Heart Rate Variability in Essential Hypertension. Part IV. The Influence of the Antihypertensive Treatment on Heart Rate Variability in Hypertension

Abstract

Essential hypertension exerts disturbing effect on heart rate variability components, representing alterations in autonomic nervous system activity. Several classes of antihypertensive drugs, among their hypotensive effect, also influence heart rate variability. Short-acting dihydropiridine calcium antagonists lead to increase of the low-to-high frequency index, which causes stimulation of the sympathetic nervous system, but their slow-release formulations, as well as newer classes of dihydropiridines, do not induce sympathetic activation or even have beneficial effects on parameters of heart rate variability. Improvement of heart rate variability indices after angiotensin-converting enzyme inhibitors mainly depends on their beneficial effect leading to the regression of structural changes, such us left ventricular hypertrophy and vascular smooth muscle growth. Moreover, they correct diurnal profile of heart rate variability components and improve reactivity of the autonomic nervous system on orthostatic stimuli. Beta-adrenergic receptors blocking agents improve parasympathetic activity, as reflected by the increase in high-frequency component and decrease of low-frequency component. Thus, varying influence of antihypertensive agents on heart rate variability should be considered when antihypertensive treatment is being chosen.