Heart rate variability on antihypertensive drugs in black patients living in sub-Saharan Africa

Chukwunomso E Osakwe, Lotte Jacobs, Benedict C Anisiuba, Mouhamado B Ndiaye, Daniel Lemogoum, Chinwuba K Ijoma, Marius M Kamdem, Lutgarde Thijs, Hilaire J Boombhi, Joseph Kaptue, Philip M Kolo, Jean B Mipinda, Augustine N Odili, Birinus Ezeala-Adikaibe, Samuel Kingue, Babatunde A Omotoso, Serigne A Ba, Ifeoma I Ulasi, Jean-Rene M'buyamba-Kabangu, Jan A Staessen, Newer Versus Older Antihypertensive Agents in African Hypertensive Patients Trial (NOAAH) Investigators, Chukwunomso E Osakwe, Lotte Jacobs, Benedict C Anisiuba, Mouhamado B Ndiaye, Daniel Lemogoum, Chinwuba K Ijoma, Marius M Kamdem, Lutgarde Thijs, Hilaire J Boombhi, Joseph Kaptue, Philip M Kolo, Jean B Mipinda, Augustine N Odili, Birinus Ezeala-Adikaibe, Samuel Kingue, Babatunde A Omotoso, Serigne A Ba, Ifeoma I Ulasi, Jean-Rene M'buyamba-Kabangu, Jan A Staessen, Newer Versus Older Antihypertensive Agents in African Hypertensive Patients Trial (NOAAH) Investigators

Abstract

Background: Compared with Caucasians, African Americans have lower heart rate variability (HRV) in the high-frequency domain, but there are no studies in blacks born and living in Africa.

Methods: In the Newer versus Older Antihypertensive agents in African Hypertensive patients trial (NCT01030458), patients (30-69 years) with uncomplicated hypertension (140-179/90-109 mmHg) were randomized to single-pill combinations of bisoprolol/hydrochlorothiazide (R) or amlodipine/valsartan (E). 72 R and 84 E patients underwent 5-min ECG recordings at randomization and 8, 16 and 24 weeks. HRV was determined by fast Fourier transform and autoregressive modelling.

Results: Heart rate decreased by 9.5 beats/min in R patients with no change in E patients (- 2.2 beats/min). R patients had reduced total (- 0.13 ms²; p = 0.0038) and low-frequency power (- 3.6 nu; p = 0.057), higher high-frequency (+ 3.3 nu; p = 0.050) and a reduced low- to high-frequency ratio (- 0.08; p = 0.040). With adjustment for heart rate, these differences disappeared, except for the reduced low-frequency power in the R group (- 4.67 nu; p = 0.02). Analyses confined to 39 R and 47 E patients with HRV measurements at all visits or based on autoregressive modelling were confirmatory.

Conclusion: In native black African patients, antihypertensive drugs modulate HRV, an index of autonomous nervous tone. However, these effects were mediated by changes in heart rate except for low-frequency variability, which was reduced on beta blockade independent of heart rate.

Keywords: Antihypertensive drugs; blacks; heart rate variability; randomized clinical trial; sub-Saharan Africa.

Figures

Figure 1.
Figure 1.
Flow diagram of patients. Logistical reasons included delayed replenishment of the local supply of study medications and internet or computer failures at local centres. HCTZ, hydrochlorothiazide. HRV refers to patients, who had at least one measurement of heart rate variability after randomization. Cohort refers to patients with all scheduled visits available for analysis.
Figure 2.
Figure 2.
Total power (A), low-frequency power (B), high-frequency power (C) and low- to high-frequency ratio (D) at randomization and during follow-up in patients randomized to old drugs (n = 72) or new drugs (n = 84). Heart rate variability was analysed using fast Fourier transform. Plotted values are means± SE. The number of patients contributing to the means is given. p values denote the significance of the between-group differences derived from a mixed model. Significance of the between-group differences at individual visits: *p ≤ 0.05; †p ≤ 0.01; ‡p ≤ 0.001.

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