Heart rate variability and target organ damage in hypertensive patients

BMC Cardiovascular Disorders

Leandro Pecchia³  Nicola De Luca¹  Raffaele Izzo¹  Paolo Melillo² 

[1] Departments of Clinical Medicine, Cardiovascular and Immunological Sciences, Federico II University Hospital, Via Pansini, 5, Naples, Italy;Multidisciplinary Department of Medical Sciences, Second University of Naples, Via Pansini, 5, Naples, Italy;Electrical Systems and optics research division, Faculty of Engineering, University of Nottingham, University Park, Nottingham, NG7 2RD, UK

关键词: Hypertension;    Target organ damage;    Heart Rate Variability;   

Others  :  857998
DOI  :  10.1186/1471-2261-12-105

 received in 2012-08-23, accepted in 2012-11-08,  发布年份 2012

【 摘 要 】

Background

We evaluated the association between linear standard Heart Rate Variability (HRV) measures and vascular, renal and cardiac target organ damage (TOD).

Methods

A retrospective analysis was performed including 200 patients registered in the Regione Campania network (aged 62.4 ± 12, male 64%). HRV analysis was performed by 24-h holter ECG. Renal damage was assessed by estimated glomerular filtration rate (eGFR), vascular damage by carotid intima-media thickness (IMT), and cardiac damage by left ventricular mass index.

Results

Significantly lower values of the ratio of low to high frequency power (LF/HF) were found in the patients with moderate or severe eGFR (p-value < 0.001). Similarly, depressed values of indexes of the overall autonomic modulation on heart were found in patients with plaque compared to those with a normal IMT (p-value <0.05). These associations remained significant after adjustment for other factors known to contribute to the development of target organ damage, such as age. Moreover, depressed LF/HF was found also in patients with left ventricular hypertrophy but this association was not significant after adjustment for other factors.

Conclusions

Depressed HRV appeared to be associated with vascular and renal TOD, suggesting the involvement of autonomic imbalance in the TOD. However, as the mechanisms by which abnormal autonomic balance may lead to TOD, and, particularly, to renal organ damage are not clearly known, further prospective studies with longitudinal design are needed to determine the association between HRV and the development of TOD.

【 授权许可】

   
2012 Melillo et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Yusuf S, Reddy S, Ounpuu S, Anand S: Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation 2001, 104(22):2746-2753.
• [2]Chambless LE, Folsom AR, Clegg LX, Sharrett AR, Shahar E, Nieto FJ, Rosamond WD, Evans G: Carotid wall thickness is predictive of incident clinical stroke: the atherosclerosis risk in communities (ARIC) study. Am J Epidemiol 2000, 151(5):478-487.
• [3]Hollander M, Bots ML, Del Sol AI, Koudstaal PJ, Witteman JC, Grobbee DE, Hofman A, Breteler MM: Carotid plaques increase the risk of stroke and subtypes of cerebral infarction in asymptomatic elderly: the Rotterdam study. Circulation 2002, 105(24):2872-2877.
• [4]O'Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK: Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. N Engl J Med 1999, 340(1):14-22.
• [5]Lorenz MW, von Kegler S, Steinmetz H, Markus HS, Sitzer M: Carotid intima-media thickening indicates a higher vascular risk across a wide age range: prospective data from the Carotid Atherosclerosis Progression Study (CAPS). Stroke 2006, 37(1):87-92.
• [6]Devereux RB, Alderman MH: Role of preclinical cardiovascular disease in the evolution from risk factor exposure to development of morbid events. Circulation 1993, 88(4 Pt 1):1444-1455.
• [7]Thayer JF, Yamamoto SS, Brosschot JF: The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. Int J Cardiol 2010, 141(2):122-131.
• [8]Malik M, Bigger JT, Camm AJ, Kleiger RE, Malliani A, Moss AJ, Schwartz PJ: Heart rate variability: Standards of measurement, physiological interpretation, and clinical use. Eur Heart J 1996, 17(3):354-381.
• [9]Rajendra Acharya U, Paul Joseph K, Kannathal N, Lim CM, Suri JS: Heart rate variability: a review. Med Biol Eng Comput 2006, 44(12):1031-1051.
• [10]Parati G, Mancia G, Di Rienzo M, Castiglioni P: Point: cardiovascular variability is/is not an index of autonomic control of circulation. J Appl Physiol 2006, 101(2):676-678. discussion 681–672
• [11]Arbolishvili GN, Mareev VY, Orlova YA, Belenkov YN: Heart rate variability in chronic heart failure and its role in prognosis of the disease. Kardiologiya 2006, 46(12):4-11.
• [12]Musialik-Lydka A, Sredniawa B, Pasyk S: Heart rate variability in heart failure. Kardiol Pol 2003, 58(1):10-16.
• [13]Melillo P, Fusco R, Sansone M, Bracale M, Pecchia L: Discrimination power of long-term heart rate variability measures for chronic heart failure detection. Med Bio Eng Comput 2011, 49(1):67-74.
• [14]Pecchia L, Melillo P, Sansone M, Bracale M: Discrimination power of short-term heart rate variability measures for CHF assessment. IEEE Trans Inf Technol Biomed 2011, 15(1):40-46.
• [15]Ueno LM, Drager LF, Rodrigues AC, Rondon MU, Mathias W Jr, Krieger EM, Junior RF, Negrao CE, Lorenzi-Filho G: Day-night pattern of autonomic nervous system modulation in patients with heart failure with and without sleep apnea. Int J Cardiol 2011, 148(1):53-58.
• [16]Alter P, Rupp H, Rominger MB, Czerny F, Vollrath A, Klose KJ, Maisch B: A new method to assess ventricular wall stress in patients with heart failure and its relation to heart rate variability. Int J Cardiol 2010, 139(3):301-303.
• [17]Vinik AI, Ziegler D: Diabetic cardiovascular autonomic neuropathy. Circulation 2007, 115(3):387-397.
• [18]Shehab A, Abdulle A: Cognitive and autonomic dysfunction measures in normal controls, white coat and borderline hypertension. BMC Cardiovasc Disord 2011, 11(1):3. BioMed Central Full Text
• [19]Oikawa K, Ishihara R, Maeda T, Yamaguchi K, Koike A, Kawaguchi H, Tabata Y, Murotani N, Itoh H: Prognostic value of heart rate variability in patients with renal failure on hemodialysis. Int J Cardiol 2009, 131(3):370-377.
• [20]Chandra P, Sands RL, Gillespie BW, Levin NW, Kotanko P, Kiser M, Finkelstein F, Hinderliter A, Pop-Busui R, Rajagopalan S, et al.: Predictors of heart rate variability and its prognostic significance in chronic kidney disease. Nephrol Dial Transplant 2012, 27(2):700-709.
• [21]Brotman DJ, Bash LD, Qayyum R, Crews D, Whitsel EA, Astor BC, Coresh J: Heart rate variability predicts ESRD and CKD-related hospitalization. J Am Soc Nephrol 2010, 21(9):1560-1570.
• [22]Martini G, Rabbia F, Gastaldi L, Riva P, Sibona MP, Morra Di Cella S, Chiandussi L, Veglio F: Heart rate variability and left ventricular diastolic function in patients with borderline hypertension with and without left ventricular hypertrophy. Clin Exp Hypertens 2001, 23(1–2):77-87.
• [23]Garcia-Garcia A, Gomez-Marcos MA, Recio-Rodriguez JI, Patino-Alonso MC, Rodriguez-Sanchez E, Agudo-Conde C, Garcia-Ortiz L: Office and 24-hour heart rate and target organ damage in hypertensive patients. BMC Cardiovasc Disord 2012, 12(1):19. BioMed Central Full Text
• [24]De Luca N, Izzo R, Iaccarino G, Malini PL, Morisco C, Rozza F, Iovino GL, Rao MA, Bodenizza C, Lanni F, et al.: The use of a telematic connection for the follow-up of hypertensive patients improves the cardiovascular prognosis. J Hypertens 2005, 23(7):1417-1423.
• [25]Izzo R, de Simone G, Chinali M, Iaccarino G, Trimarco V, Rozza F, Giudice R, Trimarco B, De Luca N: Insufficient control of blood pressure and incident diabetes. Diabetes Care 2009, 32(5):845-850.
• [26]Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, et al.: 2007 ESH-ESC practice guidelines for the management of arterial hypertension: ESH-ESC task force on the management of arterial hypertension. J Hypertens 2007, 25(9):1751-1762.
• [27]Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA 2001, 285(19):2486-2497.
• [28]Tseng KH: Standards of medical care in diabetes--2006: response to the american diabetes association. Diabetes Care 2006, 29(11):2563-2564. author reply 2564–2565
• [29]Sahn D, DeMaria A, Kisslo J, Weyman A: Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 1978, 58(6):1072-1083.
• [30]Iaccarino G, Izzo R, Trimarco V, Cipolletta E, Lanni F, Sorriento D, Iovino GL, Rozza F, De Luca N, Priante O, et al.: Beta2-adrenergic receptor polymorphisms and treatment-induced regression of left ventricular hypertrophy in hypertension. Clin Pharmacol Ther 2006, 80(6):633-645.
• [31]de Simone G, Izzo R, Chinali M, De Marco M, Casalnuovo G, Rozza F, Girfoglio D, Iovino GL, Trimarco B, De Luca N: Does information on systolic and diastolic function improve prediction of a cardiovascular event by left ventricular hypertrophy in arterial hypertension? Hypertension 2010, 56(1):99-104.
• [32]Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N: Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986, 57(6):450-458.
• [33]Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, et al.: Recommendations for chamber quantification: a report from the american society of Echocardiography's guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the european association of echocardiography, a branch of the european society of cardiology. J Am Soc Echocardiog 2005, 18(12):1440-1463.
• [34]de Luca N, Asmar RG, London GM, O'Rourke MF, Safar ME: Selective reduction of cardiac mass and central blood pressure on low-dose combination perindopril/indapamide in hypertensive subjects. J Hypertens 2004, 22(8):1623-1630.
• [35]Lembo G, De Luca N, Battagli C, Iovino G, Aretini A, Musicco M, Frati G, Pompeo F, Vecchione C, Trimarco B: A common variant of endothelial nitric oxide synthase (Glu298Asp) is an independent risk factor for carotid atherosclerosis. Stroke 2001, 32(3):735-740.
• [36]2003 European Society of Hypertension: European society of cardiology guidelines for the management of arterial hypertension. J Hypertens 2003, 21(6):1011-1053.
• [37]Levey AS, Eckardt K-U, TSukamoto Y, Levin A, Coresh J, Rossert J, Zeeuw D, Hostetter TH, Lameire N, Eknoyan G: Definition and classification of chronic kidney disease: a position statement from kidney disease: improving global outcomes. KDIGO 2005, 67(6):2089-2100.
• [38]Hamilton P: Open source ECG analysis. Computers in Cardiology 2002, 101-104.
• [39]Goldberger AL, Amaral LAN, Glass L, Hausdorff JM, Ivanov PC, Mark RG, Mietus JE, Moody GB, Peng C-K, Stanley HE: PhysioBank, PhysioToolkit, and PhysioNet: components of a New research resource for complex physiologic signals. Circulation 2000, 101(23):e215-e220.
• [40]Lomb: Least-squares frequency analysis of unequally spaced data (in astronomy). Astrophys Space Sci 1976, 39:447-462.
• [41]Schroeder EB, Liao D, Chambless LE, Prineas RJ, Evans GW, Heiss G: Hypertension, blood pressure, and heart rate variability: the atherosclerosis risk in communities (ARIC) study. Hypertension 2003, 42(6):1106-1111.
• [42]Berntsen RF, Bonaa KH, Huikuri HV, Rasmussen K: Determinants of cardiac vagal regulation: a cross-sectional study in a general population. Auton Neurosci 2011, 162(1–2):54-59.
• [43]Melillo P, Bracale M, Pecchia L: Nonlinear Heart Rate Variability features for real-life stress detection. Case study: students under stress due to university examination. Biomed Eng Online 2011, 10(1):96. BioMed Central Full Text
• [44]Kodituwakku S, Lazar S, Indic P, Chen Z, Brown E, Barbieri R: Point process time–frequency analysis of dynamic respiratory patterns during meditation practice. Med Bio Eng Comput 2012, 50(3):261-275.
• [45]Kluttig A, Schumann B, Swenne C, Kors J, Kuss O, Schmidt H, Werdan K, Haerting J, Greiser K: Association of health behaviour with heart rate variability: a population-based study. BMC Cardiovasc Disord 2010, 10(1):58. BioMed Central Full Text
• [46]Pecchia L, Melillo P, Bracale M: Remote health monitoring of heart failure with data mining via CART method on HRV features. IEEE Trans Bio Med Eng 2011, 58(3):800-804.
• [47]Melillo P, Pecchia L, Testa F, Rossi S, Bennett J, Simonelli F: Pupillometric analysis for assessment of gene therapy in Leber Congenital Amaurosis patients. Biomed Eng Online 2012, 11(1):40. BioMed Central Full Text
• [48]Ferrari G, Marques J, Gandhi R, Heller S, Schneider F, Tesfaye S, Gamba H: Using dynamic pupillometry as a simple screening tool to detect autonomic neuropathy in patients with diabetes: a pilot study. Biomed Eng Online 2010, 9(1):26. BioMed Central Full Text
• [49]Kitzman DW, Edwards WD: Age-related changes in the anatomy of the normal human heart. J Gerontol 1990, 45(2):M33-M39.
• [50]Zabalgoitia M, Rahman SN, Haley WE, Mercado R, Yunis C, Lucas C, Yarows S, Krause L, Amarena J: Comparison in systemic hypertension of left ventricular mass and geometry with systolic and diastolic function in patients <65 to > or = 65 years of age. Am J Cardiol 1998, 82(5):604-608.
• [51]Dahlof B: Left ventricular hypertrophy and angiotensin II antagonists. Am J Hypertens 2001, 14(2):174-182.
• [52]Jensen-Urstad K, Storck N, Bouvier F, Ericson M, Lindbland LE, Jensen-Urstad M: Heart rate variability in healthy subjects is related to age and gender. Acta Physiol Scand 1997, 160(3):235-241.
• [53]Bajko Z, Szekeres CC, Kovacs KR, Csapo K, Molnar S, Soltesz P, Nyitrai E, Magyar MT, Olah L, Bereczki D, et al.: Anxiety, depression and autonomic nervous system dysfunction in hypertension. J Neurol Sci 2012, 317(1–2):112-116.