Open AccessCircadian heart rate response to chronotherapy versus conventional therapy in patients with hypertension and myocardial ischemia
Author(s) -
Glasser Stephen P.,
Frishman William,
White William B.,
Stone Peter,
Johnson Mary F.
Publication year - 2000
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960230711
Subject(s) - medicine , amlodipine , atenolol , asymptomatic , verapamil , placebo , cardiology , heart rate , angina , nifedipine , bedtime , anesthesia , blood pressure , myocardial infarction , alternative medicine , pathology , calcium
Background: Changes in heart rate (HR) may contribute to the higher incidence of cardiovascular events in the morning. Hypothesis: The objectives of this analysis were to assess HR patterns in two populations (patients with chronic stable angina or stage I to HI hypertension) and to compare the effects of various antianginal and antihypertensive treatments on HR. Methods: This was a retrospective analysis of HR data from two clinical trials evaluating the efficacy of controlled‐onset, extended‐release (COER)‐verapamil. The effects of COER‐verapamil were compared with placebo, nifedipine gastrointestinal therapeutic system (GITS), amlodipine, and the combination of amlodipine and atenolol. Results: In patients with angina (n = 498), the change from baseline in HR following 4 weeks of treatment was —6.7 ± 10.5 beats/min in the COER‐verapamil group, —10.8 ± 10.8 beats/min in the amlodipine/atenolol group, + 2.5 ± 9.1 beats/min in the amlodipine monotherapy group, and —1.3 ± 10.5 beats/min in the placebo group (p < 0.001). Data were stratified based on whether patients experienced asymptomatic ischemia during baseline ambulatory electrocardiographic monitoring. The circadian HR pattern was morphologically similar in all groups; however, differences in the magnitude of HR response were evident. In the subset of patients with asymptomatic ischemia (n = 101), treatment with amlodipine monotherapy increased HR compared with placebo. In this same subset of patients, HR reductions were achieved with COER‐verapamil and amlodipine/atenolol. In patients with hypertension (n = 557), the change in HR following 10 weeks of treatment was —3.3 beats/min for patients treated with COER‐verapamil compared with + 2.0 beats/min for patients treated with nifedipine GITS (p < 0.0001, between‐group differences). Conclusion: This analysis demonstrates that morphologically similar circadian patterns of HR occur in both hypertensive patients and those with angina. In addition, significant variation exists among antianginal and antihypertensive agents regarding HR effects.