Autonomic and Vascular Control in Prehypertensive Subjects with a Family History of Arterial Hypertension

Abstract

BackgroundIndividuals with a family history of systemic arterial hypertension (FHSAH) and / or prehypertension have a higher risk of developing this pathology.ObjectiveTo evaluate the autonomic and vascular functions of prehypertensive patients with FHSAH.MethodsTwenty-five young volunteers with FHSAH, 14 normotensive and 11 prehypertensive subjects were submitted to vascular function evaluation by forearm vascular conductance(VC) during resting and reactive hyperemia (Hokanson®) and cardiac and peripheral autonomic modulation, quantified, respectively, by spectral analysis of heart rate (ECG) and systolic blood pressure (SBP) (FinometerPRO®). The transfer function analysis was used to measure the gain and response time of baroreflex. The statistical significance adopted was p ≤ 0.05.ResultsPre-hypertensive individuals, in relation to normotensive individuals, have higher VC both at rest (3.48 ± 1.26 vs. 2.67 ± 0.72 units, p = 0.05) and peak reactive hyperemia (25, 02 ± 8.18 vs. 18.66 ± 6.07 units, p = 0.04). The indices of cardiac autonomic modulation were similar between the groups. However, in the peripheral autonomic modulation, greater variability was observed in prehypertensive patients compared to normotensive individuals (9.4 [4.9-12.7] vs. 18.3 [14.8-26.7] mmHg2; p < 0.01) and higher spectral components of very low (6.9 [2.0-11.1] vs. 13.5 [10.7-22.4] mmHg2, p = 0.01) and low frequencies (1.7 [1.0-3.0] vs. 3.0 [2.0-4.0] mmHg2, p = 0.04) of SBP. Additionally, we observed a lower gain of baroreflex control in prehypertensive patients compared to normotensive patients (12.16 ± 4.18 vs. 18.23 ± 7.11 ms/mmHg, p = 0.03), but similar delay time (-1.55 ± 0.66 vs. -1.58 ± 0.72 s, p = 0.90).ConclusionPrehypertensive patients with FHSAH have autonomic dysfunction and increased vascular conductance when compared to normotensive patients with the same risk factor.

The effect of family history of hypertension and polymorphism of the ACE gene (rs1799752) on cardiac autonomic modulation in adolescents

“…Considering the total of these factors and assessing the variables in the frequency domains, group OHP (DD) presents a higher cardiac sympathovagal balance, conferring a significant risk for the development of hypertension and associated cardiovascular diseases, which corroborates the results from a study performed by Thayer et al and Amaral et al, showing that a decrease in heart rate variability precedes a series of risks factors for arterial hypertension 26,36 . Thus, impairments in the autonomic system dynamics are a significant predictor of the genesis of arterial hypertension 26,36 …”

“…The identification of autonomic dysfunction in offspring of hypertensive parents is crucial, as their cardiac autonomic modulation is altered even before the development of SAH 1,26 . However, few studies have demonstrated the association between ACE gene polymorphism (rs1799752) and family history of hypertension on autonomic dysfunction in adolescents.…”

There is urgent need to treat atherosclerotic cardiovascular disease risk earlier, more intensively, and with greater precision: A review of current practice and recommendations for improved effectiveness

“… Age ⁎⁎ Risk increases with age (age is the most determinative factor in risk calculators). Even over age 75 years, treatment is effective, safe and appropriate [284] , [285] , [286] , [287] , [288] , [289] Family history* Early ASCVD, diabetes , hypertension [290] all increase risk for descendants [291] , [292] , [293] , [294] , [295] , [296] Obesity, visceral fat Major cause of metabolic syndrome and atherosclerosis, even when at first ‘metabolically healthy’ [ 252 , [297] , [298] , [299] , [300] , [301] ]. Chronic kidney disease* CKD and atherosclerosis each increases risk and pathology of the other [302] , [303] , [304] , [305] Non-alcoholic fatty liver disease Closely related to atherosclerosis and contributory to it [169] .…”