EVAluation of the prognostic value of BARoreflex sensitivity in hypertensive patients: the EVABAR study

Ormezzano, Olivier; Cracowski, Jean‐Luc; Quésada, Jean-Louis; Pierre, Hélène; Mallion, Jean‐Michel; Baguet, Jean-Philippe

doi:10.1097/hjh.0b013e3283015e5a

Cited by 69 publications

(64 citation statements)

References 25 publications

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“…Indeed, experimental and clinical studies have extensively documented the health benefits of exercise training in hypertensive subjects. In untreated hypertensive subjects, Laterza et al (26) observed normalized baroreflex function and peripheral sympathetic nerve activity after exercise training, which are closely related to end-organ injuries (27) and cardiovascular mortality (35) in hypertension.…”

Section: Discussionmentioning

confidence: 99%

Aerobic training normalizes autonomic dysfunction, HMGB1 content, microglia activation and inflammation in hypothalamic paraventricular nucleus of SHR

Masson

Nair

Soares

et al. 2015

American Journal of Physiology-Heart and Circulatory Physiology

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Masson GS, Nair AR, Silva Soares PP, Michelini LC, Francis J. Aerobic training normalizes autonomic dysfunction, HMGB1 content, microglia activation and inflammation in hypothalamic paraventricular nucleus of SHR. Am J Physiol Heart Circ Physiol 309: H1115-H1122, 2015. First published August 7, 2015; doi:10.1152/ajpheart.00349.2015.-Exercise training (ExT) is recommended to treat hypertension along with pharmaceutical antihypertensive therapies. Effects of ExT in hypothalamic content of high mobility box 1 (HMGB1) and microglial activation remain unknown. We examined whether ExT would decrease autonomic and cardiovascular abnormalities in spontaneously hypertensive rats (SHR), and whether these effects were associated with decreased HMGB1 content, microglial activation, and inflammation in the hypothalamic paraventricular nucleus (PVN). Normotensive Wistar-Kyoto (WKY) rats and SHR underwent moderate-intensity ExT for 2 wk. After ExT, cardiovascular (heart rate and arterial pressure) and autonomic parameters (arterial pressure and heart rate variability, peripheral sympathetic activity, cardiac vagal activity, and baroreflex function) were measured in conscious and freely-moving rats through chronic arterial and venous catheterization. Cerebrospinal fluid, plasma, and brain were collected for molecular and immunohistochemistry analyses of the PVN. In addition to reduced heart rate variability, decreased vagal cardiac activity and increased mean arterial pressure, heart rate, arterial pressure variability, cardiac, and vasomotor sympathetic activity, SHR had higher HMGB1 protein expression, IB-␣ phosphorylation, TNF-␣ and IL-6 protein expression, and microglia activation in the PVN. These changes were accompanied by higher plasma and cerebrospinal fluid levels of HMGB1. The ExT ϩ SHR group had decreased expression of HMGB1, CXCR4, SDF-1, and phosphorylation of p42/44 and IB-␣. ExT reduced microglial activation and proinflammatory cytokines content in the PVN, and improved autonomic control as well. Data suggest that training-induced downregulation of activated HMGB1/CXCR4/microglia/proinflammatory cytokines axis in the PVN of SHR is a prompt neural adaptation to counterbalance the deleterious effects of inflammation on autonomic control. exercise training; baroreflex; brain inflammation; CXCR4; hypertension NEW & NOTEWORTHY Spontaneously hypertensive rats have increased HMGB1 content and CXCR4 signaling in the hypothalamic paraventricular nucleus, which contributes to microglial activation, proinflammatory cytokines production, and, finally, to autonomic dysfunction. Aerobic training decreases HMGB1 content, microglia activation and proinflammatory cytokines expression by inhibiting HMGB1-CXCR4 signaling pathway in the hypothalamic paraventricular nucleus. Aerobic training induces neuroinflammatory adaptations and autonomic benefits independent of the arterial pressure fall.AUTONOMIC DYSFUNCTION is defined as a misbalance between sympathetic and vagal activity associated with baroreflex dysfunction and increased a...

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Section: Discussionmentioning

confidence: 99%

Aerobic training normalizes autonomic dysfunction, HMGB1 content, microglia activation and inflammation in hypothalamic paraventricular nucleus of SHR

Masson

Nair

Soares

et al. 2015

American Journal of Physiology-Heart and Circulatory Physiology

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“…Previous studies have shown that depressed BRS (\3 ms/mm Hg) identifies, independently of age, a subgroup at long-term high risk of cardiovascular mortality in post-myocardial infarction patients [24]. Ormezzano et al [25] have recently shown that baroreflex sensitivity under 4.5 ms/mmHg was associated with an increased relative risk of 2.5 of major adverse cardiovascular events in hypertensive patients.…”

Section: Heart Rate Variabilitymentioning

confidence: 98%

Cardiovascular autonomic neuropathy and other complications in type 1 diabetes

et al. 2010

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Simple bedside tests can detect CAN. HRV and SBS provide additional elements on CAN severity. Diabetes duration did not discriminate sufficiently patients with CAN. The association with retinopathy is in favor of the role of poor glycemic control in CAN development. This study shows the interest of CAN detection and the need to look for extracardiac autonomic neuropathy and silent myocardial ischemia in patients with confirmed CAN.

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“…Importantly, low baroreflex sensitivity is an independent predictor of mortality and major adverse cardiovascular-related events in hypertensive patients. 43 Improvements in baroreflex function after RDN may, therefore, directly improve mortality risk in these patients. This might be related to improvements in BP lability/variability, 44 a known risk for target organ damage, including stroke incidence.…”

Section: Cardiac and Sympathetic Baroreflex Sensitivitymentioning

confidence: 99%

Translational Examination of Changes in Baroreflex Function After Renal Denervation in Hypertensive Rats and Humans

et al. 2013

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Abstract-Renal denervation has shown promise in the treatment of resistant hypertension, although the mechanisms underlying the blood pressure (BP) reduction remain unclear. In a translational study of spontaneously hypertensive rats (n=7, surgical denervation) and resistant hypertensive human patients (n=8; 5 men, 33-71 years), we examined the relationship among changes in BP, sympathetic nerve activity, and cardiac and sympathetic baroreflex function after renal denervation. In humans, mean systolic BP (SBP; sphygmomanometry) and muscle sympathetic nerve activity (microneurography) were unchanged at 1 and 6 months after renal denervation (P<0.05). Interestingly, 4 of 8 patients showed a 10% decrease in SBP at 6 months, but sympathetic activity did not necessarily change in parallel with SBP. In contrast, all rats showed significant and immediate decreases in telemetric SBP and lumbar sympathetic activity (P<0.05), 7 days after denervation. Despite no change in SBP, human cardiac and sympathetic baroreflex function (sequence and threshold techniques) showed improvements at 1 and 6 months after denervation, particularly through increased sympathetic baroreflex sensitivity to falling BP. This was mirrored in spontaneously hypertensive rats; cardiac and sympathetic baroreflex sensitivity (spontaneous sequence and the Oxford technique) improved 7 days after denervation. The more consistent results in rats may be because of a more complete (>90% reduction in renal norepinephrine content) denervation. We conclude that (1) renal denervation improves BP in some patients, but sympathetic activity does not always change in parallel, and (2) baroreflex sensitivity is consistently improved in animals and humans, even when SBP has not decreased. Determining procedural success will be crucial in advancing this treatment modality.

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EVAluation of the prognostic value of BARoreflex sensitivity in hypertensive patients: the EVABAR study

Abstract: Reduction in baroreflex sensitivity marked by a reduction in vagal reflexes is an independent marker of the risk of mortality and major adverse cardiovascular events in hypertensive patients.

Cited by 69 publications

References 25 publications

Aerobic training normalizes autonomic dysfunction, HMGB1 content, microglia activation and inflammation in hypothalamic paraventricular nucleus of SHR

Aerobic training normalizes autonomic dysfunction, HMGB1 content, microglia activation and inflammation in hypothalamic paraventricular nucleus of SHR

Cardiovascular autonomic neuropathy and other complications in type 1 diabetes

Translational Examination of Changes in Baroreflex Function After Renal Denervation in Hypertensive Rats and Humans

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