Pressor responses to hyperventilation in elderly subjects differentiate essential from secondary hypertension

• Autorzy: Fiorella Fontana , Pasquale Bernardi , Carmine Pizzi , Emilio Pich
• Języki publikacji: EN

Abstrakty

EN

We evaluated pressor responses to the hyperventilation test in elderly normotensive (n=43, mean age 82 ± 5 years) and elderly hypertensive subjects (n=45 with essential hypertension, mean age 82 ± 2 years, and n=49 with secondary hypertension, mean age 82 ± 3 years). Hyperventilation did not change blood pressure (BP) in normotensive and secondary hypertensive subjects, whereas it decreased BP in essential hypertensives. Hierarchical cluster analysis based on BP responses to hyperventilation disclosed three groups of subjects in each population: group 1 exhibited a reduction in BP (essential hypertensives: 76%), group 2 no change (normotensives: 70%, secondary hypertensives: 76%), and group 3 an increase (normotensives: 19%, essential hypertensives: 13%, secondary hypertensives: 14%). Ambulatory BP monitoring found significant differences in pressor daytime profiles of hypertensive patients according to pressor responses to hyperventilation showing wide fluctuations in group 1 and 3 patients. Interestingly, the peak ambulatory SBP values correlated to the pre-hyperventilation SBP values in group 1, and to the hyperventilation peak SBP values in group 3. In conclusion: 1) Aging decreases reactivity to respiratory alkalosis in elderly normotensives; 2) hyperventilation induces significant pressor changes frequently in essential hypertension, but rarely in secondary hypertension; 3) the significant pressor responses to hyperventilation reflect the daytime pressor profiles predicting the highest daily fluctuations of BP values.

Słowa kluczowe

EN

Hyperventilation; Respiratory alkalosis; Elderly hypertensive patients; Blood pressure ambulatory monitoring; White coat hypertension

• Czasopismo: Open Medicine
• Rocznik: 2009
• Tom: 4
• Numer: 1
• Strony: 17-25

Daty

wydano

2009-03-01

online

2009-02-11

Twórcy

autor

Fiorella Fontana

• Dipartimento di Medicina Interna, dell’Invecchiamento e delle Malattie Nefrologiche, Università di Bologna, Ospedale S. Orsola, 40138, Bologna, Italy,

autor

Pasquale Bernardi

• Dipartimento di Medicina Interna, dell’Invecchiamento e delle Malattie Nefrologiche, Università di Bologna, Ospedale S. Orsola, 40138, Bologna, Italy

autor

Carmine Pizzi

• Dipartimento di Medicina Interna, dell’Invecchiamento e delle Malattie Nefrologiche, Università di Bologna, Ospedale S. Orsola, 40138, Bologna, Italy

autor

Emilio Pich

• Discovery Medicine, GlaxoSmithKline, Medicine Research Center, 37135, Verona, Italy

Bibliografia

• [1] Fontana F., Bernardi P., Merlo Pich E., Tartuferi L., Boschi S., Spampinato S., Opioid peptide modulation of circulatory response to hyperventilation in humans, Peptides, 2000, 21, 1223–1230 http://dx.doi.org/10.1016/S0196-9781(00)00263-1[Crossref]
• [2] Fontana F., Bernardi P., Spampinato S., Di Toro R., Bugiardini R., β-endorphin modulation of pressor response to hyperventilation in hypertensive patients, Peptides, 2002, 23, 911–918 http://dx.doi.org/10.1016/S0196-9781(02)00018-9[Crossref]
• [3] Fontana F., Bernardi P., Lanfranchi G., Pisati M.S., Merlo Pich E., Blood pressure response to hyperventilation test reflects daytime pressor profile. Hypertension, 2003, 41, 244–248 http://dx.doi.org/10.1161/01.HYP.0000052315.51182.3D[Crossref]
• [4] Rowe J.W., Troen B.R., Sympathetic nervous system and aging in man, Endocr. Rev., 1980, 1, 167–178 http://dx.doi.org/10.1210/edrv-1-2-167[Crossref]
• [5] Rowlands D.B., Stallard T.J., Littler W.A., Comparison of ambulatory blood pressure and cardiovascular reflexes in elderly hypertensives, elderly normotensives and young hypertensives, J. Hypertens., 1983, 1,Suppl 2, 71–73
• [6] Guidelines Subcommittee, 1999 World Health Organization-International Society of Hypertension guidelines for the management of hypertension, J. Hypertens., 1999, 17, 151–183
• [7] Mancia G., Ferrari A., Gregorini L., Parati G., Pomidossi G., Bertinieri G., et al., Blood pressure and heart variabilities in normotensive and hypertensive human beings, Circ. Res., 1983, 53, 96–104
• [8] Romesburg C., Cluster analysis for researchers, North Carolina: Lulu press, 2004
• [9] Todd G.P.A., Chadwick I.G., Yeo W.W., Jackson P.R., Ramsay L.E., Pressor effect of hyperventilation in healthy subjects, J. Hum. Hypertens., 1995, 9, 119–122
• [10] Giannattasio C., Ferrari A.U., Mancia G., Alterations in neural cardiovascular control mechanisms with ageing, J. Hypertens., 1994, 12,Suppl 6, 13–17
• [11] Esler M.D., Thompson J.M., Kaye D.M., Turner A.G., Jennings G.L., Cox H.S., et al., Effects of aging on the responsiveness of the human cardiac sympathetic nerves to stressors, Circulation, 1995, 91, 351–358 [Crossref][PubMed]
• [12] Bertel O., Bühler F.R., Kiowski W., Lütold B.E., Decreased beta-adrenoreceptor responsiveness as related to age, blood pressure, and plasma catecholamines in patients with essential hypertension, Hypertension, 1980, 2, 130–138 [Crossref][PubMed]
• [13] Vlachakis N.D., Mendlowitz M., Guia D., Gusman D., Diminished baroreceptor sensitivity in elderly hypertensives. Possible role of atherosclerosis, Atherosclerosis, 1976, 24, 243–249 http://dx.doi.org/10.1016/0021-9150(76)90079-4[Crossref]
• [14] Folkow B., Svanborg A., Physiology of cardiovascular aging, Physiol. Rev., 1993, 73, 725–764
• [15] Langewith W., Ruddel H., Schachinger H., Reduced parasympathetic cardiac control in patients with hypertension at rest and under mental stress, Am. Heart J., 1994, 127, 122–128 http://dx.doi.org/10.1016/0002-8703(94)90517-7[Crossref]
• [16] Goldstein D., Plasma catecholamines and essential hypertension: an analytical review, Hypertension, 1983, 5, 86–99 [Crossref][PubMed]
• [17] Weiner H., Personality factors and the importance of emotional stresses in hypertensive, In: Genest J, Koiw E, Kuchel O, editors. Hypertension: physiopathology and treatment. New York: McGraw-Hill; 1977, pp. 661–673
• [18] Bhattacharyya A., Das P., Hypertension in elderlyan overview, J. Indian. Med. Assoc., 1999, 97, 96–101
• [19] Cerasola G., Cottone S., D’Ignoto G., Grasso L., Carone M.B., Sympathetic activity in borderline and established hypertension in the elderly, J. Hypertens., 1988, 6,Suppl 1, 55–58
• [20] Dluhy R.G., Uncommon forms of secondary hypertension in older patients, Am. J. Hypertens., 1998, 11, 52–56 http://dx.doi.org/10.1016/S0895-7061(98)00011-9[Crossref]
• [21] Sagie A., Larson M.G., Levy D., The natural history of borderline isolated systolic hypertension, N. Engl. J. Med., 1993, 329, 1912–1917 http://dx.doi.org/10.1056/NEJM199312233292602[Crossref]
• [22] Julius S., Valentini M., Consequences of the increased autonomic nervous drive in hypertension, heart failure and diabetes, Blood Press., 1998, Suppl 3, 5–13 [PubMed]

Identyfikatory

DOI

10.2478/s11536-009-0002-0