L/T-type calcium channel blocker reduces non-Gaussianity of heart rate variability in chronic kidney disease patients under preceding treatment with ARB.
BACKGROUND
Increased sympathetic nerve activity has been suggested in patients with chronic kidney disease (CKD). Pathologic sympathetic activity can alter heart rate variability (HRV), and the altered HRV has prognostic importance, so that reducing sympathetic activity may be an important strategy. Novel nonlinear HRVs, including deceleration capacity (DC), have greater predictive power for mortality. We have recently proposed an increase in a non-Gaussianity index of HRV, λ(25s), which indicates the probability of volcanic heart rate deviations of departure from each standard deviation level, as a marker of sympathetic cardiac overdrive. L/T-type calcium channel blocker (L/T-CCB), azelnidipine, decreases sympathetic nerve activity in experimental and clinical studies.


METHODS
In 43 hypertensive patients with CKD under treatment with an angiotensin receptor blocker (ARB), we investigated whether 8-week add-on L/T-CCB treatment could restore HRV.


RESULTS
Means of all normal-to-normal intervals over 24 h (p<0.0001) and DC (p=0.002) increased, and λ(25s) (p=0.001) decreased regardless of gender, age, renal function or blood pressure, while no significant changes were observed in the other HRVs.


CONCLUSIONS
Reduction of λ(25s) is useful to assess the effect of sympathoinhibitory treatment. Further studies are needed to investigate if the restoration of HRV is directly associated with the improvement of prognosis in patients with CKD.
Department of Cardio-Renal Medicine and Hypertension, Nagoya, Japan m-fukuda@med.nagoya-cu.ac.jp.
Michio
M
Fukuda
Department of Cardio-Renal Medicine and Hypertension, Nagoya, Japan.
Yoshiaki
Y
Ogiyama
Department of Cardio-Renal Medicine and Hypertension, Nagoya, Japan.
Ryo
R
Sato
Department of Cardio-Renal Medicine and Hypertension, Nagoya, Japan.
Toshiyuki
T
Miura
Department of Cardio-Renal Medicine and Hypertension, Nagoya, Japan.
Hidekatsu
H
Fukuta
Department of Cardio-Renal Medicine and Hypertension, Nagoya, Japan.
Masashi
M
Mizuno
Department of Mechanical Science and Bioengineering, Osaka University, Osaka, Japan.
Ken
K
Kiyono
Department of Physical and Health Education, University of Tokyo Graduate School of Education, Tokyo, Japan.
Yoshiharu
Y
Yamamoto
Department of Medical Education, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Junichiro
J
Hayano
Department of Cardio-Renal Medicine and Hypertension, Nagoya, Japan.
Nobuyuki
N
Ohte
D000704:Analysis of Variance; D057911:Angiotensin Receptor Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D001383:Azetidinecarboxylic Acid / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use*; D020746:Calcium Channels, L-Type / Q000378:metabolism*; D020747:Calcium Channels, T-Type / Q000378:metabolism*; D004095:Dihydropyridines / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D016011:Normal Distribution; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000503:physiopathology*
D057911:Angiotensin Receptor Antagonists; D002121:Calcium Channel Blockers; D020746:Calcium Channels, L-Type; D020747:Calcium Channels, T-Type; D004095:Dihydropyridines; D001383:Azetidinecarboxylic Acid; C061679:azelnidipine
Angiotensin receptor blocker; calcium channel blocker; chronic kidney disease; deceleration capacity; non-Gaussian heart rate variability