Cardiovascular parameters: sensitivity to detect autonomic dysfunction and influence of age and sex in normal subjects.

Abstract

In 137 healthy volunteers between 18 and 85 years of age, blood pressure (BP) and heart rate (HR) were measured continuously with the Finapres device during active change of posture (ACP), i.e. standing upright, passive tilt (PT, i.e. head-up tilt), Valsalva manoeuvre (VM), deep breathing (DB), isometric muscle exercise (IME) and a mental arithmetic task (MA). Mean HR activation was attenuated with increasing age in all manoeuvres, but was unrelated to sex. In non-orthostatic challenge procedures like MA and IME mean BP increases were independent of age and sex, despite lower increases in HR in the elderly. This points to a preserved sympathetic efferent activity. Following a forced fall in BP during ACP, PT and VM, the initial responses and maintenance values of BP showed a significant age-related decrease. This finding was strongly related to lower BP values in males compared with females, which became more pronounced with increasing age. Further studies to investigate age-related changes in the activation of the various components of the cardiovascular regulation need to consider the mode of activation of the autonomic nervous system and sex as factors of influence. Normal ranges, and also some new points in time not previously measurable, were calculated for all standard autonomic tests based on the continuous measurement of BP and HR. The minimum length of time necessary to assess the cardiovascular responses during ACP and PT was found to be 60 s. The upper time limits for reaching maximum activation during IME and MA were 3.5 min and 1 min, respectively. Age had a relevant influence on the lower limits of normal of all HR parameters and of some BP measurements during PT, ACP and VM. Sex was found to have no relevant impact on normal ranges. Over 65 years of age the normal values for HR activation during VM and DB hardly exceeded baseline values. The possibility of increasing the sensitivity of detection of autonomic dysfunction by measuring BP continuously must be approached with caution, as sufficient sensitivity was only reached at the lower limits of normal during late phase II of the VM. The initial increase of HR after ACP and the BP values after 60 s standing time proved to be the parameters with the best sensitivity for detecting an affection of the regulation of HR and BP over the whole range of age.