The objective of rhe study was to identify the features of the daily sinus rhythm variability (HRV), affecting the manifestations of the antihypertensive effect of b-adrenergic blockers and to establish the connection of this effect with the dynamics of the daily HRV. Material and methods. 52 patients with grade 1-2 degree essential arterial hypertension (32 to 60 years old - 21 men and 31 women) underwent general clinical and functional examination using bifunctional monitoring of ECG and blood pressure before and after treatment with carvedilol, nebivolol and bisoprolol. Monitor daily mean systolic (MSAD) and diastolic (MDAD) pressure were assessed in comparison with the distribution of heart rate during the day and the amount of HRV corresponding to different ranges of heart rate. Results. The initial average group values of the MSAD and MDAD parameters and the HR distribution during the day were equal in groups in groups with achieved (ABP) and not achieved (NABP) target blood pressure levels. Achievement of target levels of mean daily blood pressure (SBP≤130 mm Hg and DBP≤80 mm Hg) is associated with the initial quantitative parameters of daily HRV, corresponding to different ranges of HR. Differences between HRV in the ABP and NABP groups appear in the HR ranges of less than 75 beats/min: the initial values of HRV are greater in the ABP group than in the NABP group. In the range of heart rates 69-75 beats/min, the differences in HRV values become significant. As a result of therapy, the initially high mean group values of HRV in the ABP group decrease, while in the NABP group they remain unchanged. Conclusion. With initially high values of HRV in the heart rate range of 69-75 beats/min, the likelihood of a decrease in blood pressure to the target level during treatment with b-adrenergic blockers increases

Pulmonary hypertension (PH) is a severe pathology of the cardiovascular system with extremely poor prognosis, if unreated. Early diagnosis of PH is difficult, due to the absence pathognomonic symptoms, and at the initial stage the disease may be asymptomatic. An increase in pulmonary vascular resistance and pressure in the pulmonary artery cause severe dysfunction of the right ventricle, which affects the functional status of patients. The assessment of heart rate variability (HRV) parameters is used to predict the increased risk of sudden death in various diseases of the cardiovascular system and the functional status of the body. HRV is mainly regulated by the sympathetic and parasympathetic divisions of the autonomic nervous system. It is noted that pulmonary arterial hypertension is associated with increasing of sympathetic activity. The review, based on the analysis of the pathophysiological mechanisms of pulmonary arterial hypertension and chronic thromboembolic PH, presents the results of studies assessing the time and spectral parameters of HRV in patients with PH of various etiologies.

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Introduction. In contrast to coronary heart disease (CHD), heart failure and a number of other diseases, in arterial and pulmonary hypertension, the deterioration of the functional state of the patient is often not accompanied by a decrease in the parameters of his sinus rhythm variability (SRV) for long periods of time. Moreover, an increase in age and an increase in blood pressure in patients with hypertension may lead not to a decrease, but to an increase in the parameters of daily SRV. It is noted that with hypertension on the sinus rhythm, the number of so-called double fractures of the rhythmogram (DFR) sequences of RR intervals short-long-short-long becomes greater, which can greatly affect the daily SRV. Aim. To study the specifics of the effect of DFR on daily SRV in arterial and pulmonary hypertension. Materials and methods. 300 Holter ECG records were analyzed, including 67 records of healthy persons, 20 records of CHD patients with CAG-confirmed vascular damage, 126 records of patients with arterial hypertension and 87 records of patients with idiopathic pulmonary hypertension. In the analysis of daily SRV, a modification of the SRV analysis method developed at the National Medical Research Center of Cardiology, taking into account the presence of DFR, was used. Results. It is shown that DFR reflects the processes of regulation of the sinus rhythm, which are affected differently by CHD and hypertension. In CHD, the frequency of DFR and its effect on the daily SRV significantly decreases (compared to the norm). With hypertension, the frequency of the appearance of DFR increases; there is a clear trend towards a decrease in SRV in comparison with the norm in the areas without DFR; in areas with DFR, this trend is less pronounced or absent, and at ages over 50 years, SRV increases. Conclusion. When studying the daily SRV of patients with arterial and idiopathic pulmonary hypertension, it is necessary to take into account the effect of DFR on the increase in SRV.

Aim. Identify in patients with arterial hypertension (AH) the peculiarities of the effect of various classes of antihypertensive drugs on the daily variability of sinus rhythm (HRV). Material and methods. We examined 29 patients with grade 1-2 degree essential AH aged 32 to 60 years (16 men and 13 women) using bifunctional monitoring of ECG and blood pressure before and after treatment with bisoprolol, amlodipine, lisinopril and a combination consisting of lisinopril and amlodipine. We evaluated the hypotensive effect of the drugs associated with the distribution of heart rate during the day and the amount of HRV corresponding to different ranges of heart rate. Results. In cases where the antihypertensive effect (AE) of bisoprolol was expressed, the initial HRV values in the heart rate ranges close to 75 beats/min were significantly greater than in the absence of effect. After treatment, in the presence of AE of bisoprolol, a significant decrease in HRV parameters was observed in these heart rate ranges. AE of amlodipine was associated with an initially high heart rate concentration in the ranges close to 75 beats/min. The efficacy of lisinopril and the combination of lisinopril with amlodipine was associated with an initially high heart rate concentration in the range 69-83 beats/min and its decrease during the treatment. Conclusion. With a random set of patients and a random choice of drugs for the treatment of AH, the presence and absence of an antihypertensive effect was accompanied by statistically significant differences in the initial values and in the dynamics of HRV parameters.