Autonomic Control Of Circulation Research Articles

Bradykinin-mediated estrogen-dependent depressor response by direct activation of female-specific distribution of myelinated Ah-type baroreceptor neurons in rats.

AimTo understand the direct impact of bradykinin in autonomic control of circulation through baroreflex afferent pathway.MethodsThe mean arterial pressure (MAP) was monitored while bradykinin and its agonists were applied via nodose (NG) microinjection, the expression of bradykinin receptors (BRs) in the NG (1st‐order) and nucleus tractus solitarius (NTS, 2nd‐order) were tested in adult male, age‐matched female, and ovariectomized rats under physiological and hypertensive conditions. Additionally, bradykinin‐induced depolarization was also tested in identified baroreceptor and baroreceptive neurons using whole‐cell patch‐clamp technique.ResultsUnder physiological condition, bradykinin‐induced dose‐ and estrogen‐dependent reductions of MAP with lower estimated EC50 in females. B2R agonist mediated more dramatic MAP reduction with long‐lasting effect compared with B1R activation. These functional observations were consistent with the molecular and immunostaining evidences. However, under hypertensive condition, the MAP reduction was significantly less dramatic in N’‐Nitro‐L‐Arginine‐methyl ester (L‐NAME) induced secondary and spontaneous hypertension rats in males compared with female rats. Electrophysiological data showed that bradykinin‐elicited concentration‐dependent membrane depolarization with discharges during initial phase in identified myelinated Ah‐types baroreceptor neurons, not myelinated A‐types; while, higher concentration of bradykinin was required for depolarization of unmyelinated C‐types without initial discharges.ConclusionThese datasets have demonstrated for the first time that bradykinin mediates direct activation of baroreflex afferent function to trigger estrogen‐dependent depressor response, which is due mainly to the direct activation/neuroexcitation of female‐specific myelinated Ah‐type baroreceptor neurons leading to a sexual dimorphism in parasympathetic domination of blood pressure regulation via activation of B2R/B1R expression in baroreflex afferent pathway.

AJP-Regulatory, Integrative and Comparative Physiology: Looking Toward the Future

<i>AJP-Regulatory, Integrative and Comparative Physiology</i>: Looking Toward the Future

Abnormal sympathetic neural recruitment patterns and hemodynamic responses to cold pressor test in women with posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) is more prevalent in women and associated with greater risk of major forms of cardiovascular disease, but physiological mechanisms underlying this association remain unknown. We hypothesized that abnormal sympathetic responses to sympathoexcitatory stimuli might predispose PTSD patients to a greater risk of cardiovascular disease. We examined changes in integrated muscle sympathetic nerve activity (MSNA) burst and multiunit action potential (AP) recruitment patterns as well as hemodynamic responses during cold pressor test (CPT) in 14 women with PTSD and 14 healthy control subjects. Data were collected during 1-min baseline, 2-min CPT, and 3-min recovery. At baseline, blood pressure (BP) was not different between groups; however, heart rate and sympathetic neural activity were greater in women with PTSD [MSNA burst frequency (BF): 27 ± 13 vs. 18 ± 14 bursts/min (P = 0.04); AP frequency: 272 ± 152 vs. 174 ± 146 spikes/min (P = 0.03)]. In response to CPT, BP responses exhibited a significant group × time interaction (P = 0.01) highlighted by a significant diastolic BP main group effect (P = 0.048) despite the finding that increases in integrated MSNA burst responses were not different between groups (P > 0.05). However, compared with control subjects, AP firing frequency (group × time interaction P = 0.0001, group P = 0.02) and AP per burst (group × time interaction P = 0.03, group P = 0.03) were augmented in women with PTSD. Collectively, women with PTSD exhibited a greater pressor response and an exaggerated sympathetic neural recruitment pattern during sympathoexcitatory stimuli that may, in part, explain the propensity toward developing hypertension and cardiovascular disease later in life.NEW & NOTEWORTHY The novel findings of the present study are that women with posttraumatic stress disorder (PTSD) have an augmented pressor response to the sympathoexcitatory stimulus of a cold pressor test (CPT) compared with healthy control subjects. Although integrated muscle sympathetic nerve activity burst responses were not significantly different between groups, total sympathetic action potential discharge in response to the CPT was markedly elevated in women with PTSD exhibiting increased firing of low-threshold axons as well as the recruitment of latent subpopulations of larger-sized axons that are otherwise silent at baseline. Aberrant autonomic circulatory control in response to sympathoexcitatory stimulus may in part explain the propensity toward developing hypertension and cardiovascular disease in this population.

Increase in diastolic blood pressure induced by fragrance inhalation of grapefruit essential oil is positively correlated with muscle sympathetic nerve activity

Fragrance inhalation of essential oils is widely used in aromatherapy, and it is known to affect blood pressure (BP) and heart rate (HR) via autonomic control of circulation. In this study, we aimed to test the hypothesis that the changes in hemodynamics with fragrance inhalation were observed along with changes in muscle sympathetic nerve activity (MSNA). In study 1, thirteen healthy men were exposed to fragrance stimulation of grapefruit essential oil for 10 min, and BP, HR, and MSNA were continuously measured. In study 2, another nine healthy men were exposed to the same fragrance stimulation; responses in BP and HR were continuously measured, and plasma noradrenaline and cortisol concentrations were determined. We found that diastolic BP increased significantly during fragrance inhalation, while the other variables remained unchanged in both studies. Although MSNA burst frequency, burst incidence, and total activity remained unchanged during fragrance inhalation, we found a significant linear correlation between changes in diastolic BP in the last 5 min of fragrance inhalation and changes in MSNA burst frequency. The plasma cortisol concentration decreased significantly at 10 min of fragrance inhalation, though the noradrenaline concentration remained unchanged. These results suggest, for the first time, that changes in BP with fragrance inhalation of essential oil are associated with changes in MSNA even with decreased stress hormone.

Application of the coupling detection to the analysis of the low-frequency rhythms in the autonomic controlof circulation

Many authors emphasize the fundamental and practical importance of investigation of the low-frequency rhythm in the brain and cardiac signals that correlate with the activity of the autonomic control of circulation. However complexity, nonstationarity and high nonlinearity of the system complicate the research and require application of the specialized methods. This study aims to compare the methods of coupling detection that were adapted to the detection of coupling between the loops of autonomic control of circulation. The analysis of the data from healthy subject demonstrated that the methods based on the analysis of phase dynamics and coherence function calculations are adequate for the investigation of coupling patterns in the autonomic control of circulation. However the results of both methods require the control of statistical significance.

Maintenance of Blood-Brain Barrier Integrity in Hypertension: A Novel Benefit of Exercise Training for Autonomic Control.

The blood-brain barrier (BBB) is a complex multicellular structure acting as selective barrier controlling the transport of substances between these compartments. Accumulating evidence has shown that chronic hypertension is accompanied by BBB dysfunction, deficient local perfusion and plasma angiotensin II (Ang II) access into the parenchyma of brain areas related to autonomic circulatory control. Knowing that spontaneously hypertensive rats (SHR) exhibit deficient autonomic control and brain Ang II hyperactivity and that exercise training is highly effective in correcting both, we hypothesized that training, by reducing Ang II content, could improve BBB function within autonomic brain areas of the SHR. After confirming the absence of BBB lesion in the pre-hypertensive SHR, but marked fluorescein isothiocyanate dextran (FITC, 10 kD) leakage into the brain parenchyma of the hypothalamic paraventricular nucleus (PVN), nucleus of the solitary tract, and rostral ventrolateral medulla during the established phase of hypertension, adult SHR, and age-matched WKY were submitted to a treadmill training (T) or kept sedentary (S) for 8 weeks. The robust FITC leakage within autonomic areas of the SHR-S was largely reduced and almost normalized since the 2nd week of training (T2). BBB leakage reduction occurred simultaneously and showed strong correlations with both decreased LF/HF ratio to the heart and reduced vasomotor sympathetic activity (power spectral analysis), these effects preceding the appearance of resting bradycardia (T4) and partial pressure fall (T8). In other groups of SHR-T simultaneously infused with icv Ang II or saline (osmotic mini-pumps connected to a lateral ventricle cannula) we proved that decreased local availability of this peptide and reduced microglia activation (IBA1 staining) are crucial mechanisms conditioning the restoration of BBB integrity. Our data also revealed that Ang II-induced BBB lesion was faster within the PVN (T2), suggesting the prominent role of this nucleus in driven hypertension-induced deficits. These original set of data suggest that reduced local Ang II content (and decreased activation of its downstream pathways) is an essential and early-activated mechanism to maintain BBB integrity in trained SHR and uncovers a novel beneficial effect of exercise training to improve autonomic control even in the presence of hypertension.

Improved cardiovascular autonomic modulation in transgenic rats expressing an Ang-(1-7)-producing fusion protein.

Angiotensin-(1-7) counterbalances angiotensin II cardiovascular effects. However, it has yet to be determined how cardiovascular autonomic modulation may be affected by chronic and acute elevation of Ang-(1-7). Hemodynamics and cardiovascular autonomic profile were evaluated in male Sprague-Dawley (SD) rats and transgenic rats (TGR) overexpressing Ang-(1-7) [TGR(A1-7)3292]. Blood pressure (BP) was directly measured while cardiovascular autonomic modulation was evaluated by spectral analysis. TGR received A-779 or vehicle and SD rats received Ang-(1-7) or vehicle and were monitored for 5 h after i.v. administration. In another set of experiments with TGR, A-779 was infused for 7 days using osmotic mini pumps. Although at baseline no differences were observed, acute administration of A-779 in TGR produced a marked long-lasting increase in BP accompanied by increased BP variability (BPV) and sympathetic modulation to the vessels. Likewise, chronic administration of A-779 with osmotic mini pumps in TGR increased heart rate, sympathovagal balance, BPV, and sympathetic modulation to the vessels. Administration of Ang-(1-7) to SD rats increased heart rate variability values in 88% accompanied by 8% of vagal modulation increase and 18% of mean BP reduction. These results show that both acute and chronic alteration in the Ang-(1-7)-Mas receptor axis may lead to important changes in the autonomic control of circulation, impacting either sympathetic and (or) parasympathetic systems.

Sleep Architecture and Blood Pressure.

Different stages of sleep are associated with significant variability in cardiovascular function, which is mediated by marked changes in balance between 2 components of the autonomic system: parasympathetic and sympathetic. Autonomic control of circulation is essential in ensuring an adequate blood flow to vital organs through constant adjustments of arterial blood pressure, heart rate, and redistribution of blood flow. Fluctuations in components of the autonomic nervous system synchronize with electroencephalographic activity during arousal or different stages of sleep. As a result, these can lead to several cardiovascular consequences in those who have underlying heart disease or sleep-disordered breathing.

Expression patterns and quantitative assessment of neurochemical markers in the lung of the gray bichir, Polypterus senegalus (Cuvier, 1829)

Anatomical and functional studies of the autonomic innervation and the putative oxygen receptors-the neuroepithelial (NEC)-like cells of the bichirs are lacking. The present paper describes the distribution of both NEC-like cells and the polymorphous granular cells (PGCs) that populate the mucociliated epithelium of the lung in the air breathing fish Polypterus senegalus. By using confocal immunohistochemistry we determined the coexpression of specific neurochemical markers. Colocalization studies showed that 5HT is coexpressed with calbindin and nNOS in the NEC-like cells and PGCs, and choline acetyltransferase (ChAT) is coexpressed with nNOS in both the two types of cells. Distribution of neurotransmitters (5HT, NO) and neurochemical marker ChAT is also investigated in the lung muscle. The role of these transmitters may be the autonomic control of circulation and respiration. However, the importance of these signals for the respiratory responses in the species studied is still not known.The present study also shows for the first time the simultaneous occurrence of piscidin 1 and 5HT in the PGCs. The function of these cells being equivalent to ones found in fish gill subepithelial parenchyma, is still not known. Due to the importance of piscidin 1 in local immune defense, more research is useful to understand a possible interaction of PGCs with immune response in the bichir lung.

Exercise in the postural orthostatic tachycardia syndrome.

Patients with the Postural Orthostatic Tachycardia Syndrome (POTS) have orthostatic intolerance, as well as exercise intolerance. Peak oxygen uptake (VO2peak) is generally lower in these patients compared with healthy sedentary individuals, suggesting a lower physical fitness level. During acute exercise, POTS patients have an excessive increase in heart rate and reduced stroke volume for each level of absolute workload; however, when expressed at relative workload (%VO2peak), there is no difference in the heart rate response between patients and healthy individuals. The relationship between cardiac output and VO2 is similar between POTS patients and healthy individuals. Short-term (i.e., 3 months) exercise training increases cardiac size and mass, blood volume, and VO2peak in POTS patients. Exercise performance is improved after training. Specifically, stroke volume is greater and heart rate is lower at any given VO2 during exercise after training versus before training. Peak heart rate is the same but peak stroke volume and cardiac output are greater after training. Heart rate recovery from peak exercise is significantly faster after training, indicating an improvement in autonomic circulatory control. These results suggest that patients with POTS have no intrinsic abnormality of heart rate regulation during exercise. The tachycardia in POTS is due to a reduced stroke volume. Cardiac remodeling and blood volume expansion associated with exercise training increase physical fitness and improve exercise performance in these patients.

Molecular Mechanism for Hypertensive Renal Disease: Differential Regulation of Chromogranin A Expression at 3'-Untranslated Region Polymorphism C+87T by MicroRNA-107.

Chromogranin A (CHGA) is coreleased with catecholamines from secretory vesicles in adrenal medulla and sympathetic axons. Genetic variation in the CHGA 3'-region has been associated with autonomic control of circulation, hypertension, and hypertensive nephropathy, and the CHGA 3'-untranslated region (3'-UTR) variant C+87T (rs7610) displayed peak associations with these traits in humans. Here, we explored the molecular mechanisms underlying these associations. C+87T occurred in a microRNA-107 (miR-107) motif (match: T>C), and CHGA mRNA expression varied inversely with miR-107 abundance. In cells transfected with chimeric luciferase/CHGA 3'-UTR reporters encoding either the T allele or the C allele, changes in miR-107 expression levels had much greater effects on expression of the T allele. Cotransfection experiments with hsa-miR-107 oligonucleotides and eukaryotic CHGA plasmids produced similar results. Notably, an in vitro CHGA transcription/translation experiment revealed that changes in hsa-miR-107 expression altered expression of the T allele variant only. Mice with targeted ablation of Chga exhibited greater eGFR. Using BAC transgenesis, we created a mouse model with a humanized CHGA locus (T/T genotype at C+87T), in which treatment with a hsa-miR-107 inhibitor yielded prolonged falls in SBP/DBP compared with wild-type mice. We conclude that the CHGA 3'-UTR C+87T disrupts an miR-107 motif, with differential effects on CHGA expression, and that a cis:trans (mRNA:miR) interaction regulates the association of CHGA with BP and hypertensive nephropathy. These results indicate new strategies for probing autonomic circulatory control and ultimately, susceptibility to hypertensive renal sequelae.

The effects of increased plasma volume on autonomic control of the circulation after a bout of intense‐intermittent exercise in men

Plasma volume (PV) after a bout of intense‐intermittent exercise is reported to be increased by protein and carbohydrate (CHO) intake just after exercise. The possible effects of the increased PV on autonomic control of the circulation after exercise remain unknown.METHODSSeven healthy men (≈23 yrs) underwent two trials those of which differ in the timing of intake (just after exercise, 0H; and 2 hours later, 2H) of protein and CHO (3.2 kcal and 0.18 g protein/kg). After baseline (BL) in a seated position, subjects performed a 72‐min intense‐intermittent exercise (8 sets of 4 min at 80% VO2max + 5 min at 20% VO2max), then they kept seated rest during 0–5th and 22–23rd hour of recovery. Percent change in PV from BL (Δ%PV) was determined and beat‐to‐beat blood pressure, R‐R interval, heart rate, and stroke volume (SV) were measured during 5‐min spontaneous and fixed rate (0.2 Hz) respiration at BL and every hour during recovery. Dynamic arterial‐cardiac baroreflex sensitivity (BRS) was calculated by sequence analysis.RESULTSΔ%PV in 0H was higher than 2H at 5th and 23rd hour of recovery. There was no difference in BRS between trials while SV and effective arterial‐cardiac baroreflex gain estimated as BRS ~SV were higher in 0H than 2H at 5th and 23rd hour of recovery.CONCLUSIONIncreased PV enhances the effectiveness of autonomic circulatory control with increased SV after an intense‐intermittent exercise.

Microneurographic research in women

This article reviews microneurographic research on sympathetic neural control in women under both physiological and pathophysiological conditions across the lifespan. Specifically, the effects of sex, age, race, the menstrual cycle, oral contraceptives, estrogen replacement therapy, and normal pregnancy on neural control of blood pressure in healthy women are reviewed. In addition, sympathetic neural activity during neurally mediated (pre)syncope, the Postural Orthostatic Tachycardia Syndrome (POTS), obesity, the Polycystic Ovary Syndrome (PCOS), gestational hypertension, and preeclampsia, chronic essential hypertension, heart failure, and myocardial infarction in women are also reviewed briefly. It is suggested that microneurographic studies provide valuable information regarding autonomic circulatory control in women of different ages and in most cases, excessive sympathetic activation is associated with specific medical conditions regardless of age and sex. In some situations, sympathetic inhibition or withdrawal may be the underlying mechanism. Information gained from previous and recent microneurographic studies has significant clinical implications in women's health, and in some cases could be used to guide therapy if more widely available.

The Ion Channel ASIC2 Is Required for Baroreceptor and Autonomic Control of the Circulation

Arterial baroreceptors provide a neural sensory input that reflexly regulates the autonomic drive of circulation. Our goal was to test the hypothesis that a member of the acid-sensing ion channel (ASIC) subfamily of the DEG/ENaC superfamily is an important determinant of the arterial baroreceptor reflex. We found that aortic baroreceptor neurons in the nodose ganglia and their terminals express ASIC2. Conscious ASIC2 null mice developed hypertension, had exaggerated sympathetic and depressed parasympathetic control of the circulation, and a decreased gain of the baroreflex, all indicative of an impaired baroreceptor reflex. Multiple measures of baroreceptor activity each suggest that mechanosensitivity is diminished in ASIC2 null mice. The results define ASIC2 as an important determinant of autonomic circulatory control and of baroreceptor sensitivity. The genetic disruption of ASIC2 recapitulates the pathological dysautonomia seen in heart failure and hypertension and defines a molecular defect that may be relevant to its development.

Autonomic Circulatory Control during Pregnancy in Humans

Pregnancy is associated with dramatic alterations in maternal hemodynamics, which begin as early as 4 to 5 weeks of gestation. It has been proposed that these changes occur through autonomic control mechanisms, but the actual role of the autonomic nervous system in pregnancy is poorly understood. Here, we review what is known about the hemodynamic adaptation, changes in vascular endothelial function, sympathetic neural control and vascular responsiveness in pregnancy, and baroreflex function during pregnancy in humans. However, whether and how the sympathetic nervous system plays a role in hemodynamic homeostasis during EARLY human pregnancy remains completely unknown. Understanding the pathophysiology underlying autonomic control of maternal hemodynamics may be particularly important for prevention of cardiovascular complications during pregnancy and may improve risk stratification and prevention of cardiovascular disease for women well beyond the postpartum period.

Influence of Gender and the Menstrual Cycle on Autonomic Circulatory Control during Orthostasis in Humans

PURPOSE: To test the hypothesis that gender and the hormonal fluctuations that occur during the normal menstrual cycle in women affect dynamic autonomic control of the circulation during orthostatic stress. METHODS: Seven normally menstruating (−28 days) healthy women were studied twice: once during the early follicular phase (both estrogen and progesterone are low) and once during the luteal phase (both estrogen and progesterone are high) with the order counterbalanced. Also, 10 age-matched healthy men were studied. Beat-to-beat R-R interval (RRI, ECG) and systolic blood pressure (SBP, Finapres) during spontaneous respiration were recorded in the supine position and during a graded head-up tilt (HUT, 30° and 60°) for 5 min each. SBP and RR variability and dynamic cardio-vagal baroreflex sensitivity between SBP and RRI were assessed by using spectral and transfer function analysis and by the sequence technique. RESULTS: SBP and RRI while supine and at both 30° and 60° HUT were not different between the menstrual phases or between the genders. Responses in low-frequency (LF, 0.05–0.15 Hz) as well as high-frequency (HF, 0.15–0.35 Hz) BP power during HUT were not different between the menstrual phases or between the genders. Finally, there were no significant differences in responses in LF and HF RR power, in addition to indices of dynamic cardio-vagal baroreflex sensitivity during HUT between the menstrual phases or between the genders (Table 1).Table 1: Responses baroreflex sensitvity during head up tiltCONCLUSIONS: Dynamic autonomic control of the circulation, as well as static regulation of BP and RRI during orthostatic stress is not different between the genders or the menstrual phases. Thus, either gender or the hormonal fluctuations that occur during the normal menstrual cycle in women do not affect dynamic autonomic control of the circulation during, at least, short term orthostatic stress. Supported by NIH K23 (HL0752 83) and the GCRC grant (RR00633).

Different effects on circulatory control during volatile induction and maintenance of anesthesia and total intravenous anesthesia: autonomic nervous activity and arterial cardiac baroreflex function evaluated by blood pressure and heart rate variability analysis

Study Objective To evaluate the different effects on autonomic circulatory control during volatile induction/maintenance of anesthesia (VIMA) vs total intravenous anesthesia (TIVA). Design Prospective study. Setting Operating theater of a university hospital. Patients Twenty patients, with American Society of Anesthesiologists physical status of I or II, were randomly allocated into the VIMA group (n = 10) or the TIVA group (n = 10). Interventions In the VIMA group, anesthesia was induced with 5% sevoflurane and 60% N 2O in oxygen and maintained with 2% sevoflurane and 60% N 2O in oxygen. In the TIVA group, anesthesia was induced with propofol 2.0 mg/kg intravenously by bolus injection and fentanyl 2 μg/kg, and maintained with an intravenous infusion of propofol 5 mg/kg·per hour and air-oxygen mixture. Measurements Monitoring included recordings of electrocardiographic and arterial blood pressure waveforms. Autonomic nervous activity and arterial cardiac baroreflex function were evaluated by analysis of blood pressure variability, heart rate variability, and transfer function analysis between these 2 variables. Main Results In the VIMA group, the low-frequency component of blood pressure variability (LF SBP) and low- and high-frequency components of the R-R interval variability (LF RR and HF RR) decreased significantly during anesthesia. In the TIVA group, LF SBP and LF RR decreased significantly. The degree of reduction in LF SBP was greater in the VIMA group than in the TIVA group. However, changes in R-R interval variability and cardiac baroreflex indices were not significantly different between the 2 groups. Conclusions Our results demonstrated that although reductions in autonomic nervous modulation to the heart might not be so different between the 2 groups, reduction in sympathetic nervous modulation to peripheral vasculature is greater in the VIMA group than in the TIVA group.

Dose-response relationship of endurance training for autonomic circulatory control in healthy seniors

Aging results in marked abnormalities of cardiovascular regulation. Regular exercise can improve many of these age-related abnormalities. However, it remains unclear how much exercise is optimal to achieve this improvement or whether the elderly can ever improve autonomic control by exercise training to a degree similar to that observed in healthy young individuals. Ten healthy sedentary seniors [71 +/- 3 (SD) yr] trained for 12 mo; training involved progressive increases in volume and intensity. Static hemodynamics were measured, and R-wave-R-wave interval (RRI), beat-to-beat blood pressure (BP) variability, and transfer function gain between systolic BP and RRI were calculated at baseline and every 3 mo during training. Data were compared with those obtained in 12 Masters athletes (68 +/- 3 yr) and 11 healthy sedentary young individuals (29 +/- 6 yr) at baseline. Additionally, the adaptation of these variables after completion of identical training loads was compared between the seniors and the young. Indexes of RRI variability and baroreflex gain were decreased in the sedentary seniors but preserved in the Masters athletes compared with the young at baseline. With training in the seniors, baroreflex gain and resting BP showed a peak adaptation after moderate doses of training following 3-6 mo. Indexes of RRI variability continued to improve with increasing doses of training and increased to the same magnitude as the young at baseline after heavy doses of training for 12 mo; however, baroreflex gain never achieved values equivalent to the young at baseline, even after a year of training. The magnitude of the adaptation of these variables to identical training loads was similar (no interaction effects of age x training) between the seniors and the young. Thus RRI variability in seniors improves with increasing "dose" of exercise over 1 yr of training. In contrast, more moderate doses of training for 3-6 mo may optimally improve baroreflex sensitivity, associated with a modest hypotensive effect; however, higher doses of training do not lead to greater enhancement of these changes. Seniors retain a similar degree of "trainability" as young subjects for cardiac autonomic function to dynamic exercise.

Normal cerebral hemodynamic response to orthostasis in Parkinson's disease

In patients with Idiopathic Parkinson's Disease (IPD) without a history of syncope the cardiovascular and cerebrovascular response to orthostatic stress was studied to search for subclinical impairment of autoregulatory mechanisms. Fifteen patients with IPD and 15 healthy age-matched controls were studied at rest and during head-up tilt (HUT). Heart rate, mean arterial blood pressure (MAP) and mean blood flow velocity (MBFV) in the middle cerebral artery were measured simultaneously. Changes of MAP and MBFV and the relationship between both were assessed. During HUT, heart rate increased less in patients than in healthy subjects (16.3% versus 24.2%, p=0.03). In the first minute of orthostasis MAP decreased more in patients than in healthy subjects (−4.0% versus −0.6%, p=0.04). MAP reached the pre-tilt values within 2 min in healthy subjects and 5 min in patients. Cerebral blood flow velocities fell to a similar degree and with similar time characteristics in patients and controls (−15.4% versus −16.7%, p=0.3). In both groups, patients and controls, changes of MAP did not correlate with changes of MBFV. It can be concluded that in IPD patients without symptoms of orthostatic dysregulation the autonomic circulatory control is impaired while the cerebral hemodynamic regulation during orthostasis is unaffected.

Baroreceptor sensitivity and haemodynamics in normal pregnancy

The objective of the study was to determine baroreceptor sensitivity and haemodynamics during the third trimester in normal pregnancy. The study group consisted of 20 primigravidae. The measurements were made at 28, 30, 32, 34, 36 and 38 weeks. The haemodynamic measurements were made by Doppler echocardiography and parameters calculated with standard formulae. Power spectral analysis was used to estimate the baroreceptor sensitivity in mid-frequency (MF) and high-frequency (HF) bands in msec/mmHg. Statistical tests performed were paired t-test and correlation coefficient. The mean baroreceptor sensitivity (BRS) in the mid-frequency band at 28, 30, 32, 34, 36 and 38 weeks were 5·19; 5·03; 5·52; 6·00; 6·77 and 7·82 msec/mmHg. The respective values for the high-frequency band were 7·52; 5·71; 7·99; 8·15; 8·53 and 10·87 msec/mmHg. The BRS in mid-high-frequency and high-frequency bands, mean arterial pressure and peripheral vascular resistance at 38 weeks of pregnancy were significantly higher than at 28 weeks, but the cardiac output was lower. A significant positive correlation of BRS with peripheral vascular resistance was observed. There was a significant negative correlation with cardiac output. The beneficial effects of increase BRS may lead to haemodynamic stability and stronger autonomic control of circulation. This may assist in maintaining a stable normal maternal blood pressure and a satisfactory placental perfusion during pregnancy. The absence of changes in BRS may be associated with pregnancy-induced hypertension and intrauterine growth restriction.