Important differences in cardiovascular autonomic control of hypertensive middle-aged women and men – a critical appraisal

Abstract BackgroundNormotensive women before menopause showed a vagal predominance of cardiac autonomic modulation, while age-matched men showed a sympathetic modulation predominance. However, some women develop systemic arterial hypertension (SAH) even with preserved ovarian function. Our hypothesis is that these women may have cardiovascular autonomic parameters like those of hypertensive men, even when subjected to pharmacological treatment. We aim to investigate the cardiovascular autonomic modulation balance and baroreflex sensitivity (BRS) in hypertensive women with preserved ovarian function and age-matched men.MethodsOne hundred volunteers between 18 and 45 years of age, were assigned to two groups of fifty: Hypertensive group, with a SAH history for at least 6 months (25 men and 25 women) treated with monotherapy (losartan, 25-50mg/kg) and normotensive group (25 men and 25 women). Anthropometric, hemodynamic, metabolic, and autonomic cardiovascular assessments were performed focusing: BRS, autonomic modulation of heart rate variability (HRV) and blood pressure variability (BPV).ResultsThe results showed that HRV analysis, women showed higher values of HF oscillations in absolute and normalized units, and lower values of LF in normalized units and LF/HF ratio compared to men. When normotensive and hypertensive groups were compared, hypertensive groups showed lower values of total variance, LF and HF bands in absolute units. There were similar in BPV. However, hypertensive groups showed lower BRS values when compared to normotensive group.ConclusionThe results indicate that hypertensive groups even with blood pressure controlled through pharmacological treatment, continued to have reduced HRV than normotensive, and hypertensive women have minor cardiovascular autonomic impairment than men.

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Critical Appraisal of Indices for the Assessment of Baroreflex Sensitivity

Methods of Information in Medicine ◽

10.1055/s-0038-1636857 ◽

1997 ◽

Vol 36 (04/05) ◽

pp. 246-249 ◽

Cited By ~ 12

Author(s):

P. Castiglioni ◽

G. Mancia ◽

G. Parati ◽

A. Pedotti ◽

M. Di Rienzo

Keyword(s):

Blood Pressure ◽

Baroreflex Sensitivity ◽

Critical Appraisal ◽

Spectral Estimation ◽

Respiratory Frequency ◽

Pulse Interval ◽

Alpha Coefficient ◽

Before And After ◽

Reliable Parameter ◽

Spontaneous Baroreflex

Abstract:The sequence technique and the spectral estimation of the alpha coefficient are currently employed for the assessment of “spontaneous” baroreflex sensitivity (BRS). The comparison of performance and effectiveness of these techniques is obtained by the analysis of systolic blood pressure (SBP) and pulse interval (PI) tracings recorded in conscious cats before and after baroreceptor denervation. Results indicate that (1) the average BRS estimates obtained by the sequence technique and by the alpha coefficient at the respiratory frequency are similar, (2) the alpha coefficients computed at the respiratory frequency tend to be higher than alpha coefficients estimated at 0.1 Hz, and (3) in spite of what is traditionally claimed, the PI-SBP coherence does not seem to represent a reliable parameter to enhance the specificity of the spectral estimate, because coherence values often remain above the 0.5 threshold also after baroreceptor denervation.

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Effects of Low-Intensity Exercise Conditioning on Blood Pressure, Heart Rate, and Autonomic Modulation of Heart Rate in Men and Women with Hypertension

Biological Research For Nursing ◽

10.1177/1099800408324853 ◽

2009 ◽

Vol 11 (2) ◽

pp. 129-143 ◽

Cited By ~ 23

Author(s):

Lien P.T. Hua ◽

C. Ann Brown ◽

Sylvia J.M. Hains ◽

Marshall Godwin ◽

Joel L. Parlow

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Diastolic Blood Pressure ◽

Baroreflex Sensitivity ◽

Autonomic Modulation ◽

Men And Women ◽

Low Intensity ◽

Walking Program ◽

Spontaneous Baroreflex ◽

Low Intensity Exercise

Untreated hypertension increases cardiovascular risk 2-fold to 3-fold, leading to serious cardiovascular problems that include left ventricular hypertrophy, stroke, ischemic heart disease, myocardial infarction, vascular disease, renal disease, and death. Exercise conditioning is recommended as one of the initial treatments for hypertension. The purpose of this pretest—posttest study was to quantify the effects of a 12-week home-based low-intensity exercise conditioning (walking) program in hypertensive men and women on systolic and diastolic blood pressure, heart rate, and autonomic modulation of heart rate. A total of 20 mildly hypertensive men and women who were assigned to a structured exercise (walking) program were compared with a control group of 20 nonexercising mildly hypertensive participants. Electrocardiographic heart rate and R-R interval data and beat-by-beat arterial blood pressure data were collected continuously for 10 min with participants in the supine and standing postures and during low-intensity steady-state exercise. The results show that systolic and diastolic blood pressure and R-R interval decreased and spontaneous baroreflex sensitivity increased in the exercise group. The decline in blood pressure was significant statistically and clinically. The increase in spontaneous baroreflex sensitivity indicates that the ability of the cardiovascular system to respond rapidly to changing stimuli improved after the 12-week walking protocol. The low-intensity exercise conditioning program achieved a training effect in this population.

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The significance of amlodipine on autonomic nervous system adjustment (ANSA method): A new approach in the treatment of hypertension

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0908371m ◽

2009 ◽

Vol 137 (7-8) ◽

pp. 371-378 ◽

Cited By ~ 3

Author(s):

Branislav Milovanovic ◽

Danijela Trifunovic ◽

Nebojsa Milicevic ◽

Karin Vasic ◽

Mirjana Krotin

Keyword(s):

Blood Pressure ◽

Essential Hypertension ◽

Autonomic Function ◽

Statistical Significance ◽

Low Frequency ◽

Sympathovagal Balance ◽

Autonomic Modulation ◽

Short Term ◽

Hrv Analysis

Introduction. Cardiovascular autonomic modulation is altered in patients with essential hypertension. Objective To evaluate acute and long-term effects of amlodipine on cardiovascular autonomic function and haemodynamic status in patients with mild essential hypertension. Methods. Ninety patients (43 male, mean age 52.12 ?10.7) years with mild hypertension were tested before, 30 minutes after the first 5 mg oral dose of amlodipine and three weeks after monotherapy with amlodipine. A comprehensive study protocol was done including finger blood pressure variability (BPV) and heart rate variability (HRV) beat-to-beat analysis with impedance cardiography, ECG with software short-term HRV and nonlinear analysis, 24-hour Holter ECG monitoring with QT and HRV analysis, 24-hour blood pressure (BP) monitoring with systolic and diastolic BPV analysis, cardiovascular autonomic reflex tests, cold pressure test, mental stress test. The patients were also divided into sympathetic and parasympathetic groups, depending on predominance in short time spectral analysis of sympathovagal balance according to low frequency and high frequency values. Results. We confirmed a significant systolic and diastolic BP reduction, and a reduction of pulse pressure during day, night and early morning hours. The reduction of supraventricular and ventricular ectopic beats during the night was also achieved with therapy, but without statistical significance. The increment of sympathetic activity in early phase of amlodipine therapy was without statistical significance and persistence of sympathetic predominance after a few weeks of therapy detected based on the results of short-term spectral HRV analysis. All time domain parameters of long-term HRV analysis were decreased and low frequency amongst spectral parameters. Amlodipne reduced baroreflex sensitivity after three weeks of therapy, but increased it immediately after the administration of the first dose. Conclusion. The results of the study showed that amlodipine affected autonomic modulation as a shift to sympathetic hyperactivity, but without statistical significance. In the selected group of patients with vagal predominance in sympathovagal balance, amlodipine increased sympathetic and decreases vagal activity. Therefore we conclude that amlodipine mostly exerts impact on autonomic function modulation in patients with vagal predominance in resting state.

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CARDIAC SYMPATHETIC MODULATION INCREASE AFTER WEIGHT LOSS IN COMBAT SPORTS ATHLETES

Revista Brasileira de Medicina do Esporte ◽

10.1590/1517-869220182406182057 ◽

2018 ◽

Vol 24 (6) ◽

pp. 413-417 ◽

Cited By ~ 1

Author(s):

Bruno do Nascimento-Carvalho ◽

Miguel Angel Condori Mayta ◽

João Eduardo Izaias ◽

Marcio Roberto Doro ◽

Katia Scapini ◽

...

Keyword(s):

Blood Pressure ◽

Weight Loss ◽

Mood State ◽

Rapid Weight Loss ◽

Autonomic Modulation ◽

Combat Sports ◽

Time Points ◽

Sympathetic Modulation ◽

Weight Loss Strategy ◽

Weight Loss Process

ABSTRACT Introduction: Although the rapid weight loss process is undertaken by combat sports athletes very often, the impact of this practice on cardiovascular health is not fully understood. Objective: To verify the effects of the rapid weight loss process undertaken by combat sports athletes on hemodynamic parameters, cardiovascular autonomic modulation and mood state. Methods: Eight male fighters (21.62±1.49 years, 71.25±3.54 kg, 1.74±0.03 cm) were assessed in the city of São Paulo. The subjects had 5.37±0.77 years of practice and were training 5.75±0.45 days per week, for 3.05±0.69 hours per day. The athletes were assessed on 2 occasions: 14 days before and 1 day before official weigh-in. Weight, height and bioimpedance were used for body composition analysis. Mood state was assessed using the Brums Mood Scale. Blood pressure was measured at rest with a digital meter. Cardiovascular autonomic modulation was obtained through an analysis of heart rate variability recorded for 25 minutes at rest. The Student's t-test for dependent samples was used for comparison between time points. Values of p<0.05 were considered significant. Results: No differences in body composition were observed between the time points evaluated. After the weight loss strategy, increases in mood state parameters related to anger, vigor and fatigue categories were observed. Blood pressure did not change between the time points evaluated. However, an increase in heart rate associated with greater sympathetic modulation was observed after the weight loss strategy. There were no differences in autonomic modulation parameters representing parasympathetic activity. Conclusions: The study provided evidence of a higher cardiovascular risk in athletes as a result of this rapid weight loss practice, which is very concerning since combat sports athletes repeat this process several times during their lives. Level of Evidence IV; Study type: Case series.

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Obesity does not Impair Ambulatory Cardiovascular and Autonomic Responses Post-exercise

International Journal of Sports Medicine ◽

10.1055/a-1393-6184 ◽

2021 ◽

Author(s):

Gabriel Kolesny Tricot ◽

Fabiula Isoton Isoton Novelli ◽

Lucieli Teresa Cambri

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Diastolic Blood Pressure ◽

Maximal Exercise ◽

Young Men ◽

Autonomic Modulation ◽

Incremental Test ◽

Post Exercise ◽

Cardiac Autonomic Modulation ◽

Main Effect

AbstractThis study aimed to assess whether obesity and/or maximal exercise can change 24 h cardiac autonomic modulation and blood pressure in young men. Thirty-nine men (n: 20; 21.9±1.8 kg·m−2, and n: 19; 32.9±2.4 kg·m−2) were randomly assigned to perform a control (non-exercise) and an experimental day exercise (after maximal incremental test). Cardiac autonomic modulation was evaluated through frequency domain heart rate variability (HRV). Obesity did not impair the ambulatory HRV (p>0.05), however higher diastolic blood pressure during asleep time (p=0.02; group main effect) was observed. The 24 h and awake heart rate was higher on the experimental day (p<0.05; day main effect), regardless of obesity. Hypotension on the experimental day, compared to control day, was observed (p<0.05). Obesity indicators were significantly correlated with heart rate during asleep time (Rho=0.34 to 0.36) and with ambulatory blood pressure(r/Rho=0.32 to 0.53). Furthermore, the HRV threshold workload was significantly correlated with ambulatory heart rate (r/Rho=− 0.38 to−0.52). Finally, ambulatory HRV in obese young men was preserved; however, diastolic blood pressure was increased during asleep time. Maximal exercise caused heart rate increase and 24h hypotension, with decreased cardiac autonomic modulation in the first hour, regardless of obesity.

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Effects of aerobic, resistance and concurrent exercise on pulse wave reflection and autonomic modulation in men with elevated blood pressure

Scientific Reports ◽

10.1038/s41598-020-80800-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Paulo Farinatti ◽

Alex da Silva Itaborahy ◽

Tainah de Paula ◽

Walace David Monteiro ◽

Mário F. Neves

Keyword(s):

Blood Pressure ◽

Wave Reflection ◽

Pulse Wave ◽

Augmentation Index ◽

Aortic Pressure ◽

Elevated Blood Pressure ◽

Autonomic Modulation ◽

Elevated Blood ◽

Pulse Wave Reflection ◽

Concurrent Exercise

AbstractThe acute effects of exercise modes on pulse wave reflection (PWR) and their relationship with autonomic control remain undefined, particularly in individuals with elevated blood pressure (BP). We compared PWR and autonomic modulation after acute aerobic (AE), resistance (RE), and concurrent exercise (CE) in 15 men with stage-1 hypertension (mean ± SE: 34.7 ± 2.5 years, 28.4 ± 0.6 kg/m2, 133 ± 1/82 ± 2 mmHg). Participants underwent AE, RE, and CE on different days in counterbalanced order. Applanation tonometry and heart rate variability assessments were performed before and 30-min postexercise. Aortic pressure decreased after AE (− 2.4 ± 0.7 mmHg; P = 0.01), RE (− 2.2 ± 0.6 mmHg; P = 0.03), and CE (− 3.1 ± 0.5 mmHg; P = 0.003). Augmentation index remained stable after RE, but lowered after AE (− 5.1 ± 1.7%; P = 0.03) and CE (− 7.6 ± 2.4% P = 0.002). Systolic BP reduction occurred after CE (− 5.3 ± 1.9 mmHg). RR-intervals and parasympathetic modulation lowered after all conditions (~ 30–40%; P < 0.05), while the sympathovagal balance increased after RE (1.2 ± 0.3–1.3 ± 0.3 n.u., P < 0.05). Changes in PWR correlated inversely with sympathetic and directly with vagal modulation in CE. In conclusion, AE, RE, and CE lowered central aortic pressure, but only AE and CE reduced PWR. Overall, those reductions related to decreased parasympathetic and increased sympathetic outflows. Autonomic fluctuations seemed to represent more a consequence than a cause of reduced PWR.

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HRV analysis: undependability of approximate entropy at locating optimum complexity in malnourished children

Cardiology in the Young ◽

10.1017/s1047951121002316 ◽

2021 ◽

pp. 1-6

Author(s):

David M. Garner ◽

Gláucia S. Barreto ◽

Vitor E. Valenti ◽

Franciele M. Vanderlei ◽

Andrey A. Porto ◽

...

Keyword(s):

Statistical Significance ◽

Accurate Determination ◽

Approximate Entropy ◽

Effect Sizes ◽

Potential Hazard ◽

Autonomic Modulation ◽

Embedding Dimension ◽

Malnourished Children ◽

Hrv Analysis

Abstract Introduction: Approximate Entropy is an extensively enforced metric to evaluate chaotic responses and irregularities of RR intervals sourced from an eletrocardiogram. However, to estimate their responses, it has one major problem – the accurate determination of tolerances and embedding dimensions. So, we aimed to overt this potential hazard by calculating numerous alternatives to detect their optimality in malnourished children. Materials and methods: We evaluated 70 subjects split equally: malnourished children and controls. To estimate autonomic modulation, the heart rate was measured lacking any physical, sensory or pharmacologic stimuli. In the time series attained, Approximate Entropy was computed for tolerance (0.1→0.5 in intervals of 0.1) and embedding dimension (1→5 in intervals of 1) and the statistical significances between the groups by their Cohen’s ds and Hedges’s gs were totalled. Results: The uppermost value of statistical significance accomplished for the effect sizes for any of the combinations was −0.2897 (Cohen’s ds) and −0.2865 (Hedges’s gs). This was achieved with embedding dimension = 5 and tolerance = 0.3. Conclusions: Approximate Entropy was able to identify a reduction in chaotic response via malnourished children. The best values of embedding dimension and tolerance of the Approximate Entropy to identify malnourished children were, respectively, embedding dimension = 5 and embedding tolerance = 0.3. Nevertheless, Approximate Entropy is still an unreliable mathematical marker to regulate this.

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Exercise and pyridostigmine prevents gastric emptying delay and increase blood pressure and cisplatin-induced baroreflex sensitivity in rats

Life Sciences ◽

10.1016/j.lfs.2020.118972 ◽

2021 ◽

Vol 267 ◽

pp. 118972

Author(s):

Mariana Sousa Silva ◽

Yasmim de Andrade Gomes ◽

Mickael Laudrup de Sousa Cavalcante ◽

Pedro Victor Nogueira Telles ◽

Alda Cássia Alves da Silva ◽

...

Keyword(s):

Blood Pressure ◽

Gastric Emptying ◽

Baroreflex Sensitivity ◽

Increase Blood Pressure

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Heart rate and blood pressure variability and baroreflex sensitivity in patients with acute brain injury

Journal of Critical Care ◽

10.1016/j.jcrc.2005.09.048 ◽

2005 ◽

Vol 20 (4) ◽

pp. 394 ◽

Cited By ~ 1

Author(s):

V. Papaioannou ◽

M. Giannakou ◽

N. Maglaveras ◽

E. Sofianos ◽

M. Giala

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Brain Injury ◽

Blood Pressure Variability ◽

Baroreflex Sensitivity ◽

Acute Brain Injury

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Blood pressure reduction after gastric bypass surgery is explained by a decrease in cardiac output

Journal of Applied Physiology ◽

10.1152/japplphysiol.00362.2016 ◽

2017 ◽

Vol 122 (2) ◽

pp. 223-229 ◽

Cited By ~ 4

Author(s):

Peter M. van Brussel ◽

Bas van den Bogaard ◽

Barbara A. de Weijer ◽

Jasper Truijen ◽

C.T. Paul Krediet ◽

...

Keyword(s):

Blood Pressure ◽

Gastric Bypass ◽

Body Weight ◽

Cardiac Output ◽

Baroreflex Sensitivity ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

Left Ventricular ◽

Ventricular Contractility ◽

Left Ventricular Contractility

Blood pressure (BP) decreases in the first weeks after Roux-and-Y gastric bypass surgery. Yet the pathophysiology of the BP-lowering effects observed after gastric bypass surgery is incompletely understood. We evaluated BP, systemic hemodynamics, and baroreflex sensitivity in 15 obese women[mean age 42 ± 7 standard deviation (SD) yr, body mass index 45 ± 6 kg/m2] 2 wk before and 6 wk following Roux-and-Y gastric bypass surgery. Six weeks after gastric bypass surgery, mean body weight decreased by 13 ± 5 kg (10%, P < 0.001). Office BP decreased from 137 ± 10/86 ± 6 to 128 ± 12/81 ± 9 mmHg ( P < 0.001, P < 0.01), while daytime ambulatory BP decreased from 128 ± 14/80 ± 9 to 114 ± 10/73 ± 6 mmHg ( P = 0.01, P = 0.05), whereas nighttime BP decreased from 111 ± 13/66 ± 7 to 102 ± 9/62 ± 7 mmHg ( P = 0.04, P < 0.01). The decrease in BP was associated with a 1.6 ± 1.2 l/min (20%, P < 0.01) decrease in cardiac output (CO), while systemic vascular resistance increased (153 ± 189 dyn·s·cm−5, 15%, P < 0.01). The maximal ascending slope in systolic blood pressure decreased (192 mmHg/s, 19%, P = 0.01), suggesting a reduction in left ventricular contractility. Baroreflex sensitivity increased from 9.0 [6.4–14.3] to 13.8 [8.5–19.0] ms/mmHg (median [interquartile range]; P < 0.01) and was inversely correlated with the reductions in heart rate ( R = −0.64, P = 0.02) and CO ( R = −0.61, P = 0.03). In contrast, changes in body weight were not correlated with changes in either BP or CO. The BP reduction following Roux-and-Y gastric bypass surgery is correlated with a decrease in CO independent of changes in body weight. The contribution of heart rate to the reduction in CO together with enhanced baroreflex sensitivity suggests a shift toward increased parasympathetic cardiovascular control. NEW & NOTEWORTHY The reason for the decrease in blood pressure (BP) in the first weeks after gastric bypass surgery remains to be elucidated. We show that the reduction in BP following surgery is caused by a decrease in cardiac output. In addition, the maximal ascending slope in systolic blood pressure decreased suggesting a reduction in left ventricular contractility and cardiac workload. These findings help to understand the physiological changes following gastric bypass surgery and are relevant in light of the increased risk of heart failure in these patients.

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