scholarly journals 345 Blood pressure and autonomic function in essential hypertension: comparative evaluation of 24-hour heart rate variability and blood pressure

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Vanessa Pivetti ◽  
Davide Lazzeroni ◽  
Luca Moderato ◽  
Claudio Stefano Centorbi ◽  
Matteo Bini ◽  
...  

Abstract Aims Arterial hypertension (AHT) represents the leading cause of cardiovascular disease (CVD) and premature death worldwide. Essential AHT accounts for 95% of all cases of hypertension; although the aetiology of essential AHT is still largely unknown, a pivotal role of autonomic nervous system has been proposed and demonstrated. Both excessive sympathetic tone and vagal withdrawal, that define autonomic dysfunction, has been associated with essential AHT. The aim of our study was to investigate the relationship between blood pressure and autonomic function in essential hypertension; this was done comparing 24 h heart rate variability and 24 h blood pressure data, simultaneously collected, in a population of essential AHT subjects. Methods A prospective registry of 179 consecutive not selected essential AHT patients were considered in the present study. All patients underwent cardiac evaluation at the Primary and Secondary Cardiovascular Prevention Unit of the Don Gnocchi Foundation of Parma. All subjects underwent 24 h ECG monitoring, and 24 h Ambulatory Blood Pressure Monitoring, during the same day. Twenty-four hours Heart Rate variability analysis included: Time-domain, frequency-domain and non-linear domain. Results Mean age was 60 0a11.7 years, male gender was prevalent (68.4%). Among the population 26 (14.7%) subjects had diabetes; the prevalence of family history of CVD was 61.7% and 66.5% had dyslipidaemia; body mass index mean values were 27.6 7.4.3. In the whole population, the prevalence of uncontrolled AHT was 80.5%, divided into: 53.1% systo-diastolic, 17.9% isolated systolic, and 9.5% isolated diastolic. The prevalence of untreated AHT (recent diagnosis) was 40.2%, while treated AHT was 59.8% and only 19.6% had controlled blood pressure values (AHT at target). 12.3% of patients were treated with Beta Blockers. A significant correlations between diastolic blood pressure (DBP) values (24 h and day-time), LF/HF ratio (24 h) (r = 0.200; P = 007) and DFA alfa1 (24 h) (r = 0.325; P = 0.000), two know markers of sympathetic tone, were found. A higher sympathetic tone, expressed as high LF/HF, was found in isolated diastolic AHT compared to other types of AHT and the lowest sympathetic tone was found in isolated systolic AHT. Considering non-linear (complexity) analysis, DFA alfa1 (24 h) showed a significant correlation with DBP values that remained independent even after multiple adjustment for BMI, age, gender and Beta Blockers (β = 0.218; P = 0.011). Moreover, the lack of DBP control was associated with high sympathetic tone (LF/HF 3.8 112.3 vs 5.5 .33.3; P < 0.0001). On the other hand, no significant correlations between all DBP data and vagal markers, such as SDNN index, RMSSD and HF, were found. Again, no significant correlations between 24 h, daytime, night-time SBP and time or frequency HRV data as well as with non-linear (complexity) analysis were found. Finally, considering ‘autonomic dipping’, expressed as changes in HRV data between day and night, a strong inverse correlation between vagal markers and Heart Rate Dipping (r = −0.297; P < 0.0001) was found; correlation that remain independent even adjusted for age, gender, BMI, and BB. On the other hand, no association between blood pressure dipping and autonomic dipping was found. Conclusion Diastolic blood pressure and uncontrolled diastolic AHT, rather than systolic AHT, are associated with a hyper-sympathetic tone rather than with blunted vagal tone. The lack of heart rate dipping during night-time in AHT is associated with blunted vagal activation rather than a persistent night-time hyper-adrenergic tone.

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 20-20
Author(s):  
Vita Dikariyanto ◽  
Leanne Smith ◽  
May Robertson ◽  
Eslem Kusaslan ◽  
Molly O'Callaghan-Latham ◽  
...  

Abstract Objectives Stress is inversely associated with heart rate variability (HRV), an indicator of cardiac autonomic function and a predictor of risk of sudden cardiac death. At times of stress, people tend to favor high sugar and fatty foods, often as snacks, with potential adverse effects on cardiometabolic health. Dietary recommendations for cardiovascular disease (CVD) prevention emphasize fruits, vegetables, wholegrains and nuts. There is evidence that consumption of nuts can reduce LDL cholesterol and blood pressure and help with weight management, however the impact of nuts on HRV in response to stress is unknown. The ATTIS dietary intervention study investigated the HRV response to acute stress following 6-week substitution of almonds for typical snacks high in refined starch, free sugars and saturated fats, and low in fibre. The study population comprised adults aged 30–70 y, who were habitual snack consumers, and at moderate risk of developing CVD. It was hypothesized that snacking on almonds would increase HRV during stress tasks, when HRV is expected to be reduced due to increased sympathetic activity. Methods A 6-week randomized controlled parallel trial was conducted. Participants were randomized to 1) control snacks (mini-muffins formulated to follow the average UK snack nutrient profile), or 2) dry-roasted whole almonds, both providing 20% estimated energy requirement. Supine HRV was measured (Mega Electronics Emotion Faros 180°, 2-leads wearable ECG-HRV monitor) during resting (5 min), physical stress (blood pressure monitor cuff inflation 200 mmHg, 5 min) and mental stress (Stroop colour-word test, 5 min) tasks pre- and post-intervention. A total of 105 participants (73 females and 32 males; mean age 56.2 y, SD 10.4) completed the trial. Results Almonds significantly increased the beat-to-beat HRV parameter, high-frequency power, during the mental stress test (mean difference 124 ms2; 95% CI 11, 237; P = 0.031) relative to control, indicating increased parasympathetic regulation. There were no treatment effects during resting and the physical stress task. Conclusions Snacking on whole almonds as a replacement for typical snacks increases HRV during mental stress, indicating an increased resilience in cardiac autonomic function and a novel mechanism whereby nuts may be cardioprotective. Funding Sources Almond Board of California.


2017 ◽  
Vol 52 (3) ◽  
pp. 280-291
Author(s):  
Divya Sarma Kandukuri ◽  
Jacqueline K Phillips ◽  
Mark Tahmindjis ◽  
Cara M Hildreth

Neuromuscular-blocking agents are commonly used in laboratory animal research settings. Due to actions of cholinergic receptors at locations other than the motor end-plate, these agents have a strong propensity to modulate autonomic outflow and may therefore not be desirable in studies examining autonomic function. This study aimed to compare the effect of two non-depolarizing neuromuscular-blocking agents, pancuronium and cisatracurium, on blood pressure, heart rate and non-invasive indices of autonomic function (heart rate variability, systolic blood pressure variability and baroreflex sensitivity) under two different types of anaesthesia in Lewis rats. Pancuronium produced a profound vagolytic response characterized by tachycardia, reduction in heart rate variability and baroreflex sensitivity under urethane anaesthesia, and with minimal effect under isoflurane anaesthesia. Conversely, cisatracurium produced no evidence of vagolytic action under either urethane or isoflurane anaesthesia. Therefore, for studies interested in examining autonomic function, particularly baroreflex or vagal function, neuromuscular blockade would be best achieved using cisatracurium.


2011 ◽  
Vol 31 (1) ◽  
pp. 91-106 ◽  
Author(s):  
Eduardo Tejera ◽  
Maria Jose Areias ◽  
Ana Isabel Rodrigues ◽  
Jose Manuel Nieto-Villar ◽  
Irene Rebelo

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Martina Zinelli ◽  
Davide Lazzeroni ◽  
Luca Moderato ◽  
Claudio Stefano Centorbi ◽  
Matteo Bini ◽  
...  

Abstract Aims Takotsubo Syndrome (TS) occurs as an acute coronary syndrome (ACS) characterized by severe left ventricular (LV) dysfunction that typically recovers spontaneously within days or weeks and in the absence of obstructive coronary artery disease. Although during the acute phase it is well documented that an exaggerated sympathetic tone plays a central role in the development of TS, whether an impaired sympatho-vagal balance may persist long after the acute phase, despite the recovery of left ventricular function, is still an open issue. Interestingly, recent evidences suggest that an impairment in central autonomic network not only persist long after the acute event but also may be pre-existent before the acute onset of TS. The Aim of the study was to investigate whether an impairment of the autonomic function is still present long after a TS event. Methods and results We evaluated 67 patients (91% female, mean age 66 ± 8 years) divided into three groups: 24 with a history of TS (1 year after acute event), 21 subjects with a previous history of acute coronary syndrome (ACS) and complete LV ejection fraction recovery (1 year after acute event) and 22 age- and gender-matched healthy subjects. All patients underwent a non-invasive beat-to-beat arterial blood pressure and heart rate recording (short term: 5 min), after at least 3 days of β-blockers wash-out, to obtain heart rate variability (HRV) and spontaneous baroreflex sensitivity (sBRS) data. An overall autonomic dysfunction was found in both TS and ACS groups compared to controls. In particular, a lower heart rate variability, expressed as lower SDNN, has been found in TS and ACS groups compared to controls (31 ± 12 vs. 25 ± 11 vs. 41 ± 22; P = 0.006—Figure A) as a consequence of blunted vagal tone, expressed as lower RMSSD (20 ± 12 vs. 19 ± 11 vs. 40 ± 37; P = 0.007—Figure B) and higher sympathetic tone, expressed as higher LF/HF ratio (P = 0.007 Figure C) which was found to be higher in TS even when compared to ACS (TS: 3.5 ± 2.5 vs. ACS: 2.1 ± 1.7; P = 0.011). Moreover, fractal analysis of HRV showed higher complexity of heart rate regulation, expressed as higher fractal dimension (DFA 1.48 ± 0.06 vs. 1.53 ± 0.05 vs. 1.40 ± 0.10; P < 0.0001—Figure D), in both TS and ACS compared to controls. Interestingly, spontaneous BRS showed the lowest values in the TS group (sSBP: 5.6 ± 2.6 vs. 7.5 ± 3.0 vs. 12.1 ± 11.9; P = 0.027—Figure E), associated with highest levels of sympathetic peripheral control of systolic blood pressure (SBP), expressed as LF-BRS (13.7 ± 9.6 vs. 8.3 ± 5.2 ± 6.8 ± 5.8; P = 0.008—Figure F). Conclusions An autonomic dysfunction, characterized by a hyper-sympathetic tone, reduced baroreflex sensitivity and increased peripheral adrenergic control of blood pressure, persists in TS patients long after the acute phase.


2007 ◽  
Vol 118 (9) ◽  
pp. 2009-2015 ◽  
Author(s):  
Karl-Jürgen Bär ◽  
Michael Karl Boettger ◽  
Mandy Koschke ◽  
Steffen Schulz ◽  
Pratap Chokka ◽  
...  

2014 ◽  
Vol 5 (3) ◽  
pp. 91-94 ◽  
Author(s):  
M.I.Glad Mohesh ◽  
K Ratchagan ◽  
A Sundaramurthy

Background: WHO (2010) reported the rise in the number of smokeless tobacco users in India. Dipping tobacco is a form of smokeless tobacco being used in these region in various trade names. Nicotine in smoking tobacco is found to alter the cardiovascular autonomic functions. As the expected cardiovascular mortality due to tobacco use across the globe is very high, here we studied the effect of dipping tobacco on cardiovascular autonomic function using the short term heart rate variability (HRV) analysis. Methods: Five minutes Lead II ECG at rest is aquired from male dipping tobacco moderate users (n=30) and age matched controls (n=30). Frequency and time domain parameters were derived and analysed using the Kubios HRV analysis software. Blood pressure changes were also compared. Unpaired ‘t’ test was done using SPSS 17.0 and statistical significance was set at p<0.05. Results: Significant changes in certain parameters indicated that there is a developing set back in the sympathetic control over the heart (LF, 383.8+115.8, 952.8+131.1, p<0.01) and also an established increase in diastolic blood pressure (73.1+2.8, 65.48+1.5, p<0.01). Conclusion: Dipping tobacco a form of smokeless tobacco is equally harmful like any smoked tobacco in altering the cardiovascular autonomic function. Thereby the increase in smokeless tobacco users in India or any country is going to add up more to the mortality rate due to tobacco related diseases in near future as estimated by WHO. An immediate measure to stop the production, sale and use of these smokeless tobacco products could curb this menace. Asian Journal of Medical Science, Volume-5(3) 2014: 91-94 http://dx.doi.org/10.3126/ajms.v5i3.9588


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