Individual approach to antihypertensive drug selection in hypertensive patients based on individual features of autonomic cardiovascular dysfunction

Objective. Development of differentiated method for selection of antihypertensive drugs in hypertensive patients based on assessment of individual features of autonomic cardiovascular dysfunction evaluated by spectral parameters of heart rate variability (HRV) and synchronization of 0,1 Hz oscillation in heart rate and microcirculation. Design and methods. 105 patients with arterial hypertension stage 1–2 aged 47 ± 8 years were examined. 0,1 Hz oscillations in heart rate and microcirculation were registered during passive tilt test under spontaneous breathing. The signals were recorded before and after three-week treatment by angiotensin-converting enzyme (ACE) inhibitors (fosinopril or enalapril) and β-blockers (atenolol or metoprolol). Phase differences between 0,1 Hz oscillations were used to measure the synchronization index S. Power of low- (LF) and high-frequency (HF) bands of HRV spectrum was also assessed. Results. ACE inhibitors are preferred for treatment of hypertensive patients with initially severe systemic autonomic dysfunction (index S is < 25 % in vertical body position) and suffi ciently intact autonomic heart regulation (power of LF band of HRV spectrum is > 250 ms2 in supine position). β-blockers are recommended for patients with initially severe systemic autonomic dysfunction and dysfunction of autonomic heart regulation (index S < 30 % and power of LF band of HRV spectrum < 350 ms2 in vertical body position). If severe autonomic dysfunction (index S is > 25 % and power of LF band of HRV spectrum is > 250 ms2) is not present the treatment by ACE inhibitors and β-blockers is not recommended. Conclusions. The type of antihypertensive drugs (ACE inhibitors or β-blockers) should be selected based on individual features of autonomic cardiovascular dysfunction. Sensitivity and specifi city of this method was 65 and 73 %, respectively.