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Abstract

The aim of this study was to evaluate the effect of an angiotensin-converting enzyme (ACE) inhibitor, ramipril, on heart rate variability in patients with heart failure simultaneously treated with digitalis. This study was a multicentric, randomized, double-blind, placebo-controlled study including 50 patients with chronic heart failure (CHF). All patients were in NYHA functional class II and III. The etiology of CHF was mainly idiopathic dilated cardiomyopathy and ischemic heart disease. After a 4-week placebo run-in period with digoxin and diuretics, patients were randomized to receive additional ramipril or placebo. To assess heart rate variability (HRV) and arrhythmias, 24-hour ECGs were recorded at the end of the placebo run-in period, 8 and 24 weeks after randomization. Spectral analysis of HRV was performed during one diurnal and one nocturnal 5-minute time period. No statistically significant differences in HRV within low-, high-, and total-frequency bands were induced by ramipril in either the diurnal or nocturnal periods, both at 8 and 24 weeks after randomization. Ramipril produced a significant decrease in nonsustained ventricular tachycardia at 24 weeks of treatment (p = 0.01). These results run against previous observations showing an increase in parasympathetic tone with ACE inhibitors in heart failure. The present study thus suggests that the effects of ACE inhibitors in CHF are variable and depend on the patient and concomitant treatment that might influence HRV such as digoxin treatment.

Exploratory multivariate analysis of the effect of fatty fish consumption and medicinal use on heart rate and heart rate variability data

“…Another major influence on HRV is medication. Blood pressure medications ( Bonaduce et al, 1997 ; Pinar et al, 1998 ), cholesterol medication ( Riahi et al, 2002 ; Welzig et al, 2003 ; Gomes et al, 2010 ), β ( Cook et al, 1991 ; Mølgaard et al, 1993 ; Niemelä et al, 1994 ; Sandrone et al, 1994 ; Ebbehøj et al, 2002 ) - and α- blockers and ACE inhibitors ( Guedon-Moreau et al, 1997 ; Shehab et al, 2008 ) are all examples of heart medications with either known or suspected effects on HR and HRV. Among antidepressants, the most commonly used are selective serotonin reuptake inhibitors (SSRI).…”