Is Low Baroreflex Sensitivity only a Consequence of Essential Hypertension or also a Factor Conditioning Its Development?

Decreased baroreflex sensitivity is an early sign of autonomic dysfunction in patients with type-1 diabetes mellitus. We evaluated the repeatability of a mild baroreflex sensitivity decrease in diabetics with respect to their heart rate. Finger blood pressure was continuously recorded in 14 young diabetics without clinical signs of autonomic dysfunction and in 14 age-matched controls for 42 min. The recordings were divided into 3-min segments, and the mean inter-beat interval (IBI), baroreflex sensitivity in ms/mm Hg (BRS) and mHz/mm Hg (BRSf) were determined in each segment. These values fluctuated in each subject within 42 min and therefore coefficients of repeatability were calculated for all subjects. Diabetics compared with controls had a decreased mean BRS (p=0.05), a tendency to a shortened IBI (p=0.08), and a decreased BRSf (p=0.17). IBI correlated with BRS in diabetics (p=0.03); this correlation was at p=0.12 in the controls. BRSf was IBI independent (controls: p=0.81, diabetics: p=0.29). We conclude that BRS is partially dependent on mean IBI. Thus, BRS reflects not only an impairment of the quick baroreflex responses of IBI to blood pressure changes, but also a change of the tonic sympathetic and parasympathetic heart rate control. This is of significance during mild changes of BRS. Therefore, an examination of the BRSf index is highly recommended, because this examination improves the diagnostic value of the measurement, particularly in cases of early signs of autonomic dysfunction.

Diagnostic Significance of a Mild Decrease of Baroreflex Sensitivity With Respect to Heart Rate in Type 1 Diabetes Mellitus

Svačinová

Honzíková²,

Krtička³

et al. 2013

From the First Spectral Analysis of Blood Pressure Variability in the World to the Present Time: Contribution of the Department of Physiology of the Faculty of Medicine, Masaryk University, Brno

Nováková

2013

The review shows the significance of blood pressure regulation studies conducted during several decades at the Department of Physiology, Faculty of Medicine, Masaryk University, Brno. Continuous non-invasive blood pressure measurement was first introduced and patented here and, with the obtained data, the first spectral analysis of blood pressure was performed. This method was used in many different physiological studies on the relationship of blood pressure regulation to circulatory parameters, breathing, and baroreflex sensitivity. The article deals with studies on risk stratification of sudden cardiac death according to decreased baroreflex sensitivity, 24-hour heart rate variability, the amount of extrasystoles and late potentials. Importance of the new method of determination of one summation risk index is described here. A summary of the new conception of the relationship between low baroreflex sensitivity and hypertension is presented. Here, not only pathological changes of the vessel wall but also increased sympathetic activity and genetic predisposition play a role. Importance of studies conducted in young adults is highlighted, as inherited BRS decrease contributes to earlier blood pressure increase in the young. This research is highly topical, since prevention of hypertension in childhood is possible. Recent studies are dedicated to blood pressure regulation in young diabetics.

Baroreflex Sensitivity in Children and Adolescents: Physiology, Hypertension, Obesity, Diabetes Mellitus

Honzíková¹,

Závodná

2016

The increased prevalence of obesity in children and its complications have led to a greater interest in studying baroreflex sensitivity (BRS) in children. This review of BRS in children and adolescents includes subtopics on: 1. Resting values of BRS and their reproducibility, 2. Genetics of BRS, 3. The role of a primarily low BRS and obesity in the development of hypertension, and 4. Association of diabetes mellitus, BRS, and obesity. The conclusions specific to this age follow from this review: 1. The mean heart rate (HR) influences the measurement of BRS. Since the mean HR decreases during adolescence, HR should be taken into account. 2. A genetic dependency of BRS was found. 3. Low BRS values may precede pathological blood-pressure elevation in children with white-coat hypertension. We hypothesize that low BRS plays an active role in the emergence of hypertension in youth. A contribution of obesity to the development of hypertension was also found. We hypothesize that both factors, a primarily low BRS and obesity, are partially independent risk factors for hypertension in youths. 4. In diabetics, a low BRS compared to healthy children can be associated with insulin resistance. A reversibility of the BRS values could be possible after weight loss.