Cardiac autonomic dysfunction in patients with gastroesophageal reflux disease

AIM: To investigate autonomic nervous function in patients with a diagnosis of gastroesophageal reflux disease(GERD).METHODS: The investigation was performed on 29patients(14 men), aged 18-80 years(51.14 ± 18.34),who were referred to our Neurocardiology Laboratory at the Clinical and Hospital Center "Bezanijska Kosa"with a diagnosis of GERD. One hundred sixteen healthy volunteers matched in age and sex with the examinees served as the control group. The study protocol included the evaluation of autonomic function and hemodynamic status, short-term heart rate variability(HRV) analysis, 24 h ambulatory ECG monitoring with long-term HRV analysis and 24 h ambulatory blood pressure monitoring.RESULTS: Pathologic results of cardiovascular reflex test were more common among patients with reflux compared to the control group. Severe autonomic dysfunction was detected in 44.4% of patients and in7.9% of controls(P < 0.001). Parameters of short-term analysis of RR variability, which are the indicators ofvagal activity, had lower values in patients with GERD than in the control group. Long-term HRV analysis of time-domain parameters indicated lower values in patients with reflux disease when compared to the control group. Power spectral analysis of long-term HRV revealed lower low- and high-frequency values.Detailed 24 h ambulatory blood pressure analysis showed significantly higher values of systolic blood pressure and pulse pressure in the reflux group than in the control group.CONCLUSION: Patients with GERD have distortion of sympathetic and parasympathetic components of the autonomic nervous system, but impaired parasympathetic function appears more congruent to GERD.

Effect of direct moxibustion on blood pressure and clinical symptoms in elderly patients with essential hypertension

Objective： To assess the effects of direct moxibustion on 24-hour ambulatory blood pressure （ABP） and clinical symptoms of traditional Chinese medicine （TCM） in elderly patients with essential hypertension, and to explore the antihypertensive effect and influencing factors of moxibustion. Methods： A total of 101 elderly hypertension patients who met the inclusion criteria were randomly assigned to a direct moxibustion I group （n=33）, a direct moxibustion II group （n=34）, and a control group （n----34）. The treatment of calcium antagonist （CCB） or angiotensin II receptor antagonist （ARB） was adopted in the control group. The treatment of direct moxibustion I plus the same medicine as the control group were adopted in the direct moxibustion I group, five cones per acupoint and three times per week, for 5 weeks in total. The treatment of direct moxibustion II plus the same medicine as the control group were adopted in the direct moxibustion II group, five cones per acupoint and three times per week, for 5 weeks in total. The changes of 24-hour ABP and clinical symptoms of TCM after treatment were compared in the three groups. Results： The mean 24-hour ambulatory systolic blood pressure （mean 24 h ASBP）, night ASBP, percentage of mean 24-hour ambulatory diastolic blood pressure （mean 24 h ADBP）~90 mmHg, and percentage of day ADBP^90 mmHg in the control group were elevated after treatment （P^0.05）. The percentage of night ADBP^80 mmHg in the direct moxibustion I group was reduced by treatment （P〈0.01）. There were no significant differences in the other outcome measures of 24 h ABP, such as day ASBP, percentage of mean 24 h ASBP^140 mmHg, percentage of day ASBP^140 mmHg, percentage of night ASBP 〉120 mmHg, mean 24 h ADBP, day ADBP, night ADBP, 24 h ambulatory pulse pressure （APP）, after treatment in all groups （P^0.05）. The degree of improvement of the clinical symptoms of TCM showed significant differences among the three groups of patients （P^0.01）. The total effective rate in the direct moxibustion I group was 73.3%, which was superior to those in the direct moxibustion II group and control group （13.3% and 10.0%, respectively）. Conclusion： The direct moxibustion has benign regulative effect on blood pressure of elderly patients with essential hypertension, and improves their clinical symptoms. The direct moxibustion method I （burning the next moxa cone after the previous one had totally burnt out） was superior to method II （burning the next moxa cone when the previous one had not totally burnt out ） in lowering blood pressure and improving symptoms of elderly patients with essential hypertension.