Abstract 13181: Characteristics of Diurnal Change of Pulse Rate in Resistant Hypertension

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Hiroaki Watanabe ◽  
Tomoyuki Kabutoya ◽  
Satoshi Hoshide ◽  
Kazuo Eguchi ◽  
Kazuomi Kario
Keyword(s):  
Blood Pressure ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Pulse Rate ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Blood Pressure Monitoring ◽  
Hazard Ratio ◽  
Diurnal Change ◽  
Autonomic Nervous

Introduction: Sympathetic hyperactivity is one of the most important causes of resistant hypertension. Ambulatory blood pressure monitoring (ABPM) allows measurement of blood pressure (BP) and pulse rate (PR) throughout the day, as well as measurement of diurnal variations in BP and PR, which are controlled by the autonomic nervous system. Hypothesis: We hypothesized that abnormal diurnal change of BP and PR are associated with resistant hypertension. Methods: We evaluated 1003 patients with hypertension who were enrolled in the Japan Morning Surge Home Blood Pressure Study and were using ABPM. Resistant hypertension was defined as clinic BP≧140/90 mmHg despite the use of optimal doses of 3 classes of antihypertensive drugs, including a diuretic. BP or PR dipper status was defined as (awake systolic BP (SBP) or PR-sleep SBP or PR)/awake SBP or PR ≧0.1. BP or PR nondipper status was defined as (awake SBP or PR-sleep SBP or PR)/awake SBP or PR <0.1 and ≧0. BP and PR riser status were defined as awake SBP or PR < sleep SBP or PR. Results: The numbers of PR nondippers and PR risers in the resistant hypertensive groups were significantly greater than those in the non-resistant hypertensive groups (x2=9.35, p=0.009), but there were no significant differences in the diurnal variation of BP between the resistant hypertensive and non-resistant hypertensive groups (x2=3.10, p=0.21). In the resistant hypertensive groups, the proportion of PR risers was approximately three-fold greater than that in the non-resistant hypertensive groups after adjustment for age, gender, 24-h BP, PR, and BP variation (Hazard ratio 2.94, 95%Cl 1.25-6.91, p=0.013), but there were no significant differences in the proportion of PR nondippers (Hazard ratio 1.36, 95%Cl 0.82-2.26, p=0.23). Conclusions: A riser pattern of PR was associated with resistant hypertension. ABPM may be useful to identify resistant hypertensive patients who have autonomic nervous system dysfunction.

Changes in hemodynamics in uncomplicated hypertensive crises

2021 ◽  
Vol 41 (1) ◽  
pp. 63-69
Author(s):  
D. V. Leliuk ◽  
◽  
Keyword(s):  
Blood Pressure ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Risk Score ◽  
Framingham Risk Score ◽  
Antihypertensive Drugs ◽  
Outpatient Basis ◽  
Autonomic Nervous ◽  
Framingham Risk ◽  
Hypertensive Crises

Aim: to improve the results of treatment of uncomplicated hypertensive crises at the prehospital stage by studying the state of systemic hemodynamics, determining the balance of the autonomic nervous system, in patients with hypertension in uncomplicated hypertensive crises. A study of 206 patients with documented stage II hypertension, 75 people who had a stable course of the disease and were examined on an outpatient basis. Almost healthy 31 people the indicators of heart rate variability in the examined persons were analyzed. For diagnosis were recorded according to the standard method “Cardiolab” (KhAI-Medika, Kharkіv). Assessment of the initial vegetative status in patients with hypertension and the direction of its changes after taking antihypertensive drugs, conducted within the framework of acute drug tests, suggests the possibility of differentiated choice of drug therapy and to predict its effectiveness. Reducing blood pressure significantly reduced the % risk, as on a SCORE scale of 5.83 [3.68; 8.66] % to 3.39 [1.87; 6.65] %, (p < 0.05) and Framingham Risk Score with 31.93 [22.72; 43.25] % to 21.74 [15.35; 31.43] %, (p < 0.05). The provision of EMD to patients with GC was generally effective and was accompanied by a significant decrease in CAT by – 3.93 % and DBP by – 12.5 %. Effective reduction of blood pressure led to a reduction in cardiovascular risk, both on the SCORE scale and the Framingham Risk Score. Assignment of differentiated EMD to patients with HA depending on the balance of the (autonomic nervous system) ANS was effective and was accompanied by normalization of total peripheral vascular resistance.

An Evaluation of Autonomic Nervous System Function in Patients With Prader-Willi Syndrome

PEDIATRICS ◽  
1994 ◽  
Vol 93 (1) ◽  
pp. 76-81
Author(s):  
Francis J. DiMario ◽  
Barbara Dunham ◽  
Joseph A. Burleson ◽  
Jay Moskovitz ◽  
Suzanne B. Cassidy
Keyword(s):  
Blood Pressure ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Pulse Rate ◽  
Analysis Of Covariance ◽  
Prader Willi Syndrome ◽  
System Function ◽  
Autonomic Nervous ◽  
Control Subjects ◽  
Nervous System Function

Objective. Prader-Willi syndrome (PWS) is a complex multisystem genetic disorder in which many cardinal features may have a neurologically based patho-physiology involving both the central and peripheral components of the autonomic nervous system. Autonomic nervous system function was studied noninvasively in a group of subjects with PWS and control subjects to determine whether autonomic nervous system dysfunction exists as part of the PWS. Design/setting. This cross-sectional study was performed in the neurophysiology laboratory at a tertiary care facility. Methods. Evaluation included anthropometric measurements and calculation of a body mass index (BMI). Simultaneous electrocardiography and serial recordings of pulse rate and systolic/diastolic mean arterial blood pressures during orthostatic maneuvers were taken. Pupillary response to the instillation of dilute pilocarpine and measurements of plasma norepinephrine at rest and after standing were also obtained. Results were analyzed using two-tailed t tests, Fisher exact test, analysis of variance, and analysis of covariance adjusting for age, gender, and BMI. Patients. There were 14 subjects with PWS (8 female, 6 male; aged 4 to 40 years, mean age 16 years) and 8 control subjects (4 female, 4 male; aged 5 to 37 years, mean age 19 years). Results. Abnormal findings were obtained only in subjects with PWS. Analysis of covariance adjusting for age, gender, and BMI revealed a trend for subjects with PWS to have lower resting diastolic blood pressure (P &lt; .09) and significantly less change in diastolic blood pressure after standing (P &lt; .02). Subjects with PWS had significantly greater BMI than did control subjects (P &lt; .001), which correlated significantly with all pulse rate measurements where the greater the BMI the higher the pulse rate at rest (r = .25, P &lt; .04) and the lower the pulse rate after arising from lying to standing at both 15 and 30 seconds (r = .17, P &lt; .1; r = .55, P &lt; .08 respectively). Pupillary constriction of 2 mm or more was seen in 7 of 14 subjects with PWS and in no control subjects (P &lt; .004). The 30:15 R-R interval ratio was abnormal in 6 of 14 subjects with PWS and in no control subjects (P &lt; .03). Conclusions. These results suggest that patients with PWS have a detectable underlying autonomic dysfunction characterized principally by diminished parasympathetic nervous system activity.

Risk assessment of occupational and occupationally conditioned diseases connection to noise when exceeding maximum permissible levels

2019 ◽  
pp. 17-19
Author(s):  
Vladimir A. Fokin ◽  
Dmitrii M. Shlyapnikov ◽  
Svetlana V. Red’ko
Keyword(s):  
Blood Pressure ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
High Blood Pressure ◽  
Noise Exposure ◽  
Physical Factors ◽  
Autonomic Nervous ◽  
Permissible Levels ◽  
The Relationship ◽  
Perm Region

In accordance with the requirements of paragraph 3.2.6 of sanitary rules and norms «Sanitary and epidemiological requirements for physical factors at workplace», in the event of exceeding noise level at workplace above 80 dBA, an employer is obliged to assess the health risk of workers and confirm an acceptable risk to their health. The connection between the incidence of occupational and occupationally conditioned diseases with noise exposure exceeding the maximum permissible levels (80 dBA) was estimated. The assessment was carried out at a food industry enterprise of Perm Region. Assessing the relationship between morbidity and noise exposure is the first step in evaluation of occupational health risks for workers exposed to noise exceeding MAL. If a reliable relationship between morbidity and noise exposure is established, an assessment of occupational risk is conducted. The odds ratio (OR) for diseases characterized by high blood pressure and disorders of autonomic nervous system was <1 (confidence interval CI=0.11–1.61 and CI=0.08–2.78, respectively). The relative risk (RR) for diseases characterized by high blood pressure and disorders of autonomic nervous system was <1. The received data testify absence of connection of morbidity with exposure to industrial noise, calculation of etiological share of responses and levels of risk is not required.

scholarly journals Patients with Impaired Descending Nociceptive Inhibitory System Present Altered Cardiac Vagal Control at Rest

2018 ◽  
Vol 1 (21;1) ◽  
pp. E409-E418
Author(s):  
Leandro Nogueira
Keyword(s):  
Blood Pressure ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Musculoskeletal Pain ◽  
Blood Pressure Response ◽  
Pain Modulation ◽  
Pressure Response ◽  
Autonomic Modulation ◽  
Inhibitory System ◽  
Autonomic Nervous

Background: Patients with chronic musculoskeletal pain have a higher chance of presenting impairment in cardiovascular autonomic modulation, which may have implications for cardiovascular events. The autonomic nervous system plays an important role in pain modulation. However, it is unclear whether patients with inefficient descending nociceptive inhibition have poorer cardiovascular autonomic modulation. Objective: To compare the cardiovascular autonomic modulation of patients with musculoskeletal pain who had normal versus impaired functioning of descending nociceptive inhibitory system (DNIS). Study Design: A cross-sectional study. Setting: Physiotherapy outpatient service. Methods: Fifty-six patients with musculoskeletal pain were included. Conditioned pain modulation was assessed by the difference of algometric values held in the dorsal forearm and tibialis anterior muscle, before and after a thermal pain stimulus was employed via the cold pressure test (CPT). Patients with inefficient DNIS in both sites were classified as impaired responders (n = 14). The others were classified as normal responders (n = 42). Cardiac autonomic modulation was monitored at rest by heart rate variability (HRV). The blood pressure response to the CPT was used as a proxy of sympathetic responsiveness. Results: Most of the patients were women (60%) and had chronic pain (75%). The groups had similar demographic characteristics. Patients with impaired DNIS showed lower HRV [RMSSD (P = 0.020), SDRR (P = 0.009), HF (ms2 ) (P = 0.027), LF (ms2 ) (P = 0.004), and total power (P = 0.002)]. The blood pressure response to CPT was similar between groups (systolic pressure, P = 0.813; diastolic pressure, P = 0.709). Limitation: Physical activity level, emotional changes, and visceral pathologies can alter the autonomic nervous system and may represent potential confounders. The low number of patients may have biased the results. Conclusion: Patients with impaired DNIS presented lower resting HRV, indicating an altered vagal control of the heart. In contrast, the blood pressure response to a sympathoexcitatory stimulus was preserved. The study was approved by the Research Ethics Committee of Augusto Motta University Centre (CAAE number: 46245215.9.0000.5235), and all patients signed the Informed Consent Form. Key words: Musculoskeletal pain, autonomic nervous system, heart rate, chronic pain, diffuse noxious inhibitory control, blood pressure, sympathetic nervous system, parasympathetic nervous system

Heart Rate and Blood Pressure Changes During Autonomic Nervous System Challenge in Panic Disorder Patients

2010 ◽  
Vol 72 (5) ◽  
pp. 442-449 ◽  
Author(s):  
Jose M. Martinez ◽  
Amir Garakani ◽  
Horacio Kaufmann ◽  
Cindy J. Aaronson ◽  
Jack M. Gorman
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Panic Disorder ◽  
Autonomic Nervous ◽  
Pressure Changes

Effect of Variation of Blood Pressure on the Autonomic Nervous System

1940 ◽  
Vol 43 (2) ◽  
pp. 236-240 ◽  
Author(s):  
E. Gellhorx ◽  
C. W. Darrow ◽  
L. Yesinick
Keyword(s):  
Blood Pressure ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Autonomic Nervous

Abstract P129: Role of the Autonomic Nervous System in Remote Postconditioning in Humans

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Rupert P Williams ◽  
Michael I Okorie ◽  
Harminder Gill ◽  
John E Deanfield ◽  
Raymond J MacAllister ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Whole Body ◽  
Limb Ischaemia ◽  
Protective Effects ◽  
Blood Pressure Cuff ◽  
Autonomic Nervous ◽  
Pressure Cuff ◽  
Remote Postconditioning

Brief periods of ischaemia activate systemic mechanisms that induce whole-body tolerance to subsequent prolonged and injurious ischaemia. This phenomenon, remote ischaemic preconditioning (RIPC), is sufficiently acute to reduce ischaemia-reperfusion (IR) injury even when applied simultaneously with injurious ischaemia. This aspect of RIPC is termed remote postconditioning (RPostC). We have previously demonstrated a role for the autonomic nervous system in RIPC. Using an in vivo model of endothelial IR injury, we determined if RPostC is dependent on adrenergic autonomic mechanisms. Vascular ultrasound was used to assess endothelial function in healthy volunteers by measuring dilatation of the brachial artery in response to increased blood flow during reactive hyperaemia (flow-mediated dilatation; FMD). Endothelial IR injury was induced by 20 min of upper limb ischaemia (inflation of a blood pressure cuff to 200 mm Hg) followed by reperfusion. RPostC was induced by applying 2 cycles of 5 minutes ischaemia and 5 minutes reperfusion on the leg during arm ischaemia (via a second blood pressure cuff). In order to determine the dependence of RPostC on autonomic activation, we administered the alpha adrenoceptor blocker phentolamine (0.2– 0.7mg/min, intravenously) during the application of the RPostC stimulus. FMD was determined before ischaemia and at 20 minutes of reperfusion. FMD (percentage change from baseline diameter) was compared statistically by ANOVA. IR alone caused a significant reduction in FMD (5.9±0.7% pre- versus 2.2±0.4% post-IR, n=9, P<0.001). This reduction was prevented by RPostC (5.8±0.4% pre- versus 5.4±0.3% post-IR, n=8, P>0.05). Systemic phentolamine blocked the protective effects of RPostC (FMD 6.1±0.5% pre- versus 2.0±0.3% post-IR, n=7, P<0.001). These data indicate, for the first time in humans, that protection from RPostC depends on preservation of adrenergic signalling. Alpha blockade neutralises one of the endogenous mechanisms of ischemic protection in humans; the clinical consequences of this remain to be determined.

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