Systolic Blood Pressure Fluctuations Research Articles

Cardiovascular fluctuations and transfer function analysis in stable preterm infants.

To examine the baroreceptor reflex function, a beat-to-beat analysis between systolic blood pressure (SBP) and R-R interval fluctuations was studied in 10 stable appropriate-for-gestational age preterm infants (range, 27.2-33.7 wk) in the first postnatal week during quiet sleep. Spectral power analysis, using fast Fourier transform, and transfer functions (gain and phase difference) between SBP and R-R fluctuations were estimated in a low-frequency band (LF, 0.03-0.2 Hz) and high-frequency band (HF defined as the frequency band between the 10th and 90th centiles of the individual respiratory frequency). The LF/HF ratio reflects the sympathovagal balance. The mean frequency (+/-SD) of LF peaks was centered at 0.07 +/- 0.02 Hz. The mean frequency (+/-SD) of the individual HF band was 0.82 +/- 0.21 Hz. The LF/HF ratio in the R-R interval series [median, 29; interquartile range (IQR), 16-40] was higher than in the SBP series (median, 8; IQR, 4-14). The gain between R-R interval and SBP fluctuations (median, 4.2 ms/mm Hg; IQR, 2.4-5.0) in the LF band was higher than in the HF band (median, 1.7 ms/mm Hg; IQR, 1.4-3.0). SBP fluctuations lead R-R interval fluctuations in the LF band with a median phase difference of +96 degrees (IQR, 67-132). At LF the fluctuations in SBP precede changes in R-R interval with a time delay of 3.8 s. These observations indicate a dominant role of the sympathetic system in stable preterm infants in comparison with published adult values. Cross-spectral analysis allows a test for tracking the development of the sympathetic system in neonates.

Cardiac baroreflex control in humans during and immediately after brief exposure to simulated high altitude.

To examine the baroreflex response in humans during and immediately after acute hypoxia exposure, the cardiac baroreflex sensitivity (BRS) was studied using adaptation of RR intervals in response to spontaneous systolic blood pressure fluctuations (sequences methodology) in 11 unacclimatized subjects. All measurements were made under fixed breathing rate, and realized consecutively at baseline level (20 min), at an inspired oxygen concentration of 11% (15 min) and again under normoxic conditions (20 min; recovery period). The spontaneous baroreflex response decreases progressively during hypoxic exposure, causing a tachycardic response at this FiO2 without any significant alteration of the systolic or diastolic blood pressure. The magnitude of decrease for this variable at the end of exposure averaged 42.9 +/- 15.6%. The simultaneous spectral analysis of heart rate (HR) variability in hypoxic condition confirmed an alteration in the parasympathetic activity (HFnu: -17.8 +/- 30.9% versus basal conditions, P < 0.01) counterbalanced by an exaggerated sympathetic activity (LFnu: +33 +/- 42.4%, P < 0.05) at the sinus node. Interestingly, we could observe an enhanced cardiac baroreflex response during the period following the inhalation of the hypoxic mixture (+130.6 +/- 15.6% of basal conditions, P < 0.001). There is a relationship with a significant and abrupt increase in the parasympathetic control of HR (mean HR reached 111 +/- 8.1% of the mean basal HR, P < 0.01). These results suggest that brief exposure to hypoxia under rate-controlled ventilation is associated with a significant alteration in the spontaneous cardiac baroreflex. This important cardiac autonomic imbalance is followed by a significant increase in the cardiac parasympathetic drive even after the disappearance of the hypoxic stimulus.

Advanced analysis of spontaneous baroreflex sensitivity, blood pressure and heart rate variability in patients with dilated cardiomyopathy

Baroreflex sensitivity (BRS) is an important parameter in the classification of patients with reduced left ventricular function. This study aimed at investigating BRS in patients with dilated cardiomyopathy (DCM) and in healthy subjects (controls), as well as comparing the values of BRS parameters with parameters of heart rate variability (HRV) and blood pressure variability (BPV). ECG, continuous blood pressure and respiration curves were recorded for 30 min in 27 DCM patients and 27 control subjects. The Dual Sequence Method (DSM) includes the analysis of spontaneous fluctuations in systolic blood pressure and the corresponding beat-to-beat intervals of heart rate to estimate bradycardic, opposite tachycardic and delayed baroreflex fluctuations. The number of systolic blood pressure/beat-to-beat interval fluctuations in DCM patients was reduced in comparison with controls (DCM patients: male, 154.4+/-93.9 ms/mmHg; female, 93.7+/-40.5 ms/mmHg; controls: male, 245.5+/-112.9 ms/mmHg; female, 150.6+/-55.8 ms/mmHg, P<0.05). The average slope in DCM patients was lower than in controls (DCM, 5.3+/-1.9 ms/mmHg; controls, 8.0+/-5.4 ms/mmHg; P<0.05). Discriminant function analysis showed that, in the synchronous range of the standard sequence method, the DCM and control groups could be discriminated to only 76% accuracy, whereas the DSM gave an improved accuracy of 84%. The combination of six parameters of HRV, BPV and DSM gives an accuracy of classification of 96%, whereas six parameters of HRV and BPV could separate the two groups to only 88% accuracy. Thus the DSM leads to an improved characterization of autonomous regulation in order to differentiate between DCM patients and healthy subjects. BRS in DCM patients is significantly reduced and apparently less effective.

Acute and chronic alterations in blood pressure variability following experimental subarachnoid haemorrhage

This study examined the role of the renin–angiotensin and vasopressin systems on systolic blood pressure (SBP) variability following subarachnoid haemorrhage (SAH) in conscious rats. Animals received no treatment, the angiotensin II AT1 receptor antagonist, losartan, or the vascular vasopressin receptor antagonist, AVPX. SAH resulted in a transient sympathetic activation as estimated from the increase in the mid-frequency oscillations of SBP (3.2±0.8 mm Hg 2, 3 hours after the injury vs. 1.3±0.3 mm Hg 2 in control conditions, p<0.01). On the second and fourth day following SAH, a marked elevation in the low-frequency component of SBP was observed (7.1±1.0 mm Hg 2 on day 2 vs. 2.6±0.3 mm Hg 2 in control conditions, p<0.001 and 6.3±1.1 mm Hg 2 on day 4 vs. 2.6±0.3 mm Hg 2 in control conditions, p<0.01). Pre-treatment with losartan prevented the acute rise in the mid-frequency oscillations in SBP and partially reduced the low-frequency component observed at 2 and 4 days. Administration of AVPX on the second and fourth day following SAH normalised the elevated low-frequency oscillations in SBP. This study indicates that the modifications in SBP variability observed in the early and delayed stage after subarachnoid haemorrhage involve angiotensin II. Vasopressin seems to be implicated in the delayed development of low-frequency fluctuations of SBP.

Pathophysiological interactions of ventilation, arousals, and blood pressure oscillations during cheyne-stokes respiration in patients with heart failure.

Arousals from sleep can be associated with increases in blood pressure (BP). However, it is uncertain whether this is due to a direct effect of arousals on BP, or is secondary to respiratory stimuli present at the time of the arousal. Cheyne-Stokes respiration (CSR) in patients with congestive heart failure (CHF) provides unique conditions that may allow these two possibilities to be distinguished. In CSR, the apnea-hyperpnea cycle can be dissociated from arousals because when CSR occurs during wakefulness, it does so in the absence of arousals, and when it occurs during sleep, arousals occur either at the termination of apnea (early arousals) or several breaths after the onset of hyperpnea (late arousals). We therefore measured BP during wakefulness and non-rapid eye movement (NREM) sleep in eight patients with CHF and CSR. During wakefulness, CSR was associated with wide fluctuations in systolic BP (mean +/- SD, 11.3 +/- 6.0 mm Hg) synchronous with the apnea-hyperpnea cycle, in the absence of arousals. Similar fluctuations in BP were observed during CSR with early arousals (13. 7 +/- 7.0 mm Hg) in NREM sleep. However, late arousals during CSR were associated with a small, but significant additional effect on systolic BP (14.2 +/- 7.1 mm Hg, p < 0.05). Furthermore, the degree of BP increase following arousals was directly related to the associated increase in ventilation (r = 0.70, p < 0.05). We conclude that BP fluctuations during CSR in patients with CHF are primarily related to oscillations in ventilation during the CSR cycle and can occur in the absence of arousals. Arousals augment these BP oscillations, but only when they occur late in hyperpnea.

Cardiocirculatory coupling during sinusoidal baroreceptor stimulation and fixed-frequency breathing

The question of whether respiratory sinus arrhythmia (RSA) originates mainly from a central coupling between respiration and heart rate, or from baroreflex mechanisms, is a subject of controversy. If there is a major contribution of baroreflexes to RSA, cardiocirculatory coupling during breathing and during cyclic baroreflex stimulation should show similarities. We applied a sinusoidal stimulus to the carotid baroreceptors and generated heart rate fluctuations of the same magnitude as RSA with a frequency similar to, but different from, the breathing frequency (0.2 Hz, compared with 0.25 Hz), and at 0.1 Hz, in 17 supine healthy subjects (age 28-39 years). The data were analysed using discrete Fourier-transform and transfer function analysis. Respiratory fluctuations in systolic blood pressure preceded RSA with a time lag equal to that between baroreceptor stimulation and oscillations in RR interval (0.62+/-0.18 s compared with 0.57+/-0.28 s at 0.2 Hz neck suction). The response of systolic blood pressure to neck suction at 0.2 Hz was 5 times less than the respiratory blood pressure fluctuations. Neck suction at 0.1 Hz largely increased fluctuations in blood pressure and RR interval, whereas the spontaneous phase relationship between blood pressure and RR interval remained unchanged. Our results are not consistent with the hypothesis that the origin of RSA is predominantly a central phenomenon which secondarily generates fluctuations in blood pressure, but suggest that, under the condition of fixed-frequency breathing at 0.25 Hz, baroreflex mechanisms contribute to respiratory fluctuations in RR interval.

Walking 10,000 steps/day or more reduces blood pressure and sympathetic nerve activity in mild essential hypertension.

We investigated the effects of walking 10,000 steps/day or more on blood pressure and cardiac autonomic nerve activity in mild essential hypertensive patients. All subjects were males aged 47.0+/-1.0 (mean+/-SEM) years old. The original cohort consisted of 730 people in a manufacturing industry who measured the number of steps they walked each day using a pedometer. Eighty-three of these subjects walked 10,000 steps/day or more for 12 weeks. Thirty-two of these were hypertensives with systolic blood pressure (SBP) greater than 140 mmHg and/or diastolic blood pressure (DBP) greater than 90 mmHg. Thirty of these hypertensive subjects (HT) were examined twice, once during the pre- and once during the post-study period, for body mass index (BMI), maximal oxygen intake (Vo2max), blood pressure, heart rate (HR), and autonomic nerve activity by power spectral analysis of SBP and HR variability. In the HT group, walking 13,510+/-837 steps/day for 12 weeks lowered blood pressure (from 149.3+/-2.7/98.5+/-1.4 to 139.1+/-2.9/90.1+/-1.9 mmHg; p<0.01, respectively). In both the 34 normotensive controls and 17 hypertensive sedentary controls, blood pressure did not change. Walking also significantly lowered low-frequency fluctuations in SBP as an index of sympathetic nerve activity, from 1.324+/-0.192 to 0.738+/-0.154 mmHg2/Hz (p<0.05). VO2max rose significantly from 26.1+/-2.4 to 29.5+/-2.5 ml/kg/min (p<0.05). There were no changes in parasympathetic nerve activity, baroreceptor reflex sensitivity, or BMI. Our results indicate that walking 10,000 steps/days or more, irrespective of exercise intensity or duration, is effective in lowering blood pressure, increasing exercise capacity, and reducing sympathetic nerve activity in hypertensive patients.

Diminished vasomotor component of systemic arterial pressure signals and baroreflex in brain death.

We compared the cardiovascular autonomic regulatory mechanisms between patients with brain death or under a persistent vegetative state and healthy volunteers, based on auto- and cross-spectral analysis of systolic blood pressure (SBP) and interpulse interval (PPI) signals. Brain-dead patients exhibited a significant reduction in the absolute and relative power of the low-frequency (LF; 0.04-0.15 Hz) component in both SBP and PPI spectra, along with appreciable decrease in the very low frequency (VLF; 0.004-0.04 Hz), LF, and high-frequency (HF; 0.15-0.4 Hz) power of the PPI signals. Patients in a persistent vegetative state exhibited a power of the VLF and LF component in the SBP spectrum that was comparable to that in healthy subjects, although a discernible reduction in the VLF, LF, and HF power of the PPI spectrum was manifested by the former group. Assessments with the magnitude of SBP-PPI transfer function and linear regression analysis of beat-to-beat fluctuations in SBP and PPI revealed a progressive decline in spontaneous baroreflex sensitivity from healthy subjects to patients in a persistent vegetative state or with brain death. We conclude that the vasomotor component of systemic arterial pressure signals and spontaneous baroreflex are highly correlated with the functional integrity of the brain stem.

Vector autoregressive modeling for analyzing feedback regulation between heart rate and blood pressure.

We present a noninvasive technique for analyzing the feedback relationship between short-term fluctuations in blood pressure (BP) and heart rate (HR) in humans. Beat-to-beat BP was monitored for several minutes with a noninvasive BP measuring device, i.e., arterial tonometry, in 16 healthy subjects and 15 patients on hemodialysis (HD), and the recorded systolic BP (SBP) and the pulse wave interval (R-R interval) were fitted to vector autoregressive models according to Akaike's method. The impulse-response function was then simulated to determine the contribution of changes in R-R interval or SBP to the fluctuation of SBP or R-R interval along a time scale. In healthy subjects, when a simulated 1-mmHg impulse was applied to SBP, the R-R interval increased to approximately 3.5 ms with a delay of several beats. In HD patients the same impulse caused essentially no response in the R-R interval. A 1-ms impulse applied to the R-R interval decreased SBP, and the response was not different in healthy subjects and HD patients. In the R-R interval-to-R-R interval response and the SBP-to-SBP response, the exponential-like decay after the initial jump was more rapid in the HD patients than in the healthy subjects. The results demonstrated that this technique can provide information on the feedback regulation between fluctuations in BP and HR in patients with or without autonomic nervous system dysfunction. This technique provides a simple and practical way to estimate autonomic function in clinical medicine.

Contribution of humoral systems to the short-term variability of blood pressure after severe hemorrhage.

The aim of this study was to generate hemorrhage-triggered fluctuations in blood pressure (BP) at low frequency (LF, < 0.2 Hz) in conscious rats and investigate with spectral analysis the relative roles of hemorrhage-activated catecholamines, the renin-angiotensin system (RAS), and arginine vasopressin (AVP) on the generation of these fluctuations. The individual contribution of these factors was assessed using a combination of the selective antagonists, prazosin, losartan, and Manning compound (AVPX). At rest, systolic BP (SBP) LF fluctuations were slightly increased by losartan. The mid-frequency (MF; 0.2-0.6 Hz) oscillations of SBP and diastolic BP (DBP) were decreased by prazosin alone or associated with AVPX or losartan. The high-frequency (HF; respiratory) oscillations of SBP were increased by prazosin, prazosin plus losartan, and prazosin plus AVPX. After severe hemorrhage (20 ml/kg), the spontaneous BP recovery was characterized by the occurrence of slow fluctuations of SBP and DBP, centered approximately 0.065 Hz, and by increases of MF (89%) oscillations of SBP. The HF component of SBP variability tended to be increased by blood loss. The occurrence of the SBP LF fluctuations was prevented when alpha 1-adrenergic activity was blocked by prazosin. These oscillations were always present, despite inhibition of angiotensin II, and were increased after inhibition of the AVP activity. Pretreatment with the specific inhibitors used in these studies favored the amplifying effect of hemorrhage on HF fluctuations while they prevented the postbleeding increase in MF oscillations. In conclusion, the present results show an association between the dependence of the postbleeding blood pressure level on catecholamines and the occurrence of slow fluctuations of BP. The buffering role of AVP suggests the establishment of a hierarchy between humoral systems in the genesis of the LF oscillations of BP, with the slow oscillations being generated by the main pressor system and being dampened by the other systems. The postbleeding rise in the MF component of SBP variability could be considered a reflection of the activations of both the sympathetic vasomotor drive and the RAS. The postbleeding increase in the HF component of BP variability was dampened by the activation of the humoral systems. These effects may reflect the low preload state due to hypovolemia.

AUTOREGRESSIVE ANALYSIS OF ECG R-R INTERVALS AND BLOOD PRESSURE IN A SEVERE ASTHMA ATTACK CHILD

Changes in ECG R-R intervels (RR) and blood pressure were assessed by the autoregressive power spectral analysis method in a bronchial asthma patient (severe type: nine years old boy). We studied that there were two spontaneous oscillations of RR and blood pressure. Low frequency (LF: less than 0.1cycle/beat) fluctuations of RR are known to be mediated by the parasympathetic and β-adrenergic nervous system, while high frequency (HF: 0.1-0.5cycle/beat) are mediated by the parasympathetic nervous system. And LF fluctuations of systolic blood pressure (SYS) are mediated by the α-adrenergic nervous system.In this case, LF power of RR decreased, while HF power of RR and LF power of SYS increased at severe attack. The results suggested that β-adrenergic nervous system activity decreased and α-adrenergic and parasympathetic nervous system activity increased in asthma attack.

The mechanism of blood pressure variability. Study in patients with fixed ventricular pacemaker rhythm.

Several studies have shown that heart rate variability plays an anti-oscillatory role in the regulation of blood pressure variability in humans. We tested whether systolic blood pressure variability in patients with a fixed ventricular pacemaker rhythm differs from that in patients with sinus rhythm. In 18 patients with a fixed ventricular pacemaker rhythm and in ten age-matched patients with sinus rhythm the systolic blood pressure oscillation and the low and high-frequency spectral components of systolic blood pressure were studied in the resting supine position during spontaneous breathing and during forced deep ventilation of 6 cycles.min-1. Patients with a pacemaker had a higher amplitude of systolic blood pressure oscillation than control subjects during spontaneous breathing (13.5 +/- 2.0 mmHg vs 6.4 +/- 1.6 mmHg, P = 0.035), and a slight but not significant difference also persisted during forced deep ventilation 19.0 +/- 2.3 mmHg vs 15.0 +/- 2.3 mmHg, P = 0.18). The increment in systolic blood pressure fluctuation from spontaneous breathing to forced deep ventilation was less marked in the pacemaker group than in the control subjects (40% vs 130%, P = 0.43). Although all the systolic blood pressure spectral components of the pacemaker patients were higher during both spontaneous breathing and forced deep ventilation, the differences between the two groups did not reach statistical significance. Our observations in patients with a fixed ventricular pacemaker rhythm suggest that the mechanical effects on the intrathoracic vessels and the consecutive stroke volume changes are responsible for respiration-related systolic blood pressure oscillation and reflex systolic blood pressure changes.

Spectral analysis of the systolic blood pressure signal in secondary hypertension

To seek in hypertensive patients rhythmic variations of the systolic blood pressure signal obtained by ambulatory blood pressure monitoring of any inherent cycle of intermediate value between 1 and 24 h. Subjects (62 hypertensive, 39 normotensive) were evaluated by 24-h ambulatory blood pressure monitoring. The hypertensive group consisted of 48 patients with essential hypertension, nine with renovascular hypertension and five with phaeochromocytoma. The groups were matched for age and weight. The ambulatory systolic blood pressure recording served as the input for a filtering procedure that rejected unacceptable values according to predetermined criteria. The whole-day systolic blood pressure series thus obtained were subjected to Fourier analysis to obtain a spectral analysis of daily systolic blood pressure fluctuations. Daily (first 12 h), nightly (second 12 h) and whole-day average systolic blood pressure values were calculated and compared for the various groups. The average nocturnal systolic blood pressure was found to be lower than its daily counterpart in the normal subjects and in the patients with essential hypertension, whereas in the patients with renovascular hypertension or phaeochromocytoma no such nocturnal decrease was found. The power spectrum of patients with phaeochromocytoma was statistically different from that of other aetiologies of hypertension. This was achieved due mainly to a statistically significant difference in the power spectrum integral over the low-frequency band (0-0.2 cycles/h) of the power spectrum of the 24-h systolic blood pressure signal. Resection of the phaeochromocytoma normalized the power spectrum as found by analysis of the postoperative ambulatory blood pressure monitoring data in two patients who underwent a repeat recording. The technique described enables the discrimination of patients with phaeochromocytoma as a cause of hypertension from other aetiologies of hypertension. Patients with renovascular hypertension could not be distinguished from those with essential hypertension on the basis of their power spectrum. However, this technique may prove to be a valuable modality for characterizing hypertensive patients of different aetiologies.

The hypotensive effect of nisoldipine: 24-hour blood pressure profile and serial alterations of renal and hormonal function

To investigate its hypotensive effect and mechanism of action, a long-acting calcium channel blocker, nisoldipine, was administered once daily for 12 days to eight subjects with essential hypertension. Daily changes in blood pressure and heart rate, as well as serial alterations in renal and hormonal function, were investigated. Nisoldipine significantly reduced systolic blood pressure (SBP) and diastolic blood pressure (DBP) on days 2 and 12 of treatment (daytime SBP: from 161.6 ± 4.0 mmHg to 141 ± 6.1 mmHg and 131.1 ± 4.7 mmHg, respectively; daytime DBP: from 100.4 ± 3.1 mmHg to 90.1 ± 4.8 mmHg and 81.8 ± 4.0 mmHg; nocturnal SBP: from 151.2 ± 3.6 mmHg to 132.0 ± 2.0 mmHg and 121.6 ± 1.6 mmHg; and nocturnal DBP: from 91.9 ± 1.0 mmHg to 81.3 ± 1.1 mmHg and 77.1 ± 1.1 mmHg). The extent of fluctuation of SBP and DBP, as indicated by the standard error of the mean (SEM) calculated from the blood pressures of each subject, was significantly increased on day 2. There was a moderate increase in heart rate on day 2 and it returned to the pretreatment level on day 12. Urinary sodium excretion was transiently increased on day 4, and body weight decreased significantly after administration of nisoldipine. Plasma renin activity and urinary norepinephrine level were increased significantly on day 6 and returned to baseline on day 12. These results suggest that once-daily administration of nisoldipine decreases blood pressure quite rapidly and that stable blood pressure control is obtained within 2 weeks. The antihypertensive mechanism of this drug may be partly related to a reduction of baroreceptor sensitivity and a reduction of total body water and sodium, as well as to its direct vasodilatory action.

Role of the autonomic nervous function in systolic blood pressure fluctuation studied with tonometry

Role of the autonomic nervous function in systolic blood pressure fluctuation studied with tonometry

Short‐term variability of systolic blood pressure and heart rate in normotensive subjects

Short-term fluctuations in systolic blood pressure (SBP) and heart rate (HR) and their inter-relationship were analysed in a group of normotensive middle-aged men (n = 16) using a multivariate autoregressive modelling technique. This study is the first to evaluate the beat-to-beat variability of SBP and HR in a group of real normotensive subjects. Direct intra-arterial blood pressure was registered together with ECG using an ambulatory tape recording technique (the Oxford method). Power spectrum density estimated (PSD) were used as a measure of the variability. PSDs were calculated over 3-min periods for four basic physiological conditions: during sleep and in the supine, sitting and standing positions. The inter-relationship between the blood pressure and heart rate variabilities was analysed using a closed-loop model. In agreement with results presented earlier in the literature, the beat-to-beat variation in SBP and HR was concentrated in three typical power spectrum regions: the high-frequency (HF = 0.15-0.35 Hz) region (respiration), the mid-frequency (MF = 0.075-0.15 Hz) region (vasomotor oscillation) and the low-frequency (LF = 0.02-0.075 Hz) region (thermoregulation). The variability changes considerably between different situations, especially that of the MF region. The variability was most prominent in the MF region and in the standing position. The variability was generally smallest in the HF region and in sleep. The results also demonstrate that the beat-to-beat variability in SBP and HR can considerably affect one another.

Spectral analysis of blood pressure and heart rate in conscious rats: effects of autonomic blockers

We investigated the fluctuations which underly the spontaneous variability of blood pressure and heart rate in conscious rats. Intrafemoral blood pressure was computed to generate evenly spaced signals (systolic, diastolic, mean blood pressure, heart rate) at 200 ms intervals. This equidistant sampling allowed a direct spectral analysis using a Fast Fourier Transform algorithm. Systolic blood pressure and heart rate exhibited low-frequency oscillations (Mayer waves, 20–605 mHz) and a high- frequency oscillation related to respiration (1855 mHz). The respiratory fluctuations in heart rate were almost abolished by vagal blockade (atropine). Heart rate fluctuations in the low-frequency regime were diminished by vagal blockade or cardiac sympathetic blockade (atenolol). The respiratory frequency fluctuations in systolic blood pressure were markedly increased by α-sympathetic blockade (prazosin). In contrast, the low-frequency oscillations in systolic blood pressure were reduced by α-sympathetic blockade. These data indicate that in conscious rats: (1) the heart rate oscillation with respiration is vagally mediated; (2) the heart rate fluctuation in the low-frequency range is jointly mediated by β-sympathetic and parasympathetic activities; (3) the respiratory oscillation in systolic blood pressure depends on fluctuations in cardiac output and is normally counteracted by the sympathetic tone; (4) the low-frequency oscillations in systolic blood pressure reflect the sympathetic activity to the resistance vessels.

ASSAY OF URINARY CATECHOLAMINES IN PATIENTS TREATED WITH MUSCLE RELAXANT DRUGS

Increased output of urinary total free catecholamines assayed by the trihydroxyindole method has been found in patients suffering from tetanus treated with pancuronium. These increases did not correlate with elevations or fluctuations in systolic blood pressure. Total free catecholamines were decreased or undetected in the urines of patients with tetanus treated for a prolonged period with large doses of tubocurarine. Recovery of noradrenaline added to the urine of these patients was either diminished or absent. Tubocurarine added to normal urine in concentrations up to 100 μg per μg of noradrenaline did not interfere with the fluorimetric estimation of noradrenaline. It is suggested mat the prolonged administration of tubocurarine to patients with tetanus leads to the development of a factor which interferes with the production of catecholamines and prevents the detection of catecholamine fluorimetrically in the urine.

Systolic blood-pressure fluctuations with sex, anger and fear.

Systolic blood-pressure fluctuations with sex, anger and fear.

EXPERIMENTAL ATHEROSCLEROSIS AND BLOOD PRESSURE IN THE RABBIT

1. Van Leersum's range for the normal blood pressure in the rabbit, as recorded by his method, is confirmed. 2. Van Leersum's conclusion concerning the influence of a liver diet on the blood pressure of the rabbit is not substantiated by his data, since the fluctuations of blood pressure he obtained do not surpass his own recorded figures for normal animals. 3. Fluctuations of systolic blood pressure beyond the "normal" range are not necessary for the production of experimental atherosclerosis of the aorta in rabbits. Inversely, egg yolk feeding experiments in rabbits in which atherosclerosis of varying degree, even extreme, is obtained, are not accompanied by an elevation of blood pressure outside the "normal" range. 4. The fluctuations of blood pressure observed during experimental atherosclerosis do not simulate the condition of essential hypertension in man.