Influence on the autonomic cardiovascular system regulation in the treatment of hypertension, arrhythmias and heart failure

Shlyakhto, Е. V.; Конради, А. О.; Звартау, Надежда; Nedogoda, S. V.; Lopatin, Yu. M.; Sitnikova, M. Yu.; Mikhaylov, Evgeny N.; Баранова, Е. И.; Galyavich, A. S.; Duplyakov, D. V.; Salasyuk, A. S.; Galagudza, M. M.

doi:10.15829/1560-4071-2022-5195

Russ J Cardiol

2022

DOI: 10.15829/1560-4071-2022-5195

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Influence on the autonomic cardiovascular system regulation in the treatment of hypertension, arrhythmias and heart failure

Е. V. Shlyakhto

А. О. Конради

Надежда Звартау

et al.

Abstract: Cardiovascular diseases are widespread and are the leading death cause in most countries, despite the creation and improvement of strategies to reduce cardiovascular risk. A significant role in the development and evolution of cardiovascular diseases belongs to sympathetic nervous system hyperactivity, and therefore the methods of effecting it are relevant for the prevention and treatment of cardiovascular pathology. The article discusses modern approaches to interventional and conservative regulation of the a… Show more

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Cited by 3 publications

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Predictors of the preservation of renal parenchyma volume after renal denervation in patients with resistant hypertension according to magnetic resonance imaging

Ryumshina,

Zyubanova,

Musatova

et al. 2023

Arter. gipertenz.

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Objective. To define the indicators that allow predicting the preservation of the volume of the renal parenchyma according to magnetic resonance imaging (MRI) data in resistant arterial hypertension (RHT) one year after renal denervation (RDN).Design and methods. The study included 66 patients with RHT (average age 57,6 ± 9,4 years). Anamnesis, renal MRI data, results of the 24-h ambulatory blood pressure (BP) monitoring, lipid profile, serum markers of renal dysfunction initial and 1 year after RDN were analyzed. The group with preserved renal parenchyma volume consisted of 30 patients; the group with reduced renal parenchyma volume included 36 patients. Renal MRI was performed with the use of a 1,5 T device. Kidney volumes were calculated by the ellipsoid formula (Total kidney volume, TKV) and by the modified ellipsoid formula — the volume of the cortical layer (Total Cortex Volume, TCortexV). In addition, indices of renal parenchyma volumes adjusted for height are proposed for analysis: htTKV = TKV/height2,7 and htTCortexV = TCortexV/height2,7.Results. Univariate logistic regression analysis showed that statistically significant predictors of the preservation of renal parenchyma volume 1 year after RDN are lower initial values of htTKV (p = 0,02) and htTCortexV (p = 0,033), absence of diabetes mellitus type 2 (p = 0,03), lower pulse BP (p = 0,013) and younger age at the time of RDN (p = 0,03). Multivariate regression analysis, taking into account all variables, showed that the logistic regression model included the following independent predictors of renal parenchyma volume retention 1 year after RDN: age at the time of RDN (odds ratio (OR) 1,06 (confidence interval (CI) 0,99–1,13)), absence of chronic kidney disease (CKD) (OR 0,08 (CI 0,02–0,46)), htTCortexV (OR 0,89 (CI 0,82–0,96)), pulse BP (OR 0,94 (CI 0,91–0,99)), body mass index (BMI) (OR 0,95 (CI 0,85–1,07)).Conclusions. Predictors of the preservation of renal parenchyma volume include: lower age at the time of RDN, absence of CKD, lower values of htTCortexV calculated from MRI data, lower values of pulse blood pressure and BMI. These parameters can be used for the selection of patients with RHT for the RDN.

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Predictors of the preservation of renal parenchyma volume after renal denervation in patients with resistant hypertension according to magnetic resonance imaging

Ryumshina,

Zyubanova,

Musatova

et al. 2023

Arter. gipertenz.

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Theory and practice of selective imidazoline receptor agonist use in Russia

Gaponova,

Abdrakhmanov

2024

Racionalʹnaâ farmakoterapiâ v kardiologii

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Activation of the sympathetic nervous system plays an important role in arterial hypertension (AH) development. Antihypertensive drugs of central action contribute to the elimination of sympathetic activation. The selective imidazoline receptor agonist moxonidine has been successfully used in the treatment of patients with hypertension. The review article presents data on the antihypertensive efficacy of moxonidine, the possibility of its use in combination therapy to reduce elevated blood pressure (BP). The effectiveness of moxonidine in overweight patients, metabolic syndrome, diabetes mellitus, and postmenopausal women is shown. In addition to lowering blood pressure in obese patients, moxonidine reduces plasma leptin levels and weakens sympathetic overactivity, which contributes to weight loss. In patients with metabolic syndrome — obesity, type 2 diabetes mellitus, the use of moxonidine, along with the antihypertensive effect, was accompanied by an additional positive effect on increased variability in blood pressure levels, contributing to the normalization of the daily blood pressure profile, eliminating the morning rise in blood pressure levels. The beneficial effect of moxonidine on carbohydrate metabolism and tissue sensitivity to insulin was noted. The administration of moxonidine to patients with hypertension and menopausal syndrome in peri- and postmenopause, along with effective level control, was accompanied by a significant improvement in the quality of life. In patients with hypertension and osteopenia during menopause, moxonidine led to increased bone formation processes, which helps reduce the risk of developing or progressing osteopenia and osteoporosis. The article focuses on additional indications for the use of moxonidine. In the presence of concomitant pathology — chronic obstructive pulmonary disease, chronic kidney disease, dementia in elderly patients, the use of moxonidine, along with antihypertensive action, led to an improvement in the quality of life.

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Clinical and prognostic significance of left ventricular dysfunction predictors in patients with ventricular ectopy and without structural heart disease

Olesin,

Konstantinova,

Tyuteleva

et al. 2023

Fundamentalʹnaâ i kliničeskaâ medicina

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Aim. To determine the predictors of left ventricular dysfunction in patients with ventricular ectopic beats without structural heart disease.Material and Methods. We modeled ventricular ectopy in rats through early afterdepolarization (aconitine-induced arrhythmia) and delayed afterdepolarization (adrenaline arrhythmia). In addition, we modeled ventricular ectopy in rabbits and cats by delayed afterdepolarization (barium chloride-induced and strophanthin arrhythmias, respectively) and also modeled ventricular ectopy in dogs by re-entry hydrogen peroxide-induced arrhythmia. In addition to conventional electrocardiography parameters, we analyzed pre-ectopic interval, its variability, and the internal deviation index. Further, the study included 514 patients aged 16 to 34 years (mean 21.2 ± 0.2 years), and the number of premature ventricular contractions (PVCs) per day of observation ranged from 6,157 to 37,254 (mean 19,706 ± 656 PVCs). We registered the same parameters as in experimental arrhythmias but calculated them separately for mono- and polymorphic, left and right ventricular out-flow tract arrhythmias. The duration of follow-up of patients was up to 10 years. The endpoint was the detection or absence of cardiovascular and/or extracardiac pathology.Results. We recorded polymorphic PVCs and early monomorphic PVCs when modeling ventricular arrhythmias by the mechanism of delayed post-depolarization and early post-depolarization, respectively. Both early and late monomorphic PVCs were documented when inducing ventricular arrhythmias by re-entry. When modeling hydrogen peroxide-induced and strophanthin arrhythmias, we observed significantly higher values of PVC-QRS complex and ventricular arrhythmia internal deviation index in comparison with aconitine-induced arrhythmia. Favourable outcome was registered in 50.97% of patients, whilst coronary artery disease, arterial hypertension, and mitral valve prolapse were documented in 7.98%, 16.73% and 2.92% patients. The rest of the patients had gastrointestinal diseases. In patients with favourable outcome, the signs of monomorphic PVCs correlated with those revealed during the modeling of ventricular ectopy by early afterdepolarization (r = 0.92), whereas those signs of polymorphic PVCs correlated with those observed at barium chloride-induced delayed afterdepolarization (r = 0.94). In patients with CAD, signs of PVCs correlated with those registered during re-entry hydrogen peroxide-induced arrhythmia (r = 0.93), Finally, in patients with arterial hypertension and mitral valve prolapse signs of PVCs correlated with those documented at strophanthin-(r = 0.92) and adrenaline-induced delayed afterdepolarization (r = 0.89). In these patients, the values for both monomorphic and polymorphic PVCs, ventricular arrhythmia internal deviation index, duration of PVC-QRS complex and PVC-QRS/QRSaverage did not exceed 0.42 units, 149 ms and 1,44 units, respectively. The development of coronary artery disease and arterial hypertension well correlated with an increase in ventricular arrhythmia internal deviation index ≥ 0.56 units and QRS complex duration ≥ 157 ms. Mitral valve prolapse was associated with the duration of the QRS complex ≥ 159 ms of polymorphic PVCs.Conclusion. In patients with ventricular ectopy but without structural heart disease, an increase in the values of ventricular arrhythmia internal deviation index and the duration of PVC-QRS complex was ≥ 0.48 units and 149 ms, respectively, associated with the development of cardiovascular pathology. Development of coronary artery disease and hypertension correlated with ventricular arrhythmia internal deviation index ≥ 0.56 units, and QRS complex duration ≥ 157 ms in monomorphic and polymorphic PVCs, whereas development of mitral valve prolapse correlated QRS complex duration ≥ 159 ms in polymorphic PVCs.

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Influence on the autonomic cardiovascular system regulation in the treatment of hypertension, arrhythmias and heart failure

Cited by 3 publications

References 70 publications

Predictors of the preservation of renal parenchyma volume after renal denervation in patients with resistant hypertension according to magnetic resonance imaging

Predictors of the preservation of renal parenchyma volume after renal denervation in patients with resistant hypertension according to magnetic resonance imaging

Theory and practice of selective imidazoline receptor agonist use in Russia

Clinical and prognostic significance of left ventricular dysfunction predictors in patients with ventricular ectopy and without structural heart disease

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