Reduced baroreflex sensitivity is associated with increased vascular calcification and arterial stiffness

Chesterton, Lindsay J.; Sigrist, Mhairi K.; Bennett, T.; Taal, Maarten W.; McIntyre, Christopher W.

doi:10.1093/ndt/gfh808

Cited by 118 publications

(89 citation statements)

References 20 publications

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“…It is associated with reduced arterial compliance, as illustrated by the results of multivariate analysis of our present data, which in turn, appears to be associated with an altered systemic hemodynamic state. Vascular calcification and increased arterial stiffness are associated with reduced baroreflex sensitivity, potentially producing short-term dysregulation of blood pressure 26) . Although, in our study, treatment with ARBs or statins was not associated with improvement in the severity of arterial stiffness in non-diabetic CKD patients, recent studies have found that longterm blockade of the renin-angiotensin system might prevent increased arterial stiffness and vascular calcification and thereby reduce the incidence of cardiovascular events [27][28][29] .…”

Section: Discussionmentioning

confidence: 99%

Arterial Stiffness in Patients with Non-Diabetic Chronic Kidney Disease (CKD)

Matsuda

Takei

Fujiu

et al. 2009

JAT

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Background: Patients with chronic kidney disease (CKD) have a high prevalence of cardiovascular disease (CVD). Arterial stiffness plays an important role in the pathogenesis of CVD; however, to date, there have been no reports of the assessment of arterial stiffness in patients at different stages of non-diabetic CKD. Methods: We studied 50 patients with non-diabetic CKD (stages 1 − 5, 5D) receiving medical treatment at Tokyo Women's Medical University. Pulse wave velocity (PWV) was assessed using an applanation tonometer to determine arterial compliance. All current medications were recorded and biochemical parameters were analyzed. Results: Non-diabetic CKD stage 5D patients had a higher PWV, and higher serum levels of C-reactive protein (CRP), Ca, P and intact parathyroid hormone (iPTH) than non-diabetic CKD stage 1 − 5 patients (p 0.03, p 0.009, p 0.006, p 0.00005, and p 0.002, respectably). As compared to nondiabetic CKD stage 1 − 2 patients, patients with non-diabetic CKD stage 3 − 5 were older, and had higher serum levels of P and iPTH and a higher PWV (p 0.0002, p 0.009, p 0.03, and p 0.004). Nephrosclerosis was associated with a higher PWV, higher serum levels of CRP, and a higher prevalence of CVD than patients with CKD of other origins. Conclusion:We showed a stepwise increase of arterial stiffness with increasing disease severity stage in patients with CKD not associated with diabetes mellitus. CKD caused by nephrosclerosis was found to be associated with increased arterial stiffness and to be a risk factor for CVD. J Atheroscler

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Section: Discussionmentioning

confidence: 99%

Arterial Stiffness in Patients with Non-Diabetic Chronic Kidney Disease (CKD)

Matsuda

Takei

Fujiu

et al. 2009

JAT

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“…Because baroreceptors do not respond directly to changes in intravascular pressure but rather to the mechanical deformation of the vessel wall, it is not surprising that increased arterial stiffness and calcification are associated with reduced baroreflex sensitivity. [8][9][10] In most studies, baroreflex sensitivity has been assessed from the relationship between the changes in systolic BP and those in heart rate (or the R-R interval) during such maneuvers as Valsalva or the injection of vasoactive substances. This approach evaluates the cardiovagal component of the baroreflex system.…”

Section: Pathophysiology Of Bp Regulation In the Oldest Oldmentioning

confidence: 99%

Treatment of Hypertension in the Oldest Old

et al. 2014

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A n 88-year-old woman with chronic hypertension was seen in the internal/geriatric medicine outpatient clinic. She had been treated for high blood pressure (BP) for ≈20 years with a low-dose thiazide, to which an angiotensin-converting enzyme-inhibitor had been added 5 years ago. In addition, after a possible transient ischemic attack 10 years ago, aspirin, omeprazole, and simvastatin had been added. She is known with mild cognitive impairment, which is stable with a mini-mental state examination score of 25, and a mild depression for which fluoxetine has been prescribed. In addition, she experienced 2 falls in the past 2 years; calcium/vitamin D and alendronate were started for the management of osteoporosis. On physical examination, she appears vital with a normal fluent gait and no signs of hemiparesis. Her BP is 165/75 mm Hg in the sitting position. Immediately after standing up from her chair, she feels dizzy for ≈10 seconds, but after 1 and 3 minutes, no orthostatic hypotension is found. Estimated glomerular filtration rate is 50 mL/min per 1.73 m 2 . Should antihypertensive treatment be intensified, left unaltered, or reduced?The oldest old, that is, persons aged ≥80 years, will be the fastest growing segment of the population for the next 40 years. By 2050, more than one quarter of all men and women aged ≥65 years in the Western world will be in the oldest old group. 1Despite longer life expectancy, the prevalence of various chronic diseases and functional impairment increases with age. As a result, populations of older individuals are often highly heterogeneous and individuals with same chronological age vary widely in health and functional ability. In other words, there is substantial heterogeneity in their biological age, and those at the higher end of biological age are often referred to as vulnerable or frail.BP rises with age, and ≈80% of people in Western societies aged ≥80 years have hypertension.2 Their hypertension is commonly characterized by elevated systolic BP, with often normal or even low diastolic BP. The widened pulse pressure (PP) is a reflection of increased arterial stiffness. Despite the large body of evidence in middle-aged populations, the predictive value of high BP in this rapidly growing older population is still debated, as is the question of whether hypertension should be treated, and if so, how intensively. Importantly, the current paradigm of lower is better may not apply to (untreated or treated) BP in the oldest old.In this concise narrative review, we summarize evidence from observational studies and randomized clinical trials. We conclude that biological age/frailty is becoming an important criterion for treatment decisions. Finally, we address what we think are the most pressing research questions for the coming years. Pathophysiology of BP Regulation in the Oldest OldAlthough hypertension in the oldest old may reflect a longstanding condition, often it manifests itself as a de novo abnormality. Data from the Framingham Heart Study indicate that the majority of patient...

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“…The authors postulated that aortic arch baroreceptors in this prestenotic area may be activated less at a given pressure than receptors placed in a vessel, with normal distensibility thus allowing a higher pressure to be tolerated by the cardiac baroreflex. The inter-relationship between reduced arterial compliance and a less sensitive baroreceptor reflex has been examined in other forms of secondary hypertension, 33 but has yet to be reported in patients with CoA. The progression in this inter-relationship throughout childhood when control mechanisms are potentially set for life, is also of significant interest.…”

Section: Multiple System Involvementmentioning

confidence: 99%

Hypertension and coarctation of the aorta: an inevitable consequence of developmental pathophysiology

et al. 2011

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Patients with coarctation of the aorta develop early onset hypertension in spite of early effective repair. This is associated with significant morbidity and is arguably the single most important outcome variable in this patient group. We discuss the potential pathophysiological mechanisms involved in the development of hypertension with clinical reference to monozygotic twins, and review potential strategies for therapy and prevention in this setting.

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Reduced baroreflex sensitivity is associated with increased vascular calcification and arterial stiffness

Abstract: The reduction in BRS and the resulting aberrant blood pressure response to the physiological stress and volume changes of HD may be important in the further understanding of the pathophysiology of the increased mortality in HD patients with vascular calcification.

Cited by 118 publications

References 20 publications

Arterial Stiffness in Patients with Non-Diabetic Chronic Kidney Disease (CKD)

Arterial Stiffness in Patients with Non-Diabetic Chronic Kidney Disease (CKD)

Treatment of Hypertension in the Oldest Old

Hypertension and coarctation of the aorta: an inevitable consequence of developmental pathophysiology

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