Cardiology Letters 2015, 24(5):315-320

Baroreflex sensitivity and resistant hypertension

Čelovská D¹, Gonsorčík J², Dukát A¹, Gašpar Ľ¹

¹ 1II. interná klinika LF UK a UN Bratislava, Nemocnica Staré Mesto, Bratislava

² Východoslovenský ústav srdcových a cievnych chorôb, Košice a Kardiologická klinika UPJŠ, Košice, Slovenská republika

Aim: Baroreflex sensitivity is a noninvasive marker of autonomic nervous system integrity, which characterises efficacy of blood pressure regulation. The aim of study was to evaluate differences and clinical significance of baroreflex sensitivity in risk stratification of patients with primary, well controlled hypertension and resistant hypertension.

Patients and Methods: A total of 105 patients, 96 patients with primary hypertension (46 M/50 F, 68±9.54 years of age) and 9 patients with resistant hypertension (3M/6F, 64±5.86 years of age), were studied. The relationship between baroreflex sensitivity (BRS) and blood pressure, global cardiovascular risk and major cardiovascular (CV) events in hypertensives was assessed. BRS was determined by the sequence and spectral method, with controlled breathing protocol at a frequency of 0.1 Hz, during five-minute non-invasive beat-to-beat recording of blood pressure and R-R interval.

Results: We found significant negative correlation between spontaneous BRS and systolic BP values (-0.52, p<0.001). Spontaneous BRS values in hypertensives with major CV event (stroke, myocardial infarction) were significantly lower even 6 months and more after event onset compared to hypertensives without CV event (p<0.05). Patients with critical value of BRS ≤ 3 ms/mmHg (36 patients, 34.28%, 24M/12F) were mostly men with arterial hypertension and metabolic syndrome with BMI 32.46±3.4 kg/m2. 7(77.7%) patients with resistant hypertension had BRS ≤ 3 ms/mmHg. BRS values were significantly reduced in hypertensives with resistant hypertension compared to hypertensives (2.18±1.05 vs 5.92±2.51 ms/mmHg, p<0.001).

Conclusion: Arterial hypertension is associated with decreased BRS. Patients with resistant hypertension have significantly more often critical values BRS ≤ 3 ms/mmHg than other hypertensives. Reduced BRS value could be a potential predictor of baroreflex stimulation therapy response.

Keywords: baroreflex sensitivity; autonomic nervous system; arterial hypertension; resistant hypertension

Published: May 1, 2015  Show citation