title: Evidence of increased sympathetic vasomotor drive with shorter acting dihydropyridine calcium channel antagonists in human hypertension: a study using spectral analysis of RR interval and systolic arterial pressure variability.
abstract: We studied the effects of common antihypertensive regimens on autonomic cardiovascular control. We considered calcium channel antagonists (nicardipine twice a day and isradipine once a day, respectively) and also examined, as reference treatments, once-a-day atenolol and cilazapril. A noninvasive evaluation of autonomic cardiovascular profile was obtained with spectral analysis of RR interval and systolic arterial pressure variability. We studied moderate essential hypertensives before and after 2 weeks of treatment, both at rest and during active standing and mental arithmetic. All treatments reduced arterial pressure equally well; however, marked differences in spectral profiles were observed. The low-frequency spectral component of RR interval variability [in normalized units, marker of sympathetic modulation of the sinoatrial (SA) node] tended to be greater at rest and during stimuli (p < 0.001) in subjects treated with dihydropyridines. No differences at rest, but striking increases of the low-frequency component of systolic arterial pressure variability were observed in nicardipine-treated patients during both standardized excitatory stimuli, suggesting a marked increase in sympathetic vasomotor drive. As to reference treatments, patients treated with atenolol displayed the lowest values, and patients treated with cilazapril (for 4 weeks) provided intermediate values. In conclusion, shorter acting dihydropyridine calcium channel antagonists may induce an exaggerated increase in sympathetic vasomotor drive during standardized laboratory stressors.
authors.affiliation: Centro Ricerche Cardiovascolari, CNR, Milan, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Lucini
authors.forename: G S
authors.initials: GS
authors.lastname: Mela
authors.forename: A
authors.initials: A
authors.lastname: Malliani
authors.forename: M
authors.initials: M
authors.lastname: Pagani
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology; D000959:Antihypertensive Agents / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects*; D002121:Calcium Channel Blockers / Q000494:pharmacology*; D017315:Cilazapril / Q000494:pharmacology; D004095:Dihydropyridines / Q000494:pharmacology*; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009131:Muscle, Smooth, Vascular / Q000187:drug effects / Q000294:innervation*; D013564:Sympathetic Nervous System / Q000187:drug effects / Q000502:physiology*
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004095:Dihydropyridines; D017315:Cilazapril