TY - JOUR
T1 - Nocturnal cardiovascular activity in essential hypotension
T2 - Evidence of differential autonomic regulation
AU - Covassin, Naima
AU - De Zambotti, Massimiliano
AU - Cellini, Nicola
AU - Sarlo, Michela
AU - Stegagno, Luciano
PY - 2012
Y1 - 2012
N2 - Objective: Essential hypotension represents a form of chronic low blood pressure (BP) not explained by medical or orthostatic conditions. The pathogenesis of essential hypotension may involve sympathetic hypoactivation and other forms of autonomic dysregulation. The aim of the current study was to investigate autonomic and cardiovascular activity during sleep in individuals with essential hypotension. Methods: A case-control study was conducted in 14 individuals with essential hypotension (mean [standard error] = 23.4 [0.6] years, all women) and 14 controls (mean [standard error] age = 22.2 [0.4] years, all women). The following measures were collected over a night of sleep: BP, heart rate (HR), stroke volume, cardiac output (CO), preejection period (PEP), total peripheral resistance, and time-domain measures of HR variability. Results: Hypotensive participants had consistently lower BP, HR, and CO than did normotensives. Cardiac autonomic variables revealed enhanced parasympathetic tone (proportion of adjacent normal-to-normal intervals that differed in length by more than 50 milliseconds = 40.8 [6.3] versus 23.4 [4.5], p = .03) and reduced sympathetic drive in hypotensives (PEP = 99.4 [3.6] versus 86.1 [4.3], p = .02). Analysis of temporal profiles showed that HR, stroke volume, and CO decreased throughout the night in both groups, whereas PEP and HR variability increased. Unlike controls, BP remained essentially unchanged in hypotensives, as the decrease in CO was counterbalanced by a parallel rise in total peripheral resistance. Conclusions: These findings suggest that nocturnal cardiac sympathetic withdrawal combined with vagal hyperactivity is a characteristic of the autonomic regulation in essential hypotension.
AB - Objective: Essential hypotension represents a form of chronic low blood pressure (BP) not explained by medical or orthostatic conditions. The pathogenesis of essential hypotension may involve sympathetic hypoactivation and other forms of autonomic dysregulation. The aim of the current study was to investigate autonomic and cardiovascular activity during sleep in individuals with essential hypotension. Methods: A case-control study was conducted in 14 individuals with essential hypotension (mean [standard error] = 23.4 [0.6] years, all women) and 14 controls (mean [standard error] age = 22.2 [0.4] years, all women). The following measures were collected over a night of sleep: BP, heart rate (HR), stroke volume, cardiac output (CO), preejection period (PEP), total peripheral resistance, and time-domain measures of HR variability. Results: Hypotensive participants had consistently lower BP, HR, and CO than did normotensives. Cardiac autonomic variables revealed enhanced parasympathetic tone (proportion of adjacent normal-to-normal intervals that differed in length by more than 50 milliseconds = 40.8 [6.3] versus 23.4 [4.5], p = .03) and reduced sympathetic drive in hypotensives (PEP = 99.4 [3.6] versus 86.1 [4.3], p = .02). Analysis of temporal profiles showed that HR, stroke volume, and CO decreased throughout the night in both groups, whereas PEP and HR variability increased. Unlike controls, BP remained essentially unchanged in hypotensives, as the decrease in CO was counterbalanced by a parallel rise in total peripheral resistance. Conclusions: These findings suggest that nocturnal cardiac sympathetic withdrawal combined with vagal hyperactivity is a characteristic of the autonomic regulation in essential hypotension.
KW - autonomic nervous system
KW - blood pressure
KW - heart rate variability
KW - hypotension
KW - impedance cardiography
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U2 - 10.1097/PSY.0b013e318272db69
DO - 10.1097/PSY.0b013e318272db69
M3 - Article
C2 - 23107844
AN - SCOPUS:84870238312
SN - 0033-3174
VL - 74
SP - 952
EP - 960
JO - Psychosomatic Medicine
JF - Psychosomatic Medicine
IS - 9
ER -