Effects of digoxin and enalapril on heart period variability and response to head-up tilt in normal subjects

To test the effects of digitalis and angiotensinconverting enzyme inhibition on the RR interval variability in an electrocardiogram, 20 normal subjects were given digoxin 0.25 mg, enalapril 10 mg, and placebo twice daily in a randomized, doubleblind, crossover study. Continuous 24-hour electrocardiographic recordings obtained on day 5 of each treatment were analyzed and several time domain and power spectral measures of heart period variability were calculated. Digoxin markedly increased (up to 51%) indexes of vagal modulation of heart period without changing mean RR interval. Enalapril did not change any measure of heart period variability despite a modest hypertensive effect. To determine the effect of each treatment on the response to orthostatic stress, 10 subjects also underwent 15 minutes of 60 ° headup tilt; power spectra were calculated for 15 minutes at 0 ° and at 60 ° of tilt. Neither active treatment affected the response to head-up tilt.