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The value of baroreflex sensitivity for cardiovascular risk stratification in hypertensives


Authors: D. Čelovská 1;  J. Staško 2;  J. Gonsorčík 3;  A. Dukát 1
Authors‘ workplace: II. interná klinika Lekárskej fakulty UK a FNsP Bratislava, Slovenská republika, prednosta prof. MU Dr. Andrej Dukát CSc., FESC2Klinika kardiológie FNsP J. A. Reimana Prešov, Slovenská republika, prednosta doc. MU Dr. Alexander Kiško, CSc. 3Klinika kardio 1
Published in: Vnitř Lék 2010; 56(6): 607-612
Category: 65th Birthday - Petr Svacina, MD

Overview

Impaired baroreflex sensitivity (BRS) is a marker of autonomous dysfunction, which may play an important role in the long‑term development of arterial hypertension, disease progression as well as complications related to global cardiovascular risk. The aim of the study was to evaluate the clinical significance of baroreflex sensitivity in hypertensives with/ without major cardiovascular events. We found out that essential hypertension is associated with decreased BRS, and that grade of hypertension is inversely related to BRS values. Spontaneous BRS values in hypertensives with major cardiovascular event (stroke, myocardial infarction) were significantly lower even 6 months and more after myocardial infarction and stroke onset compared to remaining patients (p < 0.05). BRS is a clinically applicable, noninvasive method for assessing early dysfunction of autonomic nervous system, which seems to be an additive emerging marker of cardiovascular risk stratification in hypertensive patients.

Key words:
baroreflex sensitivity –  autonomic nervous system –  arterial hypertension –  stroke –  myocardial infarction


Sources

1. Schachter M. The sympathetic nervous system and hypertension. London: Martin Dunitz Ltd 1997.

2. Izzo JL, Black HR. Hypertension Primer Second Edition. The Essentials of High Blood Pressure. Dallas: American Heart Association 1999.

3. Robertson RM, Robertson D. Cardiovascular manifestations of autonomic disorders. In: Zipes DP, Libby P, Bonow RO et al (eds). Braunwald’s heart disease: A text book of cardiovascular medicine. 7th ed. Philadelphia: Elsevier Saunders 2005: 2173– 2182.

4. Korner PI. Baroreceptor resetting and other determinants of baroreflex properties in hypertension. Clin Exp Pharmacol Physiol Suppl 1989; 15: 45– 64.

5. Krieger EM. Mechanisms of complete baroreceptor resetting in hypertension. Drugs 1988; 35 (Suppl 6): 98– 103.

6. Persson PB. Baroreflexes in hypertension: a mystery revisited. Hypertension 2005; 46: 1095– 1096.

7. Lanfranchi PA, Somers VK. Arterial baroreflex function and cardiovascular variability: interactions and implications. Am J Physiol Regul Integr Comp Physiol 2002; 283: R815– R826.

8. Ormezzano O, Poirier O, Mallion JM et al. A polymorphism in the endothelin‑A receptor gene is linked to baroreflex sensitivity. J Hypertens 2005; 23: 2019– 2026.

9. Jíra M, Závodná E, Honzíková N et al. Association of eNOS gene polymorphisms T‑ 786C and G894T with blood pressure variability. Physiol Res 2006; 55: 26P.

10. Ylitalo A, Airaksinen J, Hautanen A et al. Baroreflex sensitivity and variants of the renin angiotenzin system genes. J Am Coll Cardiol 2000; 35: 194– 200.

11. Krontorádová K, Honzíková N, Fišer B et al. Overweight and decreased baroreflex sensitivity as independent risk factors for hypertension in children, adolescents and young adults. Physiol Res 2008; 57: 385– 391.

12. Parati G, Di Rienzo MD, Mancia G. How to measure baroreflex sensitivity: from cardiovascular laboratory to daily life. J Hypertens 2000; 18: 7– 19.

13. La Rovere MT, Gnemmi M, Vaccarini C. Baroreflex sensitivity. Ital Heart J Suppl 2001; 2: 472– 477.

14. Jira M, Zavodna E, Honzikova N et al. Baroreflex sensitivity as an individual characteristic feature. Physiol Res 2006; 55: 349– 351.

15. Ormezzano O, Cracowski JL, Baguet JP et al. Oxidative stress and baroreflex sensitivity in healthy subjects and patients with mild‑ to‑ moderate hypertension. J Hum Hypertens 2004; 18: 517– 521.

16. Borchard U. The role of the sympathetic nervous system in cardiovascular disease. J Clin Basic Cardiol 2001; 4: 175– 177.

17. Liu AJ, Ma XJ, Shen FM et al. Arterial baroreflex: a novel target for preventing stroke in rat hypertension. Stroke 2007; 38: 1916– 1923.

18. La Rovere MT, Bigger JT Jr, Marcus FI et al. Baroreflex sensitivity and heart variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI Investigators. Lancet 1998; 351: 478– 484.

19. Robinson TG, Dawson SL, Eames PJ et al. Cardiac baroreceptor sensitivity predicts long‑term outcome after acute ischemic stroke. Stroke 2003; 34: 705– 712.

20. Mussalo H, Vanninen E, Ikäheimo R et al. Baroreflex sensitivity in essential and secondary hypertension. Clin Auton Res 2002; 12: 465– 471.

21. Del Colle S, Milan A, Caserta M et al. Baroreflex sensitivity is impaired in essential hypertensives with central obesity. J Hum Hypertens 2007; 21: 473– 478.

22. Svačina Š. Systém renin‑aldosteron v tuku a v dalších orgánech a tkáních. Vnitř Lék 2008; 54: 508– 510.

23. Monahan KD. Effect of aging on baroreflex function in humans. Am J Physiol Regul Integr Comp Physiol 2007; 293: R3– R12.

24. Lantelme P, Khettab F, Custaud MA et al. Spontaneous baroreflex sensitivity: toward an ideal index of cardiovascular risk in hypertension? J Hypertens 2002; 20: 935– 944.

25. Sykora M, Diedler J, Rupp A et al. Impaired baroreflex sensitivity predicts outcome of acute intracerebral hemorrhage. Crit Care Med 2008; 36: 3074– 3079.

26. Ziegler D, Laude D, Akila F et al. Time and frequency‑ domain estimation of early diabetic cardiovascular autonomic neuropathy. Clin Auton Res 2001; 11: 369– 376.

27. Honzíková N, Lábrová R, Fišer B et al. Influence of age, body mass index and blood pressure on the carotid‑ media thickness in normotensive and hypertensive patients. Biomed Tech 2006; 51: 159– 162.

28. Ormezzano O, Cracowski JL, Quesada JL et al. Evaluation of the prognostic values of baroreflex sensitivity in hypertensive patients: the EVABAR study. J Hypertens 2008; 26: 1373– 1378.

29. Lábrová R, Honzíková N, Maděrová E et al. Age‑ dependent relationship between the carotid intima‑ media thickness, baroreflex sensitivity and the inter‑ beat interval in normotensive and hypertensive subjects. Physiol Res 2005; 54: 593– 600.

30. Souček M, Kára T. Hypertenze a sympatický nervový systém: možnosti ovlivnění. Farmakoterapie 2005; 1: 167– 171.

31. Widimský J Jr. Léčba hypertenze u metabolického syndromu. Vnitř Lék 2009; 55: 631– 635.

32. Mancia G, Dell’Oro R, Quarti‑ Trevano F et al. Angiotensin‑sympathetic system interactions in cardiovascular and metabolic disease. J Hypertens Suppl 2006; 24: S51– S56.

33. Lefrandt JD, Heitmann J, Sevre K et al. The effects of dihydropyridine and phenylalkylamine calcium antagonist classes on autonomic function in hypertension: the VAMPHYRE study. Am J Hypertens 2001; 14: 1083– 1089.

34. Julius S, Majahalme S. Meniaca sa tvár nadmernej aktivity sympatika pri hypertenzii. Ann Med 2000; 32: 365– 370.

35. Ray CA. Melatonin attenuates the sympathetic nerve response to orthostatic stress in humans. J Physiol 2003; 551: 1043– 1048.

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