Heart rate variability indicators, as predictors of the adverse course of uncomplicated hypertensive crisis

Abstract

Purpose of the study. Improve the outcomes of treatment for uncomplicated hypertensive crises at the prehospital stage by studying the state of systemic hemodynamic, determining the balance of the autonomic nervous system and markers associated with the systemic inflammatory response in arterial hypertension patients in uncomplicated cases of hypertensive crisis. Materials and methods. During the 2017–2019 period, an open, prospective and comparative study was conducted and consisted of 206 patients with documented second-stage hypertension, of which 131 patients sought emergency medical attention in the «Municipal Institution Zaporizhzhya Station of Emergency (Ambulance) Medical Assistance» and 75 people who had a stable course of the disease and were examined on an out patiently on the basis of the «Primary health care Centre No 10». Practically healthy 31 people were examined on the basis of the MI «Regional medical exercises dispensary». The indices of heart rate variability in the examined persons were analyzed. All patients were examined physically, used generally clinical, instrumental and laboratory methods for ECG diagnosis were recorded according to the standard method, on a 12-channel computer-cardiographic complex «Cardiolab» (KhAI-Medika, Kharkov). The examinations were performed before the start of emergency care and after HC relief. For the analysis of heart rate variability, a 5-minute ECG interval recorded at rest was used, and the signal was recorded in the supine position, with calm breathing. The obtained data were analyzed with the help of the Cardiolab-HRV software complex, followed by the analysis of the cardiorhythmogram according to the generally accepted method. Results. The analysis of the obtained evidence showed that the total HRV (by all indicators was significantly reduced in patients with hypertonic disease compared with healthy individuals), and with the development of hypertensive crisis in patients with hypertonic disease was even lower. In the hypertonic disease group with hypertensive crisis, activation of the sympathetic division of the autonomic nervous system (with increasing LF/HF ratio) was detected, but despite a higher LF/HF index of 2,21 (0,86–3,94) there was no significant difference against level 1,85 (1,56–2,03) in the hypertonic disease group without hypertensive crisis and a value of 1,81 (1,66–1,89) among healthy persons (p > 0,05). Conclusions. The results obtained indicate that the decrease in compensatory capacity in all HRV indicators is more pronounced in patients with hypertonic disease in the development of hypertensive crisis. Assessment of heart rate variability indicators may be a useful component of cardiovascular risk stratification, requiring further statistical analysis. Keywords: hypertension, uncomplicated hypertensive crisis, heart rate variability.