Abstract
Purpose Comprehensive study of autonomic regulation assessed during follow-up could provide new detailed information about the risks stratification for hypertensive patients. Therefore, we investigated the associations of these indices with death, stroke, and revascularization during the follow-up observation of 55 patients. Methods All patients were with target organ damage, and 27 of them had associated clinical conditions (ACC). Mean age of patients with and without ACC was 62.6 ± 4.2 and 51.9 ± 9.9 (mean ± SD) years, respectively. Follow-up was from 66 to 95 months. At entry, autonomic regulation was assessed by the tilt test, Valsalva maneuver, hand-grip test, and cold-stress vasoconstriction. Hemodynamic parameters were measured by continuous blood pressure monitoring, occlusion plethysmography, and electrocardiography. Re-examination of patients was carried out by questioning and physical and laboratory examination. Results We found that fatal outcomes were associated with a lower Valsalva index (1.34 ± 0.16 vs. 1.69 ± 0.37, P < 0.05) and depressed cold vasoconstriction (0.20 ± 0.02 vs. 0.39 ± 0.16%, P < 0.05) and depressed cold vasoconstriction (0.20 ± 0.02 vs. 0.39 ± 0.16%, P < 0.05) and depressed cold vasoconstriction (0.20 ± 0.02 vs. 0.39 ± 0.16%, P < 0.05) and depressed cold vasoconstriction (0.20 ± 0.02 vs. 0.39 ± 0.16%, P < 0.05) and depressed cold vasoconstriction (0.20 ± 0.02 vs. 0.39 ± 0.16%, P < 0.05) and depressed cold vasoconstriction (0.20 ± 0.02 vs. 0.39 ± 0.16%, P < 0.05) and depressed cold vasoconstriction (0.20 ± 0.02 vs. 0.39 ± 0.16%, Conclusions This study shows that such autonomic regulation indices as Valsalva index, blood pressure dynamics in the tilt test, cold-stress vasomotor reactivity, and BPV are important for prognosis of hypertension course.
Highlights
Hypertension is the most important factor worsening the prognosis and survival of patients with cardiovascular diseases [1]
There are often studies in which autonomic regulation and parameters of hemodynamic were studied resulting in inclusion of respective indicators in the management for sudden death issued by the American Heart Association [4]
A comprehensive assessment of autonomic regulation of blood circulation was carried out for all patients according to the following sequence of tests: (1) Tilt test of a shortened protocol (10 min. at rest and 10 min. in orthostasis)
Summary
We found that fatal outcomes were associated with a lower Valsalva index (1.34 ± 0.16 vs 1.69 ± 0.37, P < 0.05) and depressed cold vasoconstriction (0.20 ± 0.02 vs 0.39 ± 0.16%, P < 0.05) but with higher peripheral resistance (1.36 ± 0.19 vs 0.89 ± 0.25, P < 0.001) and respiratory-range blood pressure variability (BPV) (18.2 ± 14.2 vs 6.2 ± 4.2 mmHg, P < 0.001). Initial diastolic orthostatic hypertension (6.6 ± 10.8 vs 0.4 ± 6.3 mmHg, P < 0.05) and lower Valsalva index (1.36 ± 0.11 vs 1.82 ± 0.37, P < 0.05) in patients who suffered a new ACC were important findings as well. Is study shows that such autonomic regulation indices as Valsalva index, blood pressure dynamics in the tilt test, cold-stress vasomotor reactivity, and BPV are important for prognosis of hypertension course Conclusions. is study shows that such autonomic regulation indices as Valsalva index, blood pressure dynamics in the tilt test, cold-stress vasomotor reactivity, and BPV are important for prognosis of hypertension course
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