Applicability of new techniques in the assessment of arterial baroreflex sensitivity in the elderly: a comparison with established pharmacological methods.
1. There has been considerable interest in techniques recently developed for the study of arterial baroreceptor-cardiac reflex sensitivity based on analysis of spontaneous baroreflex sequences and on spectral analysis. This study examined how these newer techniques agreed with the established pharmacological methods in elderly subjects. 2. In 20 elderly subjects [10 hypertensive (clinic blood pressure 180 +/- 4/88 +/- 2 mmHg) and 10 normotensive (clinic blood pressure 136 +/- 3/73 +/- 2 mmHg)], we assessed baroreflex sensitivity from spontaneous sequences of increasing and decreasing blood pressure and pulse interval and their mean, and from spectral analysis to derive alpha, the index of overall baroreflex gain. Pharmacological baroreflex sensitivity was derived from the blood pressure and pulse interval responses to depressor (sodium nitroprusside) and pressor (phenylephrine) stimuli, and their mean. 3. Baroreflex sensitivity was significantly lower in the hypertensive group by the pharmacological, sequence and spectral methods (all P < 0.05). 4. There was acceptable agreement between pharmacological baroreflex sensitivity and sequences of the same direction, but with some systematic bias. There was also reasonable agreement between pharmacological and spectral baroreflex sensitivity and close agreement without bias between sequence and spectral methods. 5. The newer and established techniques demonstrate acceptable agreement in the elderly, albeit with some systematic bias. Pharmacological methods have enjoyed historical precedence but newer techniques give equivalent results, and are preferable in some circumstances. The newer techniques may be more descriptive of the spontaneous behaviour of the arterial baroreflex at rest rather than under artificially stimulated conditions.
James
M A
MA
University Department of Medicine for the Elderly, Glenfield Hospital, Leicester, U.K.
Panerai
R B
RB
Potter
J F
JF
D000368:Aged; D017704:Baroreflex / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology; D004562:Electrocardiography; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008875:Middle Aged; D009599:Nitroprusside; D010656:Phenylephrine; D011674:Pulse; D012815:Signal Processing, Computer-Assisted; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents
D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D009599:Nitroprusside; D010656:Phenylephrine