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Abstract

Since reduced heart rate variability (HRV) is known to be a predictor of prognosis of congestive heart failure, we examined long-term effects of conventional medical therapy on HRV in 314 patients with congestive heart failure (62±1 years, NYHA classification 1 to 4), consisting with dilated cardiomyopathy, coronary artery disease, or hypertensive heart disease. Patients were randomly assigned to beta-blocker, angiotensin converting enzyme (ACE) inhibitor, dihydropyridine derivatives, diltiazem, nitrate, or these combinations with or without digitalis and furosemide therapy. 48 patients were treated only by life style modification (LIFE). 24-hour ECG recordings were repeated before and after the therapy (mean duration: 76 weeks), and HF (0.15-0.4 Hz), TF(0.004-1 Hz) and LF (0.04-0.15 Hz) /HF ratio of HRV were calculated by maximum entropy method. Both HF and TF were significantly (p<0.01) deceased in LIFE while those in beta-blocker were significantly (p<0.01) increased. None of the interval changes in the rest of therapy groups was significant. Although none of the baseline values between groups before therapy was significant, both HF and TF were significantly (p<0.01) lower after therapy in dihydropyridine and nitrate groups than those in beta-blocker group. However, when dihydropyridine and nitrate were used as a combination drug with ACE inhibitor or beta-blocker, these differences vanished. In conclusion, long-term beta-blocker therapy only improves autonomic control of heart rate in patients with heart failure. Furthermore, dihydropyridine or nitrate may be useful only when these drugs were used as combination drug with ACE inhibitor or beta-blocker.

ACE inhibitor, beta-blocker, heart rate variability
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© American Journal of Hypertension, Ltd. 2001
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