Effects of drug, biobehavioral and exercise therapies on heart rate variability in coronary artery disease: a systematic review

Nolan, Robert P.; Jong, Philip; Barry-Bianchi, Susan M.; Tanaka, Tim Hideaki; Floras, John S.

doi:10.1097/hjr.0b013e3283030a97

Cited by 101 publications

(82 citation statements)

References 44 publications

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“…23 The present trial extends these findings by demonstrating this therapeutic effect in association with reduced ambulatory SBP and PP among subjects with hypertension. This outcome was observed after only an 8-week intervention, which may underestimate a potential benefit of BNT for long-term prognosis.…”

Section: Nolan Et Al Behavioral Neurocardiac Training and Hypertensionsupporting

confidence: 60%

Behavioral Neurocardiac Training in Hypertension

et al. 2010

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Abstract-It is not established whether behavioral interventions add benefit to pharmacological therapy for hypertension.We hypothesized that behavioral neurocardiac training (BNT) with heart rate variability biofeedback would reduce blood pressure further by modifying vagal heart rate modulation during reactivity and recovery from standardized cognitive tasks ("mental stress"). This randomized, controlled trial enrolled 65 patients with uncomplicated hypertension to BNT or active control (autogenic relaxation), with six 1-hour sessions over 2 months with home practice. Outcomes were analyzed with linear mixed models that adjusted for antihypertensive drugs. BNT reduced daytime and 24-hour systolic blood pressures (Ϫ2.4Ϯ0.9 mm Hg, Pϭ0.009, and Ϫ2.1Ϯ0.9 mm Hg, Pϭ0.03, respectively) and pulse pressures (Ϫ1.7Ϯ0.6 mm Hg, Pϭ0.004, and Ϫ1.4Ϯ0.6 mm Hg, Pϭ0.02, respectively). No effect was observed for controls (PϾ0.10 for all indices). BNT also increased RR-high-frequency power (0.15 to 0.40 Hz; Pϭ0.01) and RR interval (PϽ0.001) during cognitive tasks. Among controls, high-frequency power was unchanged (Pϭ0.29), and RR interval decreased (Pϭ0.03). Neither intervention altered spontaneous baroreflex sensitivity (PϾ0.10). In contrast to relaxation therapy, BNT with heart rate variability biofeedback modestly lowers ambulatory blood pressure during wakefulness, and it augments tonic vagal heart rate modulation. It is unknown whether efficacy of this treatment can be improved with biofeedback of baroreflex gain. BNT, alone or as an adjunct to drug therapy, may represent a promising new intervention for hypertension. Key Words: hypertension Ⅲ heart rate variability Ⅲ baroreflex Ⅲ clinical trials Ⅲ biofeedback Ⅲ relaxation Ⅲ stress T he hypothesis that a behavioral intervention augments the hypotensive effect of pharmacological treatment of hypertension was tested in a randomized, controlled trial first by Patel and North. 1 Training in yoga-induced relaxation with electrodermal biofeedback significantly reduced systolic and diastolic blood pressures (BPs; SBP and DBP), whereas no change was observed with self-guided relaxation as the control intervention. The therapeutic model for this approach can be traced to early research by Smirk, who recognized that BP could be lowered to a basal level by an emotionally calm or "desensitized" state and that emotional and environmental factors contributed to the "supplemental" elevation that was observed during casual BP measurements. 2 It was subsequently asserted that repeated exposure to a "hypometabolic" state, popularly known as the relaxation response, could lower BP by reducing environmentally driven sympathetic overactivity. 1,3 Commentary at the time concerning a behavioral treatment for hypertension focused on 2 issues: the need for differentiation between the depressor effect of biofeedback-assisted relaxation and any placebo response 4 and whether active training with biofeedback augmented or interfered with the passive mental attitude that was considered necessary for ther...

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Section: Nolan Et Al Behavioral Neurocardiac Training and Hypertensionsupporting

confidence: 60%

Behavioral Neurocardiac Training in Hypertension

et al. 2010

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“…The decrease in HF values and a concomitant change in LF/HF ratio corresponded to a decrease of parasympathetic tone. Both the results of experimental studies in rats and clinical observations in humans and dogs imply that HRV parameters may change during pharmacotherapy of heart failure, irrespective of its etiology (Tacoy et al 2007, Nolan et al 2008, Sal'nikov 2009, Henze et al 2013, Chom-poosan et al 2014, Dias da Silva et al 2015. Consequently, ST-HRV parameters may soon be applied as prognostic and predictive markers in dogs treated due to CMVD.…”

Section: Discussionmentioning

confidence: 99%

Short-term heart rate variability in dogs with sick sinus syndrome or chronic mitral valve disease as compared to healthy controls

Bogucki¹,

Noszczyk-Nowak²

2017

Polish Journal of Veterinary Sciences

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Heart rate variability is an established risk factor for mortality in both healthy dogs and animals with heart failure. The aim of this study was to compare short-term heart rate variability (ST-HRV) parameters from 60-min electrocardiograms in dogs with sick sinus syndrome (SSS, n=20) or chronic mitral valve disease (CMVD, n=20) and healthy controls (n=50), and to verify the clinical application of ST-HRV analysis. The study groups differed significantly in terms of both time -and frequency-domain ST-HRV parameters. In the case of dogs with SSS and healthy controls, particularly evident differences pertained to HRV parameters linked directly to the variability of R-R intervals. Lower values of standard deviation of all R-R intervals (SDNN), standard deviation of the averaged R-R intervals for all 5-min segments (SDANN), mean of the standard deviations of all R-R intervals for all 5-min segments (SDNNI) and percentage of successive R-R intervals >50 ms (pNN50) corresponded to a decrease in parasympathetic regulation of heart rate in dogs with CMVD. These findings imply that ST-HRV may be useful for the identification of dogs with SSS and for detection of dysautonomia in animals with CMVD.

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“…Prescribed medication included all drugs taken in the previous 14 days that were prescribed by a doctor such as analgesics, antihyperlipidemic agents, antidiabetic agents, psychotropic agents, and antibiotics. We distinguished between beta blockers (British National Formulary codes, chapter 2.4) and other prescribed medications because previous studies have shown the former to have a beneficial effect on HRV levels 36. Other cardiovascular and central nervous system–related medications have been shown to decrease or have no effect on HRV levels 17, 18…”

Section: Methodsmentioning

confidence: 99%

Are Changes in Heart Rate Variability in Middle‐Aged and Older People Normative or Caused by Pathological Conditions? Findings From a Large Population‐Based Longitudinal Cohort Study

Jandackova

Scholes

Britton

et al. 2016

JAHA

107

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BackgroundNo study to date has investigated longitudinal trajectories of cardiac autonomic modulation changes with aging; therefore, we lack evidence showing whether these changes occur naturally or are secondary to disease or medication use. This study tested whether heart rate variability (HRV) trajectories from middle to older age are largely normative or caused by pathological changes with aging in a large prospective cohort. We further assessed whether HRV changes were modified by socioeconomic status, ethnicity, or habitual physical activity.Methods and ResultsThis study involved 3176 men and 1238 women initially aged 44 to 69 years (1997–1999) from the UK Whitehall II population‐based cohort. We evaluated time‐ and frequency‐domain HRV measures of short‐term recordings at 3 time points over a 10‐year period. Random mixed models with time‐varying covariates were applied. Cross‐sectionally, HRV measures were lower for men than for women, for participants with cardiometabolic conditions, and for participants reporting use of medications other than beta blockers. Longitudinally, HRV measures decreased significantly with aging in both sexes, with faster decline in younger age groups. HRV trajectories were not explained by increased prevalence of cardiometabolic problems and/or medication use. In women, cardiometabolic problems were associated with faster decline in the standard deviation of all intervals between R waves with normal‐to‐normal conduction, in low‐frequency HRV, and in low‐frequency HRV in normalized units. Socioeconomic status, ethnicity, and habitual physical activity did not have significant effects on HRV trajectories.ConclusionsOur investigation showed a general pattern and timing of changes in indices of cardiac autonomic modulation from middle to older age. These changes seem likely to reflect the normal aging process rather than being secondary to cardiometabolic problems and medication use.

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Effects of drug, biobehavioral and exercise therapies on heart rate variability in coronary artery disease: a systematic review

Abstract: Pharmacologic, biobehavioral and exercise strategies for secondary prevention of CAD significantly increase HRV. This review provides a framework to assist efforts to evaluate the contribution of HRV change to CAD prognosis.

Cited by 101 publications

References 44 publications

Behavioral Neurocardiac Training in Hypertension

Behavioral Neurocardiac Training in Hypertension

Short-term heart rate variability in dogs with sick sinus syndrome or chronic mitral valve disease as compared to healthy controls

Are Changes in Heart Rate Variability in Middle‐Aged and Older People Normative or Caused by Pathological Conditions? Findings From a Large Population‐Based Longitudinal Cohort Study

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