Baroreflex sensitivity changes with calcium antagonist therapy in elderly subjects with isolated systolic hypertension

Metcalfe, James; Rakicka, H; Panerai, R.B.; Potter, JF

doi:10.1038/sj.jhh.1000780

Cited by 14 publications

(7 citation statements)

References 43 publications

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“…For ethical reasons we did not stop antihypertensive treatment. According to previous studies, the drugs used in this study (ACE inhibitors, calcium channel blockers and beta-blockers) rather improve cardiovascular reflexes [18,19,20,21,22,23]. This indicated that the CRF group would perform even worse (thus the difference between CRF and NTX would be even more pronounced) without antihypertensive treatment.…”

Section: Discussionmentioning

confidence: 51%

Signs of autonomic neuropathy in childhood uremia

Tory

Sartipy

Tóth-Heyn

et al. 2001

Pediatric Nephrology

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To evaluate the presence of autonomic neuropathy in childhood uremia, cardiovascular autonomic reflexes were examined in children with chronic renal failure. Cardiovascular autonomic reflexes of 10 uremic patients on chronic dialysis and 10 transplanted patients were compared to assess the effect of transplantation on autonomic neuropathy. Resting heart rate, heart rate changes induced by deep breathing, by Valsalva maneuver, and following standing up, and blood pressure change induced by handgrip test were examined. Of the 10 uremic children, 4 showed early involvement and 2 had definite involvement of autonomic neuropathy. Only 1 of the 10 transplanted patients showed early signs of autonomic neuropathy. Autonomic tests demonstrated predominantly parasympathetic dysfunction. In conclusion, cardiovascular autonomic neuropathy is not rare in children and adolescents and young adults with chronic renal failure. In contrast, the prevalence is very low in transplanted patients with similar uremic precedents. Efforts should be made to prevent or delay this uremia-related complication.

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Section: Discussionmentioning

confidence: 51%

Signs of autonomic neuropathy in childhood uremia

Tory

Sartipy

Tóth-Heyn

et al. 2001

Pediatric Nephrology

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“…In the treatment of isolated systolic hypertension, the Systolic Hypertension in the Elderly Program [33] reported no increased incidence of symptoms related to orthostatic intolerance or falls in the diuretic-based treatment group. Elderly subjects with isolated systolic hypertension treated with modified-release dihydropyridine calcium-channel blockade show improvements in orthostatic tolerance and other aspects of cardiovascular homeostasis [34]. We must not deny elderly hypertensive patients effective stroke prevention simply because of a perception that it will inevitably provoke or exacerbate postural symptoms or orthostatic hypotension in them.…”

Section: Discussionmentioning

confidence: 99%

Orthostatic blood pressure changes and arterial baroreflex sensitivity in elderly subjects

Metcalfe¹

1999

Age and Ageing

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we found a relationship between baroreflex sensitivity and the systolic blood pressure fall with orthostasis, even after adjustment for prevailing systolic blood pressure. Despite equivalent changes in forearm vascular resistance with tilt, greater falls in systolic blood pressure were seen in hypertensive subjects than in normotensive controls, due in part to an inadequate baroreflex-mediated heart rate response. The postural fall in blood pressure often observed in elderly hypertensive subjects may be related to the reduced baroreflex sensitivity seen in this condition.

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“…It has been shown that the MSNA was reduced and the baroreflex sensitivity was enhanced by chronic treatment with an ACE inhibitor in patients with heart failure. 45,46) It has also been shown that baroreflex sensitivity was increased significantly by chronic treatment with a Ca antagonist in patients with hypertension 47) and some Ca antagonists inhibited sympathetic nerve activity. 48,49) Therefore, in patients with stable effort angina and with impaired BRS, the same mechanisms might be observed with an ACE inhibitor or a Ca antagonist.…”

Section: Discussionmentioning

confidence: 99%

Cigarette Smoking Augments Sympathetic Nerve Activity in Patients With Coronary Heart Disease

2008

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SUMMARYIt has been shown that cigarette smoking increases blood pressure (BP) and heart rate (HR), and decreases muscle sympathetic nerve activity (MSNA) in healthy young smokers. The decrease in MSNA might be secondary to baroreflex responses to the pressor effect. We tested the hypothesis that cigarette smoking increases MSNA in smokers with impaired baroreflex function.The effects of cigarette smoking on BP, HR, forearm blood flow (FBF), forearm vascular resistance (FVR), and MSNA were examined in 14 patients with stable effort angina (59 ± 3 years, group CAD) and 10 healthy smokers (23 ± 1 years, group C). In group CAD, the arterial baroreflex sensitivity (BRS) was significantly lower than in group C (4.7 ± 0.8 versus 15.1 ± 2.2 msec/mmHg, P < 0.01). In both groups, cigarette smoking increased the plasma concentration of nicotine, systolic and diastolic BP, HR, and FVR significantly (P < 0.01), but decreased FBF significantly (P < 0.01). After smoking, MSNA was decreased significantly in group C (from 35.2 ± 3.5 to 23.5 ± 3.2 bursts/100 beats, P < 0.01), but increased significantly in group CAD (from 48.8 ± 5.4 to 57.3 ± 5.5 bursts/100 beats, P < 0.01). There was significant correlation between BRS and changes in MSNA (r = -0.62, P < 0.01).Cigarette smoking increased MSNA in smokers with impaired baroreflex function. This demonstrates that cigarette smoking stimulates sympathetic nerve activity by both a direct peripheral effect and a centrally mediated effect. (Int Heart J 2008; 49: 261-272)

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Baroreflex sensitivity changes with calcium antagonist therapy in elderly subjects with isolated systolic hypertension

Cited by 14 publications

References 43 publications

Signs of autonomic neuropathy in childhood uremia

Signs of autonomic neuropathy in childhood uremia

Orthostatic blood pressure changes and arterial baroreflex sensitivity in elderly subjects

Cigarette Smoking Augments Sympathetic Nerve Activity in Patients With Coronary Heart Disease

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