Determinants of Spontaneous Baroreflex Sensitivity in a Healthy Working Population

Abstract

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, 3.24Ϫ0.03ϫage; r 2 ϭ0.23; PϽ0.0001) 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. which measures BRS as the slope of the relationship between the increase in systolic blood pressure (SBP) that follows an intravenous bolus of phenylephrine and the reflex lengthening of the pulse interval (PI). By use of this technique, studies have shown BRS to decrease with age 2,3 and in the presence of hypertension, coronary artery disease, and heart failure. 4,5 In addition, a recent large prospective study has demonstrated that BRS is an important independent prognostic predictor of total cardiac mortality in patients after myocardial infarction. 6 In the past few years, noninvasive techniques have gained increasing popularity. In particular, measurement of BRS as the slope of the relationship between spontaneous changes in SBP and PI (the "spontaneous sequence method") 7,8 has proved to be an easy and practical method that minimizes risk and circumvents the problems related to potential extravascular effects of vasoactive agents. 9 However, this technique has been used to date only in small studies. Little information is available regarding determinants of variability of spontaneous BRS in healthy subjects and the feasibility of this measurement in large-scale population studies. In the present study, we evaluated BRS by the spontaneous sequence method in a large population of healthy working subjects between 18 and 60 years of age with the aim of assessing (1) feasibility of this method in a large "field" study; (2) age-adjusted normal ranges for spontan...

Factors Associated with Baroreflex Sensitivity: Association with Morning Blood Pressure

“…The reason why BRS was independently associated only with morning BP is unknown, but one possible explanation is that activation of the sympathetic nervous system, which is seen in hypertensive patients with morning hypertension, decreases BRS (24,25). It is also possible that heart rate is inversely correlated with BRS (26,27), which might have affected our results. In the present study, only the Valsalva-BRS was associated with morning SBP, but the spontaneous-BRS, which was associated with clinic and ambulatory PRs, was not associated with any BP measures.…”

New insights in diabetic autonomic neuropathy in children and adolescents

“…The mean regression coefficient of falling and rising sequence is the BRS; BRS !10 mmHg/ms is considered pathologic (70)(71)(72).…”

The pathophysiologic mechanisms associated with hypotensive susceptibility

“…It is generally accepted that the sympathetic component of the baroreflex remains intact with aging [10,25], while the cardiovagal response might decrease [16,17]. Therefore, our results of a decrease in BRG with age could be explained by either the presence of a blunted efferent cardiovagal response of the reflex arc or intrinsic sinus node disease [21]. Our findings of the relationship between age and type of tilt response are aligned with the work of Kurbaan et al who showed that age was associated with greater prevalence of a vasodepressor response in older patients (>65 years; OR 29.5, p <0.0001) [24].…”