Επίδραση της τορλεστάτης στην ημερονύκτια διακύμανση της μεταβλητότητας της καρδιακής συχνότητας σε ασθενείς με διαβητική νευροπάθεια του αυτόνομου νευρικού συστήματος
Καραμήτσος, Δημήτριος - Σπυρίδων - Έριχ
Purpose: Evaluation of the effect of tolrestat, an aldose reductase inhibitor, on heart rate variability (HRV), a reliable index of sympathovagal interaction, in 8-hour time intervals, given the paradoxical dominance of sympathetic over vagal tone during the night hours in patients (pts) with diabetic autonomic neuropathy (DAN). The effect of aldose reductase inhibitors on the circadian pattern of autonomic function in DAN pts has not been studied. Patients-Methods: 45 pts with DAN (mean age 52 years), 22 IDDM, 23 NIDDM, were randomized into tolrestat (n=22, 200 mgr/day) or placebo (n-23). Parameters of HRV frequency domain were assessed in 8-hour time intervals at baseline and after one year of treatment with a digital Holter monitor. 20 pts with diabetes without DAN and 20 normal subjects were used as controls. Results: In comparison to placebo, tolrestat improved significantly (p<0.05) all HRV frequency domain indices during the entire 24-hour period. During the night 8-hour period 23.00-7.00, time at which prevalence of sympathetic tone was most markedly increased, tolrestat increased high frequency power (vagal), decreased low frequency power (sympathetic) and their ratio (sympathovagal), p<0.01 for all three counts, in comparison to baseline and placebo. Nevertheless, the low to high frequency power ratio was still higher in DAN pts than controls for the 23.00-7.00 time interval, but in a lesser degree. Con- clusions: The improvement of sympathovagal interaction by tolrestat in DAN pts at time interval most adversely affected might be beneficial in reducing malignant ventricular arrhythmias and sudden death in these pts.
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