Modification of the structural and functional response of the heart and systemic hemodynamics to the cardioselective β1-blockers in patients with arterial hypertension and adaptation to cold

Аннотация

We investigated the features of the structural and functional organization of the left heart (ventricle—LV, atrium—LA) and the state of systemic hemodynamics at rest and in response to a single dose of cardioselective β₁-blocker (BB) Egilok. We examined the patients with stage II (1–2 degrees) of arterial hypertension (AH); the study was performed in summer and winter in the northern regions of Russia. It was found that the process of adaptation to cold is accompanied by the inhibition of the pacemaker, a decrease in the rate of active diastolic blood filling of the LV and transaortic blood flow in the aortic root (VAo), an increase in the contractility of the LV posterior wall and interventricular septum (IVS). The negative chronotropic cardiac effect in these conditions results in the reduction of heart productivity per minute in 65% of cases. In winter we observed a more pronounced diastolic LV dysfunction and a decrease in the connectivity of active relaxation of LV posterior wall and LA walls with certain structural and functional cardiac parameters. In contrast to summer, in winter period BB causes a decrease in the active relaxation of LA walls and IVS and LA contractility, which leads to a decrease in the blood filling of passive and active LV. At the same time, LV systolic function (ejection fraction, VAo) and the rhythm and the performance of the heart (stroke volume and cardiac output) decreases; the hypotensive effect accompanied by an increase in peripheral vascular resistance is more pronounced. In winter, the effect of BB reduces the correlation between IVS and LV posterior wall contractions, but the feedback rate or passive to active LV diastolic hyperemia and after load increases. We suggest that in winter component “contractile apparatus” retains its the leading role in the organization of intracardiac response to the BB in patients with hypertension; in addition, new dominant components were formed: “contingency of the LV wall contraction with afterload” and “reverse contingency of early and late diastolic LV function.”