Afferent baroreflex dysfunction and age-related orthostatic hypotension

1991 ◽  
Vol 81 (s25) ◽  
pp. 531-538 ◽  
Author(s):  
A. L. Tonkin ◽  
L. M. H. Wing ◽  
M. J. Morris ◽  
V. Kapoor
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cold Stress ◽  
Orthostatic Hypotension ◽  
Autonomic Neuropathy ◽  
Isometric Exercise ◽  
Control Subjects ◽  
Age Related ◽  
Head Up Tilt ◽  
Elderly Control

1. To test the hypothesis that in apparently healthy elderly subjects with orthostatic hypotension there is afferent baroreflex dysfunction, cardiovascular and neurohumoral responses were measured after separate stimuli which activated baroreceptor (head-up tilt) and non-baroreceptor (cold stress, isometric exercise) afferent pathways. 2. In 15 healthy elderly control subjects blood pressure did not change with 60° head-up tilting and there was a moderate increase in heart rate, whereas in 13 subjects with age-related orthostatic hypotension head-up tilting was associated with a marked fall in blood pressure but a similar heart rate response to that in the elderly control group. In contrast, both groups of subjects had similar blood pressure and heart rate responses to cold stress and sustained isometric exercise. 3. Nine subjects with autonomic neuropathy also showed a marked hypotensive response to head-up tilt, but produced no pressor response to cold stress or isometric exercise. 4. The plasma concentrations of noradrenaline, adrenaline and neuropeptide-Y-like immunoreactivity rose and that of atrial natriuretic peptide fell after head-up tilt in the study population as a whole. There were no significant differences between groups despite the much greater blood pressure drops in the subjects with autonomic neuropathy and in those with age-associated orthostatic hypotension. 5. The aorto-iliac pulse wave velocity index was significantly higher in subjects with age-associated orthostatic hypotension compared with that in control subjects. 6. The pattern of responses to the separate stresses observed in the group with age-associated orthostatic hypotension is characteristic and different from that in the elderly control subjects and the subjects with autonomic neuropathy. It suggests that age-associated orthostatic hypotension is related predominantly to dysfunction in the afferent limb of the baroreflex arc, possibly partially caused by a splinting of arterial baroreceptors by non-compliant arterial walls.

Cardiovascular and Autonomic Reflexes in Haemodialysis Patients

1981 ◽  
Vol 60 (2) ◽  
pp. 165-170 ◽  
Author(s):  
R. B. Naik ◽  
C. J. Mathias ◽  
C. A. Wilson ◽  
J. L. Reid ◽  
D. J. Warren
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Plasma Noradrenaline ◽  
Valsalva Manoeuvre ◽  
Induced Hypotension ◽  
Autonomic Nervous ◽  
Control Subjects ◽  
Head Up Tilt ◽  
And Control ◽  
Noradrenaline Levels

1. Blood pressure and heart rate responses to head-up tilt, standing, the Valsalva manoeuvre, sustained handgrip and cutaneous cold were measured in 27 haemodialysis patients (10 of whom had episodes of haemodialysis-induced hypotension) and 15 control subjects to assess autonomic nervous function. Plasma nor-adrenaline levels were measured at rest and during head-up tilt. 2. Mean resting supine blood pressure, heart rate and plasma noradrenaline levels were higher in haemodialysis patients than in the control subjects. There was no fall in blood pressure during head-up tilt or standing. The ratio of the R-R intervals of the thirtieth and the fifteenth heart beat after standing (30: 15) was lower in the patients; this may be related to their higher resting heart rate. Head-up tilt raised plasma noradrenaline levels in both groups. Heart rate responses to the Valsalva manoeuvre were similar in the patients and control subjects. 3. Systolic blood pressure and heart rate responses to sustained handgrip were similar in both groups. Diastolic and mean blood pressure changes, however, were lower in the patients. The blood pressure and heart rate responses to cutaneous cold were similar in the patients and control subjects. 4. We conclude that generalized autonomic nervous dysfunction does not appear to cause haemodialysis-induced hypotension in patients with chronic renal failure on maintenance haemodialysis.

Vasopressin Secretion in Diabetic Subjects with and without Autonomic Neuropathy: Responses to Osmotic and Postural Stimulation

1989 ◽  
Vol 77 (6) ◽  
pp. 589-597 ◽  
Author(s):  
W. Reid ◽  
D. J. Ewing ◽  
S. L. Lightman ◽  
D. Eadington ◽  
T. D. M. Williams ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Body Weight ◽  
Autonomic Neuropathy ◽  
Plasma Osmolality ◽  
Normal Subjects ◽  
Cardiovascular Reflex ◽  
Head Up Tilt ◽  
Vasopressin Secretion ◽  
Osmotic Stimulus

1. The release of arginine vasopressin (AVP) after an osmotic stimulus and head-up tilt was assessed in diabetic subjects with and without autonomic neuropathy 2. Six diabetic subjects with (DAN +ve) and five without (DAN − ve) evidence of autonomic neuropathy and five normal subjects were infused with 5% (w/v) NaCl at a rate of 0.05 ml min−1 kg−1 body weight for 120 min. Blood pressure, heart rate and plasma AVP were measured over this period 3. Seven DAN +ve, six DAN −ve and six normal subjects were tilted head-up to 45° for 120 min. Blood pressure, heart rate and plasma AVP were measured during the study 4. Infusion of 5% (w/v) NaCl produced appropriate rises in plasma osmolality and plasma AVP levels which did not differ between the three groups, confirming the normal osmotic release of AVP in the diabetic subjects 5. During head-up tilt, there were no differences in AVP responses between the three groups, despite a major hypotensive stimulus in the DAN + ve group 6. We conclude that osmotic release of AVP is normal in diabetes, but that cardiovascular release of AVP is impaired in diabetic subjects with cardiovascular reflex evidence of autonomic neuropathy, reflecting an afferent defect.

scholarly journals Haemodynamic Characteristics And Factors Influencing The Head-Up Tilt Test In Patients With Orthostatic Hypotension

2021 ◽  
Author(s):  
Wang Jiayu ◽  
Wu Yueyang ◽  
Wang Yongjun ◽  
Zhao Xingquan ◽  
Wang Yilong ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Stroke Volume ◽  
Systolic Blood Pressure ◽  
Orthostatic Hypotension ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Tilt Test ◽  
Head Up Tilt ◽  
Head Up Tilt Test

Abstract Background: Failure to activate autonomic neural and hormonal reflex mechanisms could result in orthostatic hypotension. Patients with orthostatic hypotension often experience symptoms of cerebral hypoperfusion, including syncope. The purpose of this study was to investigate the haemodynamic characteristics of patients with orthostatic hypotension and the factors affecting blood pressure regulation.Methods: This retrospective study enrolled 45 patients who were diagnosed with typical orthostatic hypotension by the head-up tilt test at Beijing Tiantan Hospital, Capital Medical University from June 2019 to December 2020. Changes in haemodynamic parameters in these patients were compared in the supine and tilted upright positions.Results: For all patients, haemodynamic parameters in the supine and tilted upright positions were compared, and systolic blood pressure, diastolic blood pressure, mean blood pressure, cardiac output and stroke volume were all significantly decreased per minute. Heart rate significantly increased per minute, but systemic vascular resistance did not significantly change. The absolute value, percentage and rate of increases in heart rate and the absolute value, percentage and rate of decreases in stroke volume from the supine to the titled upright position were significantly lower in patients 60 years and older than in patients under 60 years old. Linear regression analyses found that the changes in heart rate, stroke volume and systemic vascular resistance were related to changes in systolic blood pressure, while the changes in stroke volume and systemic vascular resistance had more important effects on systolic blood pressure.Conclusions: In patients with orthostatic hypotension, we observed no significant increase in systemic vascular resistance from the supine position to the tilted upright position. Nevertheless, an increase in systemic vascular resistance had a significant impact on the maintenance of systolic blood pressure. In addition, in orthostatic hypotension patients younger than 60 years of age, heart rate increased while stroke volume decreased significantly after tilting upright compared with orthostatic hypotension patients older than 60 years of age and older.

Compression Stocking Length Effects on Arterial Blood Pressure and Heart Rate Following Head-Up Tilt in Healthy Volunteers

2014 ◽  
Vol 63 (6) ◽  
pp. 435-438 ◽  
Author(s):  
Kunihiko Tanaka ◽  
Shiori Tokumiya ◽  
Yumiko Ishihara ◽  
Yumiko Kohira ◽  
Tetsuro Katafuchi
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Healthy Volunteers ◽  
Arterial Blood Pressure ◽  
Compression Stocking ◽  
Arterial Blood ◽  
Head Up Tilt ◽  
Length Effects

INFLUENCE OF THE AGE ON BAROREFLEX SYNCHRONIZATION OF ARTERIAL PRESSURE AND HEART RATE DURING THE PASSIVE STANDING TEST

2021 ◽  
Vol 55 (1) ◽  
pp. 46-50
Author(s):  
Е.А. Orlova ◽  
◽  
О.S. Tarasova ◽  
V.D. Son'kin ◽  
А.S. Borovik ◽  
...  
Keyword(s):  
Heart Rate ◽  
Phase Synchronization ◽  
Tilt Test ◽  
Breathing Rate ◽  
Age Related ◽  
Head Up Tilt ◽  
Wave Range ◽  
Standing Test ◽  
Head Up Tilt Test ◽  
Over 40 Years

Age-related changes in phase synchronization of spontaneous blood pressure (BP) and heart rate (HR) fluctuations within the baroreflex wave range (about 0.1 Hz) were studied in 66 subjects aged 20 to 52 years. Measurements performed during the head-up tilt test included continuous BP monitoring using the volume-compensation method, ECG recording for ensuing HR calculation, and breathing rate recording. The phase synchronization index (PSI) was used for evaluation of BP-HR coupling. In supine position, phase synchronization in the subjects over 40 years was higher as compared with their counterparts at the age of 20 to 24 years. Along with that, less pronounced PSI increase in people over 40 in response to the tilt test suggests a decline of the baroreflex activity with aging.

scholarly journals Pulsed Wave Doppler Ultrasound Is Useful to Assess Vasomotor Response in Patients with Multiple System Atrophy and Well Correlated with Tilt Table Study

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Ke-Vin Chang ◽  
Wen-Shiang Chen ◽  
Ruey-Meei Wu ◽  
Ssu-Yuan Chen ◽  
Hsiu-Yu Shen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Correlation Analysis ◽  
Multiple System Atrophy ◽  
Cardiovascular Response ◽  
Vasomotor Response ◽  
Tilt Table ◽  
Hemodynamic Variables ◽  
Pulsed Wave Doppler ◽  
Head Up Tilt

The study aim was to assess sympathetic vasomotor response (SVR) by using pulsed wave Doppler (PWD) ultrasound in patients with multiple system atrophy (MSA) and correlate with the tilt table study. We recruited 18 male patients and 10 healthy men as controls. The SVR of the radial artery was evaluated by PWD, using inspiratory cough as a provocative maneuver. The response to head-up tilt was studied by a tilt table with simultaneous heart rate and blood pressure recording. The hemodynamic variables were compared between groups, and were examined by correlation analysis. Regarding SVR, MSA patients exhibited a prolonged latency and less heart rate acceleration following inspiratory cough. Compared with the tilt table test, the elevation of heart rate upon SVR was positively correlated to the increase of heart rate after head-up tilt. The correlation analysis indicated that the magnitude of blood pressure drop from supine to upright was positively associated with the SVR latency but negatively correlated with the heart rate changes upon SVR. The present study demonstrated that blunted heart rate response might explain MSA's vulnerability to postural challenge. PWD may be used to predict cardiovascular response to orthostatic stress upon head-up tilt in MSA patients.

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