title: Sequence of cardiovascular autonomic alterations after fingolimod initiation.
abstract: BACKGROUND
  Homeostasis between heart rate and blood pressure is based on several interacting regulatory reflexes, which become influenced by fingolimod initiation. The aim of this study was to determine the sequence of changes in cardiovascular autonomic regulation after fingolimod initiation.
  
  
  METHODS
  Twenty-seven patients with relapsing-remitting multiple sclerosis underwent continuous electrocardiogram recording during the first 6 hr after the first dose of fingolimod. In addition to the time interval between two consecutive R-peaks (RR interval), blood pressure and heart rate variability (HRV) were measured on hourly basis. Cardiac parasympathetic and sympathetic regulation were assessed by the different components of HRV.
  
  
  RESULTS
  HRV demonstrated an enhancement in cardiac parasympathetic regulation starting 1 hr after the first dose of fingolimod. Blood pressure started to decrease 2 hr and sympathetic cardiac regulation 3 hr after fingolimod initiation. Recovery in RR interval, systolic and diastolic blood pressure, as well as in cardiac autonomic regulation started after 5 hr postdose, whereas pulse pressure (difference between systolic and diastolic blood pressure) continued to increase at the time of hospital discharge.
  
  
  CONCLUSIONS
  RR interval, blood pressure, as well as the parasympathetic and sympathetic components of cardiac autonomic regulation alter sequentially in different temporal pattern after fingolimod initiation. These findings enhance the understanding of the effects of fingolimod initiation on cardiovascular autonomic regulation in real life.
authors.affiliation: Department of Neurology, Mikkeli Central Hospital, Mikkeli, Finland.
authors.forename: Sakari
authors.identifier: http://orcid.org/0000-0003-1623-5819
authors.initials: S
authors.lastname: Simula
authors.affiliation: Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.
authors.forename: Tomi P
authors.initials: TP
authors.lastname: Laitinen
authors.affiliation: Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.
authors.forename: Tiina M
authors.initials: TM
authors.lastname: Laitinen
authors.affiliation: Neuro Center, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.
authors.forename: Päivi
authors.initials: P
authors.lastname: Hartikainen
authors.affiliation: Heart Center, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.
authors.forename: Juha E K
authors.initials: JEK
authors.lastname: Hartikainen
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000187:drug effects*; D001794:Blood Pressure / Q000187:drug effects; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D000068876:Fingolimod Hydrochloride / Q000494:pharmacology* / Q000627:therapeutic use; D006321:Heart / Q000187:drug effects*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology* / Q000627:therapeutic use; D008297:Male; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy*
chemical_list: D007166:Immunosuppressive Agents; D000068876:Fingolimod Hydrochloride
keywords: cardiac autonomic regulation; fingolimod; heart rate variability