Baroreflex Sensitivity In Men Research Articles

Influence of D,L-Sotalol on Baroreflex Sensitivity Response to Posture Following Coronary Artery Bypass Graft Surgery in Men and Women

Low baroreflex sensitivity (BRS) following coronary artery bypass graft (CABG) surgery increases the risk of sympathetically mediated cardiac arrhythmias. To reduce this risk, D,L-sotalol, a nonselective β-adrenergic receptor antagonist (Class II) and an antiarrhythmic (Class III), is prescribed postoperatively. However, its effect on BRS has not been reported. The purpose of this study was to characterize the influence of D,L-sotalol on BRS measures in supine and standing postures 4 days following CABG surgery. BRS was measured in 27 men and 10 women receiving D,L-sotalol and compared with archival data for 21 men and 10 women obtained prior to the routine administration of D,L-sotalol. In the latter (control) group, 61% had BRS of less than 3 ms/mmHg in the supine posture and 74% in the standing posture compared to 42% with less than 3 ms/mmHg in the supine posture and 65% in the standing posture in the D,L-sotalol group. Men in the D,L-sotalol group showed higher R-R interval and BRS in both supine and standing postures compared with controls. Women in the D,L-sotalol group had higher R-R interval in the supine posture. The higher BRS in men not only reduces the risk of arrhythmias after CABG surgery but may also allow a more rapid circulatory response to the standing posture, thereby decreasing the risk of syncope.

Baroreflex sensitivity is associated with blood pressure transients in young men but not young women

Baroreflex sensitivity is calculated from the slope of the relationship between blood pressure and muscle sympathetic nerve activity (MSNA) or cardiac R‐R interval. The magnitude of decrease in blood pressure during a vasoactive drug bolus (i.e. modified Oxford) to test the baroreflex may be associated with the calculated baroreflex sensitivity (BRS) slope. We investigated whether the cardiac or sympathetic BRS are associated with the acute decrease in blood pressure during a modified Oxford in young healthy men and women. Forty‐five women (27 ± 1 yrs, BMI 22.9 ± 0.3 kg/m2) and 30 men (27 ± 1 yrs, 24.2 ± 0.4 kg/m2) were studied. MSNA was measured via peroneal microneurography and blood pressure was measured with a brachial intraarterial catheter. Women and men had similar mean arterial pressures (91 ± 1 vs. 90 ± 1 mmHg), cardiac BRS (19 ± 1 vs. 21 ± 2 ms/mmHg), and sympathetic BRS (−6 ± 0.4 vs. −7 ± 0.6 AU/beat/mmHg), respectively. The decrease in systolic blood pressure (SBP) and pulse pressure (PP) was positively related to cardiac BRS in men (r=.47; p<0.01; r=.49; p<0.01). However, there was no relationship between the decrease in blood pressure and sympathetic BRS in men. In addition, there was no association between any blood pressure transients with either cardiac or sympathetic BRS in women. Our results suggest the magnitude of decrease in blood pressure is associated with cardiac BRS in men, but not women.Funded by NIH

How good is spontaneous sequence analysis at measuring baroreflex sensitivity in man?

How good is spontaneous sequence analysis at measuring baroreflex sensitivity in man?

Can baroreflex measurements with spontaneous sequence analysis be improved by also measuring breathing and by standardization of filtering strategies?

Baroreflex sensitivity (BRS) is known to be attenuated by inspiration and all the original BRS methodologies took this into account by measuring only in expiration. Spontaneous sequence analysis (SSA) is a non-invasive clinical tool widely used to estimate BRS in Man but does not take breathing into account. We have therefore modified it to test whether it too can detect inspiratory attenuation. Traditional SSA is also entangled with issues of distinguishing causal from random relationships between blood pressure and heart period and of the optimum choice of data filter settings. We have also tested whether the sequences our modified SSA rejects do behave as random relationships and show the limitations of the absence of filter standardization. SSA was performed on eupneic data from 1 h periods in 20 healthy subjects. Applying SSA traditionally produced a mean BRS of 23 ± 3 ms mmHg−1. After modification to measure breathing, SSA detected significant inspiratory attenuation (11 ± 1 ms mmHg−1), and the mean expiratory BRS was significantly higher (26 ± 5 ms mmHg−1). Traditional SSA therefore underestimates BRS by an amount (3 ms mmHg−1) as big as the major physiological and clinical factors known to alter BRS. We show that the sequences rejected by SSA do behave like random associations between pressure and period. We also show the minimal effect of the r2 filter and the biases that some pressure and heart period filters can introduce. We discuss whether SSA might be improved by standardization of filter settings and by also measuring breathing.

Effect of Long-Acting Testosterone Treatment on Functional Exercise Capacity, Skeletal Muscle Performance, Insulin Resistance, and Baroreflex Sensitivity in Elderly Patients With Chronic Heart Failure: A Double-Blind, Placebo-Controlled, Randomized Study

This study investigated the effect of a 12-week long-acting testosterone administration on maximal exercise capacity, ventilatory efficiency, muscle strength, insulin resistance, and baroreflex sensitivity (BRS) in elderly patients with chronic heart failure (CHF). CHF is characterized by a metabolic shift favoring catabolism and impairment in skeletal muscle bulk and function that could be involved in the pathophysiology of heart failure. Seventy elderly patients with stable CHF-median age 70 years, ejection fraction 31.8 +/- 7%-were randomly assigned to receive testosterone (n = 35, intramuscular injection every 6 weeks) or placebo (n = 35), both on top of optimal medical therapy. At baseline and at the end of the study, all patients underwent echocardiogram, cardiopulmonary exercise test, 6-min walk test (6MWT), quadriceps maximal voluntary contraction (MVC), and isokinetic strength (peak torque) and BRS assessment (sequences technique). Baseline peak oxygen consumption (VO(2)) and quadriceps isometric strength showed a direct relation with serum testosterone concentration. Peak VO(2) significantly improved in testosterone but was unchanged in placebo. Insulin sensitivity was significantly improved in testosterone. The MVC and peak torque significantly increased in testosterone but not in placebo. The BRS significantly improved in testosterone but not in placebo. Increase in testosterone levels was significantly related to improvement in peak VO(2) and MVC. There were no significant changes in left ventricular function either in testosterone or placebo. These results suggest that long-acting testosterone therapy improves exercise capacity, muscle strength, glucose metabolism, and BRS in men with moderately severe CHF. Testosterone benefits seem to be mediated by metabolic and peripheral effects.

Stress and catecholamines.

Stress and catecholamines.

Local metabolite accumulation augments passive muscle stretch‐induced modulation of carotid–cardiac but not carotid–vasomotor baroreflex sensitivity in man

We examined the effects of muscle mechanoreflex stimulation by passive calf muscle stretch, at rest and during concurrent muscle metaboreflex activation, on carotid baroreflex (CBR) sensitivity. Twelve subjects either performed 1.5 min one-legged isometric plantarflexion at 50% maximal voluntary contraction with their right or left calf [two ischaemic exercise (IE) trials, IER and IEL] or rested for 1.5 min [two ischaemic control (IC) trials, ICR and ICL]. Following exercise, blood pressure elevation was partly maintained by local circulatory occlusion (CO). 3.5 min of CO was followed by 3 min of CO with passive stretch (STR-CO) of the right calf in all trials. Carotid baroreflex function was assessed using rapid pulses of neck pressure from +40 to -80 mmHg. In all IC trials, stretch did not alter maximal gain of carotid-cardiac (CBR-HR) and carotid-vasomotor (CBR-MAP) baroreflex function curves. The CBR-HR curve was reset without change in maximal gain during STR-CO in the IEL trial. However, during the IER trial maximal gain of the CBR-HR curve was smaller than in all other trials (-0.34+/-0.04 beats min(-1) mmHg(-1) in IER versus -0.76+/-0.20, -0.94+/-0.14 and -0.66+/-0.18 beats min(-1) mmHg(-1) in ICR, IEL and ICL, respectively), and significantly smaller than in IEL (P<0.05). The CBR-MAP curves were reset from CO values by STR-CO in the IEL and IER trials with no changes in maximal gain. These results suggest that metabolite sensitization of stretch-sensitive muscle mechanoreceptive afferents modulates baroreflex control of heart rate but not blood pressure.

Exercise‐induced sensitisation of stretch‐activated muscle mechanoreceptors? Effects on baroreflex sensitivity in man

Baroreflex (BR) control of blood pressure (BP) and heart rate (HR) is regulated by central command and muscle afferent feedback. The influence of muscle mechanoreflex stimulation on the BR and its possible sensitisation during various levels of concurrent metaboreflex activation was assessed. 10 subjects performed 1.5mins of one-legged isometric plantarflexor exercise at 0, 30, 50 and 70% maximal voluntary contraction to produce incremental increases in BP during post-exercise circulatory occlusion (PECO). 3.5mins of PECO was followed by 3mins of passive calf stretch. Mean (±SEM) arterial pressures at rest were 86 ± 2, 89 ± 3, 93 ± 3 and 94 ± 3 mmHg prior to the 0, 30, 50 and 70% trials, respectively, and during PECO were 88 ± 3, 97 ± 3, 105 ± 3 and 111 ± 3 mmHg, respectively. Regression equations produced by sequence analysis of R-R intervals and systolic BP gave the mean slope values, representing spontaneous BR sensitivity (BRS), shown in the table below. Stretch significantly decreased BRS from both Rest and PECO, irrespective of exercise trial. The decrease in BRS during stretch, in the face of progressive elevations in BP during PECO and hence increased BR activation, might be explained by metabolite sensitisation of stretch-activated muscle mechanoreceptive afferents.

Orthostatic tolerance and spontaneous baroreflex sensitivity in men versus women after 7 days of head-down bed rest

Many factors are involved in the development of orthostatic intolerance after real or simulated weightlessness. The aim of our study was to compare the effects of 7-day head-down bed rest (HDBR) in eight women and eight men on the spontaneous baroreflex sensitivity (standard spectral method and new time–frequency algorithm) during lower body negative pressure (LBNP) tests. Results obtained before HDBR have shown in women, compared to men, higher heart rate, lower blood pressure, higher parasympathetic modulation at rest and greater decrease in baroreflex sensitivity with greater increase in sympathetic activity during LBNP. After HDBR, we observed in both men and women a dramatic decrease in orthostatic tolerance (7.0 min at R+1 vs. 10.0 min, p<0.05, at BDC-1 in men; 5.4 vs. 9.0 min, p<0.05, in women) together with a decrease in plasma volume (−9.1±0.9% in men, −9.5±1.4% in women) and in spontaneous baroreflex sensitivity without gender effect. After HDBR, at the highest level of LBNP, diastolic blood pressure increased in men (+5.6±1.3 mm Hg) and decreased in women (−1.0±2.7 mm Hg) with a gender difference ( p<0.05). This result suggests impaired vasoconstriction in women after HDBR. Neither endocrine response nor alterations to the cardiac baroreflex can explain gender differences in orthostatic tolerance after HDBR as reported by previous studies. Further studies need to be conducted in order to obtain a more precise analysis of gender difference in arteriolar vasoconstriction after HDBR. The time frequency method we developed to study changes in spontaneous baroreflex might be applied to the analysis of LBNP tests.

Exercise-induced muscle chemoreflex modulation of spontaneous baroreflex sensitivity in man.

1. The goal of this study was to determine the effect of exercise-induced muscle chemoreflex activation on baroreflex sensitivity (BRS). This is a retrospective study using data obtained during two prior studies. 2. Twenty-three subjects with a mean (S.E.M.) age of 28 (1.5) years took part in the study. Sequence analysis was performed on the systolic blood pressure (SBP) responses, measured by a Finapres, and R-R intervals, measured from the ECG. 3. Electrically evoked isometric exercise (Stim) of the triceps surae was performed for 2 min at 30 % maximum voluntary contraction force. During exercise and for a further 2 min thereafter, circulation to the lower leg was occluded by inflation of a thigh cuff to above 200 mmHg. 4. Prior to exercise mean (+/- S.E.M.) BRS was 10.92 +/- 6.3 ms mmHg(-1), and BRS remained at this level during evoked exercise (10.90 +/- 7.1 ms mmHg(-1)). BRS increased to 12.34 +/- 6.0 ms mmHg(-1) during post-exercise circulatory occlusion (PECO) (P < 0.05, MANOVA, post hoc Student's paired t test vs. Stim) and fell to 9.27 +/- 4.4 ms mmHg(-1) during recovery (P < 0.01 vs. PECO value, P = 0.059 vs. resting value). 5. These data indicate that during PECO following electrically evoked plantar flexion, where only muscle chemosensitive afferents were likely to be stimulated, BRS was increased.

The effects of gender on adrenergic receptor responsiveness.

This study was conducted to determine whether gender differences exist in adrenergic receptor sensitivity and baroreflex response. Adrenergic receptor sensitivity was assessed by administering sequentially increasing intravenous doses of phenylephrine and isoproterenol. Baroreflex sensitivity was determined from the slope of pulse intervals plotted against phenylephrine-induced rise in systolic blood pressure (SBP). Drug-induced changes in heart rate, blood pressure, and brachial artery diameter were measured and statistically compared. Women required a lower infusion rate of phenylephrine to increase SBP by 20 mmHg from baseline. There were no statistically significant gender-related differences in baroreflex sensitivity. The dose of isoproterenol needed to increase heart rate by 25 beats per minute from baseline also did not differ significantly between groups. Percent changes from baseline in brachial artery diameters in response to phenylephrine also were similar between groups. These data suggest that women may have greater alpha-adrenergic receptor sensitivity than men, whereas beta1-adrenergic receptor sensitivity is similar between genders. A trend toward a greater baroreflex sensitivity in men than in women was also observed. This study also provides evidence for a possible relationship between adrenergic receptor sensitivity and baroreflex sensitivity.

Baroreflex sensitivity in men with recent myocardial infarction; impact of age

We investigated the effect of age on baroreflex sensitivity (BRS) in 39 male patients, who had survived their first myocardial infarction (MI) and in 15 age-matched controls. BRS was inversely related to age in both MI patients (r = -0.632, P < 0.0001) and controls (r = -0.706, P < 0.0001). The relationship between BRS and age, however, was significantly different in MI patients as compared with healthy controls: BRS was markedly higher and the BRS-age regression slope was significantly steeper in controls than in MI patients. As a consequence, the decrease in BRS caused by MI (delta BRS = age-specific expected BRS--measured BRS) was related inversely to age (r = -0.66, P < 0.05) i.e. delta BRS was greatest among young MI patients. However, the relative BRS (BRS% = measured BRS divided by the age-specific expected BRS) did not correlate with age. The average BRS% of MI patients was 37% lower than that of controls. MI size and left ventricular (LV) systolic function did not correlate with BRS. BRS correlated with variables related to cardiac diastolic function (peak late LV filling rate r = -0.43, P < 0.05), exercise capacity (r = 0.31, P < 0.05) and the extent of ST-depression during exercise (r = -0.40, P < 0.05), but all these correlations lost their significance after the adjustment for age. In conclusion, age is a factor that should be taken into consideration when evaluating the mechanisms of BRS impairment associated with different diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

Attenuation by diltiazem of arterial baroreflex sensitivity in man

The effect of oral diltiazem 120 mg, on the responses to baroreflex activation and deactivation by phenylephrine and nitroglycerin, respectively, were investigated in normotensive subjects, with simultaneous measurement of plasma catecholamine levels. Diltiazem significantly reduced the tachycardia induced by bolus injections of nitroglycerin and abolished the concomitant increase in plasma noradrenaline. It also significantly decreased the bradycardiac response to phenylephrine infusion. Diltiazem reduced, although not significantly so, the bradycardia induced by boluses of phenylephrine. The overall reduction in baroreflex sensitivity, which might contribute to the limited tachycardiac effect of diltiazem in man, is consistent with the drug-induced attenuation of the sympathetic and also of the parasympathetic components of the baroreceptor reflex.

The Effect of Mental Arithmetic on Blood Pressure Variability and Baroreflex Sensitivity in Man

1. Baroreflex sensitivity was tested in three normal, three borderline and one hypertensive subject before and during mental arithmetic, the prolongation of pulse interval caused by a provoked rise in blood pressure being used as a measure of baroreflex sensitivity. 2. Baroreflex sensitivity was significantly decreased during mental arithmetic. 3. During mental arithmetic the arterial pressure fluctuated markedly. 4. These findings suggest that in man, as well as animals, the defence of alerting reaction depresses baroreflex control and thus contributes to the rise in blood pressure seen at this time.

Effect of age and high blood pressure on baroreflex sensitivity in man.

The purpose of this study was to relate baroreflex sensitivity to age and arterial pressure in 61 male and 20 female untreated subjects, aged 19-66 years, whose mean arterial pressures ranged from 70 to 150 mm Hg. In this selected group of subjects there was no correlation between age and arterial pressure. The index of sensitivity used was the increase in pulse interval which occurs reflexly in response to a rise in systolic pressure induced by the intravenous injection of phenylephrine and is measured as the increase in pulse interval in milliseconds per mm Hg rise in systolic blood pressure. It ranged from 1.9 to 48.9 msec/mm Hg. Increasing age and arterial pressure act independently to reduce baroreflex sensitivity. Eight subjects who had normal blood pressure at the time of testing but whose pressure had been elevated in the past, had reflex sensitivities significantly less than expected in persons of the same age and mean arterial pressure. The heart rate in these subjects was not significantly different from that in the controls; the heart rate of the 12 hypertensive subjects aged under 40 years was significantly faster than that of age-matched normotensive subjects but not that of older hypertensive subjects.