZ, PJ .
CIRCULATION, 1988, 78 (04) :816-824
[10]   EFFECT OF BETA-BLOCKADE ON HEART-RATE-VARIABILITY IN PATIENTS WITH CORONARY-ARTERY DISEASE [J].
NIEMELA, MJ ;
AIRAKSINEN, KEJ ;
HUIKURI, HV .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1994, 23 (06) :1370-1377