Morning surge, pulse wave velocity, and autonomic function tests in elderly adults
OBJECTIVE: To assess the complex interplay between morning surge (MS), the autonomic reflex response at the cardiovascular level, and target organ damage (arterial stiffening, left ventricle hypertrophy). METHODS: Fifty-nine consecutive elder patients (>65 years old) underwent a 24-h ambulatory b...
| Autores: | , , , |
|---|---|
| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2012 |
| País: | Argentina |
| Institución: | Consejo Nacional de Investigaciones Científicas y Técnicas |
| Repositorio: | CONICET Digital (CONICET) |
| Idioma: | inglés |
| OAI Identifier: | oai:ri.conicet.gov.ar:11336/67496 |
| Acceso en línea: | http://hdl.handle.net/11336/67496 |
| Access Level: | acceso abierto |
| Palabra clave: | Arterial Stiffness Autonomic Tests Blood Pressure Variability Left Ventricular Hypertrophy Morning Surge Pulse Wave Velocity https://purl.org/becyt/ford/3.2 https://purl.org/becyt/ford/3 |
| Sumario: | OBJECTIVE: To assess the complex interplay between morning surge (MS), the autonomic reflex response at the cardiovascular level, and target organ damage (arterial stiffening, left ventricle hypertrophy). METHODS: Fifty-nine consecutive elder patients (>65 years old) underwent a 24-h ambulatory blood pressure monitoring. Pulse wave velocity (PWV) was measured as an indicator of arterial stiffness. Autonomic status was assessed by scoring five conventional tests [handgrip, orthostatic pressor response, Valsalva maneuver, heart rate variation during deep breathing ('I:E'), and immediate heart rate response to standing ('30 : 15')]. RESULTS: (a) MS was correlated to left ventricle mass (P<0.005), the orthostatic pressor response (P<0.02), and blood pressure variability (BPVar) (P<0.0001) (n=59). (b) PWV explained 61.4% of MS variation for MS values 40 mmHg or less (84% of patients) (P<0.03, n=49) and 38% of MS variation in nondippers (P<0.04, n=25). (c) There were sex-related differences. PWV was associated with the orthostatic pressor response (P<0.02), 'I:E' values (P<0.04) and the '30 : 15' test (P<0.04) in men (n=14). In women (n=41), the 'I:E' values were associated with MS and BPVar (P<0.003). CONCLUSION: MS was closely related to PWV (arterial stiffening) and BPVar in a small urban sample of cardiovascular patients. MS was also associated with dysautonomia (orthostatic blood pressure/heart rate response to challenges), mostly with impaired parasympathetic modulation. MS and high BPVar cause left ventricular hypertrophy, whereas arterial stiffness alters baroreceptor sensitivity, which in turn affects BPVar, perpetuating a vicious cycle. These findings, although obtained in a small number of participants, provide relevant information not yet available in the local databases. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins. |
|---|