1
|
Man T, Tegegne BS, van Roon AM, Rosmalen JGM, Nolte IM, Snieder H, Riese H. Spontaneous baroreflex sensitivity and its association with age, sex, obesity indices and hypertension: a population study. Am J Hypertens 2021; 34:1276-1283. [PMID: 34329370 DOI: 10.1093/ajh/hpab122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/01/2021] [Accepted: 07/27/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Low baroreflex sensitivity (BRS) was an established risk factor for cardiovascular disorders. We investigated determinants of BRS in a large sample from general population. METHODS In a population-based study (n = 901), data were collected on BRS, arm cuff blood pressure (BP), and obesity indices including body mass index, waist-to-hip ratio, waist circumference, and percentage body fat (%BF). BRS was calculated by spectral analysis software based on continuously recorded spontaneous fluctuations in beat-to-beat finger BP for 10-15 minutes. Correlations and multivariable regression analyses were used to test associations of age, sex, obesity indices, and hypertension with BRS while considering effects of lifestyle factors (smoking, alcohol consumption, and physical activity). RESULTS In multivariable analysis, age, sex, %BF, and hypertension were independently associated with BRS. BRS decreased with -0.10 (95% confidence interval: -0.15 to -0.06) ms/mm Hg with each year of increase in age. Women had -1.55 (95% confidence interval: -2.28 to -0.73) ms/mm Hg lower mean BRS than men. The effects of %BF (per 10% increase) and hypertension on BRS were -0.55 (95% confidence interval: -0.97 to -0.13) ms/mm Hg and -1.23 (95% confidence interval: -1.92 to -0.46) ms/mm Hg, respectively. There was no evidence of associations between BRS and lifestyle factors. Age, age2, sex, and their interactions plus %BF and hypertension contributed 16.9% of total variance of BRS. CONCLUSIONS In this large general population study, we confirmed prior findings that age and sex were important factors associated with BRS and found %BF was more strongly related to less favorable BRS levels than body mass index.
Collapse
Affiliation(s)
- Tengfei Man
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Balewgizie S Tegegne
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arie M van Roon
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Judith G M Rosmalen
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ilja M Nolte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harriëtte Riese
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
2
|
|
3
|
Spontaneous baroreceptor reflex sensitivity for risk stratification of heart failure patients: optimal cut-off and age effects. Clin Sci (Lond) 2015; 129:1163-72. [DOI: 10.1042/cs20150341] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 10/01/2015] [Indexed: 11/17/2022]
Abstract
This study provides statistical support for 3 ms/mmHg as a cut-off value that is the identifier of a homogeneous group of patients with depressed BRS, and highlights the robustness of this threshold in risk stratification due to its age-independent prognostic value.
Collapse
|
4
|
Wada N, Singer W, Gehrking TL, Sletten DM, Schmelzer JD, Kihara M, Low PA. Determination of vagal baroreflex sensitivity in normal subjects. Muscle Nerve 2014; 50:535-40. [PMID: 24477673 DOI: 10.1002/mus.24191] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 01/22/2014] [Accepted: 01/27/2014] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The Valsalva maneuver (VM) is used widely to quantify the sensitivity of the vagal baroreflex loop (vagal baroreflex sensitivity, BRS_v), but most studies have focused on the heart rate (HR) response to blood pressure (BP) decrement (BRS_v↓), even though the subsequent response to an increment in BP after the VM (BRS_v↑) is important and different. METHODS We evaluated recordings of HR and BP in 187 normal subjects during the VM and determined both BRS_v↑, as determined by relating HR to the BP increase after phase III and BRS_v↓. RESULTS BRS_v↑ was related inversely to age. In addition, BRS_v↓, age, and magnitude of phase IV were independent predictors of BRS_v↑ in a multivariate model, accounting for 47% of the variance of BRS_v↑. CONCLUSIONS The results indicate that both BRS_v↑ and BRS_v↓ become blunted with increasing age and that these indices relate to each other.
Collapse
Affiliation(s)
- Naoki Wada
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA; Hidaka kai, Hidaka Hospital, Takasaki, Gunma, Japan
| | | | | | | | | | | | | |
Collapse
|
5
|
Depressed mood and blood pressure: The moderating effect of situation-specific arousal levels. Int J Psychophysiol 2012; 85:212-23. [DOI: 10.1016/j.ijpsycho.2012.04.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 04/20/2012] [Accepted: 04/24/2012] [Indexed: 01/30/2023]
|
6
|
Messerli-Burgy N, Meyer K, Steptoe A, Laederach-Hofmann K. Autonomic and Cardiovascular Effects of Acute High Altitude Exposure After Myocardial Infarction and in Normal Volunteers. Circ J 2009; 73:1485-91. [DOI: 10.1253/circj.cj-09-0004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nadine Messerli-Burgy
- Autonomic Laboratory; Department of Endocrinology, Diabetology & Clinical Nutrition, Inselspital, University of Bern
- Department of Clinical Psychology and Psychotherapy, University of Bern
- Swiss Health Observatory (OBSAN)
| | | | - Andrew Steptoe
- Psychobiology Group, Department of Epidemiology and Public Health, University College
| | - Kurt Laederach-Hofmann
- Autonomic Laboratory; Department of Endocrinology, Diabetology & Clinical Nutrition, Inselspital, University of Bern
- Center for Psychobiology and Psychosomatics, University of Trier
| |
Collapse
|
7
|
Laederach-Hofmann K, Rüddel H, Mussgay L. Pathological baroreceptor sensitivity in patients suffering from somatization disorders: do they correlate with symptoms? Biol Psychol 2008; 79:243-9. [PMID: 18611426 DOI: 10.1016/j.biopsycho.2008.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 06/04/2008] [Accepted: 06/10/2008] [Indexed: 11/17/2022]
Abstract
AIM We conducted a study to investigate whether patients with somatization disorders (ICD-10, F45.0) show abnormal values in autonomic testing. METHOD 35 patients with a diagnosis of somatization disorder (SP) were matched to 35 healthy volunteers (HV). International standardized autonomic testing based on heart rate variation and continuously measured blood pressure signals was used to assess autonomic activity and establish baroreceptor sensitivity (BRS). Three different statistical procedures were used to confirm the reliability of the findings. RESULTS There were no statistical differences between the 2 groups in age, BMI, systolic and diastolic blood pressures, and spectral values (total power, low, and high frequency power). However, heart rate was higher (p=0.044) and baroreceptor sensitivity was lower (p=0.002) in the patients compared to the healthy volunteers. Median BRS (+/-S.E.M.) of patients was 9.09+/-0.65 compared to 12.04+/-0.94 ms/mmHg in healthy volunteers. Twenty-two of the 35 patients had a BRS of -1.0S.D. below the mean of HV. SP with lower values differed from SP with normal BRS in values of total power, low-, mid-, and high-frequency bands (p<0.01 to <0.0001). No differences in psychometric testing were found between patients with lower or higher BRS. In addition, no correlation whatsoever was found in relation to autonomic variables between HV and SP, except for a higher LF/HF quotient in the latter (p<0.05). CONCLUSION Autonomic regulation was impaired in 62% of patients with a somatization disorder. Severity of clinical symptoms measured by psychometric instruments did not preclude autonomic function impairment. Accordingly, autonomic dysfunction may constitute an independent somatic factor in this patient group.
Collapse
Affiliation(s)
- Kurt Laederach-Hofmann
- Psychobiology and Psychosomatic Center, Department of Behavioural Medicine and Rehabilitation, University of Trier, St-Franziska-Stift Psychosomatic Hospital, Bad Kreuznach, Germany.
| | | | | |
Collapse
|
8
|
EGUCHI K, TOMIZAWA H, ISHIKAWA J, HOSHIDE S, PICKERING TG, SHIMADA K, KARIO K. Factors Associated with Baroreflex Sensitivity: Association with Morning Blood Pressure. Hypertens Res 2007; 30:723-8. [DOI: 10.1291/hypres.30.723] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
9
|
Dietrich A, Riese H, van Roon AM, van Engelen K, Ormel J, Neeleman J, Rosmalen JGM. Spontaneous baroreflex sensitivity in (pre)adolescents. J Hypertens 2006; 24:345-52. [PMID: 16508583 DOI: 10.1097/01.hjh.0000200517.27356.47] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To present normal spontaneous baroreflex sensitivity (BRS) values and investigate the influence of posture, sex, age, pubertal stage, body mass index (BMI), and physical activity level on BRS in (pre)adolescents. BRS is a sensitive measure of both sympathetic and parasympathetic cardiovascular regulation that may help detect early subclinical autonomic dysfunction. DESIGN A cross-sectional cohort study in a large sample of 10-13-year-old Dutch (pre)adolescents from the general population. METHODS Short-term spontaneous BRS was determined non-invasively by Portapres in both the supine and standing position. BRS was calculated by power spectral analysis using the discrete Fourier method (frequency band 0.07-0.14 Hz). Univariate statistical methods and multiple regression analyses were applied. RESULTS BRS in a standing position was lower than in a supine position (9.0 +/- 4.9 versus 15.3 +/- 9.1 ms/mmHg; t = 27.8, P < 0.001). Girls had lower BRS values than boys in both postures (supine 14.3 +/- 8.7 versus 16.4 +/- 9.4 ms/mmHg, beta = 0.12, P < 0.001; standing 8.4 +/- 4.4 versus 9.5 +/- 5.4 ms/mmHg, beta = 0.08, P = 0.012), independent of age, pubertal stage, BMI, and physical activity. Lower limits (P2.5) for normal BRS values in supine and standing positions were for girls 3.6 and 2.2 ms/mmHg and for boys 3.9 and 2.5 ms/mmHg, respectively. BRS declined with age in the standing position (beta = -0.13, P < 0.001). In obese (pre)adolescents, BMI was negatively associated with BRS during standing (Kendall's tau = -0.26, P = 0.010). CONCLUSION The BRS of (pre)adolescents was negatively related to female sex, age, and obesity. A reduced BRS in obese (pre)adolescents might be a candidate predictor of future cardiovascular health, and therefore warrants further exploration.
Collapse
Affiliation(s)
- Andrea Dietrich
- Graduate School of Behavioral and Cognitive Neurosciences, Department of Psychiatry, University of Maastricht, Maastricht, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
10
|
Newnham DM. Asthma medications and their potential adverse effects in the elderly: recommendations for prescribing. Drug Saf 2002; 24:1065-80. [PMID: 11735662 DOI: 10.2165/00002018-200124140-00005] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The incidence of drug-induced adverse effects is likely to increase as a result of advanced age and exposure of elderly patients to polypharmacy. Therefore, pharmacological therapy of asthma and chronic obstructive pulmonary disease (COPD) in the elderly patient can be potentially hazardous. beta(2)-agonists, administered as therapy for asthma and COPD, have recognised systemic sequelae, such as hypokalaemia and chronotropic effects, which may be life-threatening in susceptible patients. Adverse effects such as hypokalaemia can be aggravated by concomitant treatment with other drugs promoting potassium loss including diuretics, corticosteroids and theophyllines. In addition, relatively minor adverse events associated with the administration of beta(2)-agonists, such as tremor and blood pressure changes, may be of significance to the elderly patient leading to impairment in the quality of life. However, long-term treatment with beta(2)-agonists may reduce the incidence of drug-induced adverse effects as a result of beta-receptor subsensitivity. Oral and inhaled corticosteroids have been used for the treatment of acute asthma and COPD in the elderly patient. Long-term treatment with oral corticosteroids can result in serious systemic adverse effects such as suppressed adrenal function, bone loss, skin thinning and cataract formation. In contrast to beta(2)-agonists, oral corticosteroids can upregulate beta(2)-adrenoceptors and thereby potentiate the systemic sequelae of beta(2)-agonists. Hence, oral corticosteroids should be administered with caution for as short a duration as possible. Inhaled corticosteroids appear to be relatively well tolerated when administered at doses below approximately 1000 microg. However, larger doses of inhaled corticosteroids may affect hypothalamic-pituitary-adrenal function and bone turnover. In the case of inhaled corticosteroids, spacer devices, often used in older patients who cannot operate metered dose inhalers, can potentiate the systemic sequelae of both corticosteroids and beta(2)-agonists. The use of theophyllines in the treatment of COPD or chronic asthma is controversial. Theophyllines have a wide adverse effect profile and are prone to drug-drug interactions. The adverse effects may be mild or life threatening and include nausea and vomiting or sinus and supraventricular tachycardias. Therefore, theophyllines should be prescribed with extreme caution to elderly patients with asthma or COPD. In contrast, inhaled anticholinergic drugs such as ipratropium bromide and oxitropium bromide are generally safe in elderly patients and have useful bronchodilator function. Commonly reported adverse effects are an unpleasant taste and dryness of the mouth. When used as first-line therapy, anticholinergic drugs may optimise the bronchodilator effects of low-dose inhaled beta(2)-agonists in patients with chronic airflow obstruction, and hence obviate the need for higher doses.
Collapse
Affiliation(s)
- D M Newnham
- Department of Medicine for the Elderly, Woodend Hospital, Aberdeen, Scotland.
| |
Collapse
|
11
|
Piccirillo G, Di Giuseppe V, Nocco M, Lionetti M, Moisè A, Naso C, Tallarico D, Marigliano V, Cacciafesta M. Influence of aging and other cardiovascular risk factors on baroreflex sensitivity. J Am Geriatr Soc 2001; 49:1059-65. [PMID: 11555067 DOI: 10.1046/j.1532-5415.2001.49209.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To examine the influence of known cardiovascular risk factors (cholesterol, blood glucose levels, arterial pressures, heart rate, and aging) on baroreflex sensitivity. DESIGN An observational epidemiological study. SETTING Geriatric Division at the Policlinico Umberto Primo, University of Rome La Sapienza. PARTICIPANTS Two hundred three subjects whose ages ranged from 9 to 94 years, apparently healthy and free of detectable clinical evidence of atherosclerosis. MEASUREMENTS All subjects underwent determination of baroreflex sensitivity by phenylephrine infusion (BSphe), and by a noninvasive method derived from spectral analysis of R-R interval and arterial pressure variabilities (alpha index). RESULTS The population, subdivided into tertiles for each variable studied, had lower BSphe values and lower alpha indexes as a function of age, plasma low-density lipoprotein (LDL) cholesterol, and systolic blood pressure. The alpha index was significantly lower in both groups with elevated LDL cholesterol levels than in those with lower levels (II and III vs I tertile, P <.001), whereas BSphe differed significantly only in the two groups who had extreme levels of LDL (I vs III tertile, P <.001). Multiple regression analysis identified a negative association of the alpha index with age (P <.001), heart rate (P <.01), area under the glucose-response curve (P <.001), and LDL cholesterol (P <.01), but of BSphe only with age (P <.001) and heart rate (P <.01). CONCLUSION These findings indicate that some risk factors for coronary heart disease adversely influence baroreflex sensitivity.
Collapse
Affiliation(s)
- G Piccirillo
- Istituto di Prima Clinica Medica, Università La Sapienza, Rome, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Kardos A, Watterich G, de Menezes R, Csanády M, Casadei B, Rudas L. Determinants of spontaneous baroreflex sensitivity in a healthy working population. Hypertension 2001; 37:911-6. [PMID: 11244017 DOI: 10.1161/01.hyp.37.3.911] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Baroreflex sensitivity (BRS) by the spontaneous sequence technique has been widely used as a cardiac autonomic index for a variety of pathological conditions. However, little information is available on determinants of the variability of spontaneous BRS and on age-related reference values of this measurement in a healthy population. We evaluated BRS as the slope of spontaneous changes in systolic blood pressure (BP) and pulse interval from 10 minutes BP (Finapres) and ECG recordings in 1134 healthy volunteers 18 to 60 years of age. Measurement of BRS could be obtained in 90% of subjects. Those with unmeasurable spontaneous BRS had a slightly lower heart rate but were otherwise not different from the rest of the population. BRS was inversely related to age (lnBRS, 3.24-0.03xage; r(2)=0.23; P:<0.0001) in both genders. In addition, univariate analysis revealed a significant inverse correlation between BRS and heart rate, body mass index, and BP. Sedentary lifestyle and regular alcohol consumption were also associated with lower BRS. However, only age, heart rate, systolic and diastolic BP, body mass index, smoking, and gender were independent predictors of BRS in a multivariate model, accounting for 47% of the variance of BRS. The present study provides reference values for spontaneous BRS in a healthy white population. Only approximately half of the variability of BRS could be explained by anthropometric variables and common risk factors, which suggests that a significant proportion of interindividual differences may reflect genetic heterogeneity.
Collapse
Affiliation(s)
- A Kardos
- University Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital Oxford, United Kingdom.
| | | | | | | | | | | |
Collapse
|
13
|
Harrington F, Murray A, Ford GA. Relationship of baroreflex sensitivity and blood pressure in an older population. J Hypertens 2000; 18:1629-33. [PMID: 11081776 DOI: 10.1097/00004872-200018110-00014] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Ageing and hypertension are associated with reduced baroreflex sensitivity (BRS) in young and middle-aged populations. The effects of blood pressure level on BRS in the older population are unclear. We examined the association between blood pressure and BRS in older persons with blood pressure below 180 mmHg. METHODS BRS, high (alphaHF 0.15-0.4 Hz) and low (alphaLF 0.04-0.15 Hz) frequency alpha-index, was determined in 75 normotensive subjects (aged 75 +/- 4 years, 41% female, 131 +/- 10/74 +/- 7 mmHg) and 64 untreated hypertensive subjects (aged 76 +/- 5 years, 48% female, 165 +/- 7/ 88 +/- 7 mmHg) by spectral analysis of 20 min continuous blood pressure and heart rate recordings using finger plethysmography. Subjects were recruited from 10 general practices and were taking no cardiovascular medications. RESULTS High but not low frequency alpha-index was significantly blunted in hypertensive subjects (alphaHF 5.1 +/- 3.1 versus 8.4 +/- 7.4 ms/mmHg, P< 0.001 and alphaLF 4.7 +/- 3.0 versus 5.8 +/- 3.9 ms/mmHg, P= 0.07). Multivariate analysis of the relationship between age and blood pressure demonstrated systolic and to a lesser extent diastolic blood pressure were significant predictors of variance in BRS for alphaHF [systolic blood pressure (SBP) P< 0.0001, diastolic blood pressure (DBP) P< 0.05, r2 = 0.1] and alphaLF (SBP P=0.01, DBP P<0.05, r2 = 0.04). Age was not a significant predictor for either measure, in the 20 year range studied. CONCLUSIONS In an older population blood pressure is associated with reduced BRS, particularly for the high frequency component. Such a change may place older subjects with hypertension at increased risk of orthostatic hypotension, vasovagal syncope and sudden cardiac death.
Collapse
Affiliation(s)
- F Harrington
- Department of Medicine (Geriatrics), University of Newcastle upon Tyne, UK
| | | | | |
Collapse
|