Document Detail

Beneficial effect of candesartan treatment on cardiac autonomic nervous activity in patients with chronic heart failure: simultaneous recording of ambulatory electrocardiogram and posture.
MedLine Citation:
PMID:  15188948     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Reclining in the right lateral decubitus position in chronic heart failure (CHF) is a self-protective mechanism for normalizing impaired cardiac autonomic nervous activity (CANA).
HYPOTHESIS: Candesartan, an angiotensin II receptor blocker, exerts beneficial effects on CANA and postural preferences in patients with CHF.
METHODS: We studied 15 patients with CHF due to coronary artery disease. Cardiac autonomic nervous activity was assessed using spectral heart rate variability (HRV) analysis based on 24-h ambulatory electrocardiogram monitoring before and after an 8-week treatment with candesartan. The patients' posture was simultaneously recorded using a specially devised detector, as the right (R) or left (L) lateral decubitus or supine (S) positions, to evaluate postural modulations of CANA. Normalized high-frequency (0.15 to 0.40 Hz) power (nHF) and the low-frequency (0.04 to 0.15 Hz)/high-frequency power ratio (LF/HF) were used as indices of vagal activity and sympathovagal balance, respectively.
RESULTS: When HRV was analyzed in each position, CANA was changed in L and S, but not in R, from sympathetic to parasympathetic prevalence by the treatment (R, nHF, 50 +/- 20 vs. 52 +/- 19 nu, p = 0.87; LF/HF, 1.39 +/- 1.11 vs. 1.32 +/- 1.32, p =0.93; L, nHF, 28 +/- 13 vs. 47 +/- 19 nu, p = 0.019; LF/HF, 3.34 +/- 2.48 vs. 1.56 +/- 1.39, p = 0.029; S, nHF, 38 +/- 17 vs. 53 +/- 16 nu, p = 0.0023; LF/HF, 2.43 +/- 2.21 vs. 1.03 +/- 0.59, p = 0.025). The fractions of the time in R and L were decreased and increased, respectively, by the treatment (R, 40 +/- 30 vs. 18 +/- 24%, p = 0.0018; L, 11 +/- 20 vs. 27 +/- 26%, p = 0.025).
CONCLUSIONS: In patients with CHF, candesartan treatment improves cardiac autonomic balance, and the preference for the right lateral decubitus position disappears after the treatment.
Keiichi Tambara; Masatoshi Fujita; Yoshiyuki Sumita; Shoichi Miyamoto; Hiroyuki Sekiguchi; Shigeru Eiho; Masashi Komeda
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Clinical cardiology     Volume:  27     ISSN:  0160-9289     ISO Abbreviation:  Clin Cardiol     Publication Date:  2004 May 
Date Detail:
Created Date:  2004-06-10     Completed Date:  2004-10-14     Revised Date:  2013-05-28    
Medline Journal Info:
Nlm Unique ID:  7903272     Medline TA:  Clin Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  300-3     Citation Subset:  IM    
Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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MeSH Terms
Aged, 80 and over
Angiotensin II Type 1 Receptor Blockers*
Autonomic Nervous System / drug effects*
Benzimidazoles / pharmacology*
Electrocardiography, Ambulatory
Heart / innervation*
Heart Failure / physiopathology*
Heart Rate / drug effects*
Middle Aged
Sleep / physiology
Supine Position / physiology
Tetrazoles / pharmacology*
Reg. No./Substance:
0/Angiotensin II Type 1 Receptor Blockers; 0/Benzimidazoles; 0/Tetrazoles; S8Q36MD2XX/candesartan

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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