EVAluation of the prognostic value of BARoreflex sensitivity in hypertensive patients: the EVABAR study.
OBJECTIVE
The prognostic value of baroreflex sensitivity in hypertensive patients has not much been studied.


METHODS
A cohort of 451 hypertensive patients without cardiovascular history was studied for an average of 6.2 +/- 2.8 years follow-up. Each patient had a baroreflex sensitivity measurement by the sequence method, which is represented by the slope of up-sequences (systolic blood pressure+/pulse interval+) and down-sequences (systolic blood pressure-/pulse interval-) of spontaneous fluctuations in systolic blood pressure and pulse interval.


RESULTS
During the follow-up, there were 20 deaths from any cause and 30 patients presented a major adverse cardiovascular event. Deaths and major adverse cardiovascular events were associated with a reduction in baroreflex sensitivity (systolic blood pressure+/pulse interval+ and systolic blood pressure-/pulse interval-). In multivariate analysis, the reduction in baroreflex sensitivity systolic blood pressure+/pulse interval+ was associated with an increased risk of deaths from any cause (Odds ratio 1.23; 95% confidence interval 1.02-1.67, P = 0.04). A baroreflex sensitivity systolic blood pressure+/pulse interval+ under 4.5 ms/mmHg was associated with a 2.5-increased relative risk of major adverse cardiovascular event (95% confidence interval 1.11-5.93, P = 0.03). However, multivariate analysis showed that baroreflex sensitivity systolic blood pressure-/pulse interval- was not associated either with death or major adverse cardiovascular events.


CONCLUSIONS
Reduction in baroreflex sensitivity marked by a reduction in vagal reflexes is an independent marker of the risk of mortality and major adverse cardiovascular events in hypertensive patients.
Cardiology and Hypertension Department, Michallon University Hospital, Grenoble, France. OOrmezzano@chu-grenoble.fr
Olivier
O
Ormezzano
Jean-Luc
JL
Cracowski
Jean-Louis
JL
Quesada
Hélène
H
Pierre
Jean-Michel
JM
Mallion
Jean-Philippe
JP
Baguet
D000328:Adult; D017704:Baroreflex / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000401:mortality / Q000503:physiopathology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis