Open AccessSequence of cardiovascular autonomic alterations after fingolimod initiation
Author(s) -
Simula Sakari,
Laitinen Tomi P.,
Laitinen Tiina M.,
Hartikainen Päivi,
Hartikainen Juha E.K.
Publication year - 2017
Publication title -
annals of noninvasive electrocardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.494
H-Index - 48
eISSN - 1542-474X
pISSN - 1082-720X
DOI - 10.1111/anec.12443
Subject(s) - fingolimod , medicine , blood pressure , heart rate , cardiology , baroreflex , autonomic nervous system , anesthesia , multiple sclerosis , psychiatry
Background Homeostasis between heart rate and blood pressure is based on several interacting regulatory reflexes, which become influenced by fingolimod initiation. The aim of this study was to determine the sequence of changes in cardiovascular autonomic regulation after fingolimod initiation. Methods Twenty‐seven patients with relapsing–remitting multiple sclerosis underwent continuous electrocardiogram recording during the first 6 hr after the first dose of fingolimod. In addition to the time interval between two consecutive R‐peaks ( RR interval), blood pressure and heart rate variability ( HRV ) were measured on hourly basis. Cardiac parasympathetic and sympathetic regulation were assessed by the different components of HRV . Results HRV demonstrated an enhancement in cardiac parasympathetic regulation starting 1 hr after the first dose of fingolimod. Blood pressure started to decrease 2 hr and sympathetic cardiac regulation 3 hr after fingolimod initiation. Recovery in RR interval, systolic and diastolic blood pressure, as well as in cardiac autonomic regulation started after 5 hr postdose, whereas pulse pressure (difference between systolic and diastolic blood pressure) continued to increase at the time of hospital discharge. Conclusions RR interval, blood pressure, as well as the parasympathetic and sympathetic components of cardiac autonomic regulation alter sequentially in different temporal pattern after fingolimod initiation. These findings enhance the understanding of the effects of fingolimod initiation on cardiovascular autonomic regulation in real life.