Abstract
The study aimed to determine the relationship between left ventricular (LV) diastolic function and the heart’s spontaneous baroreflex at rest and in response to orthostatic stress during a prospective follow-up of hypertensive patients with LV hypertrophy (LVH+). LV structure and function and baroreflex sensitivity (BRS) during tilt testing were evaluated in 24 LVH+ patients and compared with 25 age-matched healthy controls and 25 hypertensive patients without LVH (LVH−). Clinical status, diastolic function and BRS were then assessed in LVH+ patients during treatment with telmisartan (monotherapy or combined with hydrochlorothiazide and/or amlodipine) at 6- and 18-month follow-ups. LVH+ patients had significantly altered diastolic function indices and decreased BRS as compared with healthy controls and LVH− patients. During the 18-month follow-up, favorable changes in diastolic function were associated with improvement in BRS at rest and during tilting. In multivariate regression models, an index reflecting rate of LV myocardial relaxation (E'sept) where E'sept denotes peak early diastolic velocity at the septal mitral annulus and a surrogate for LV filling pressure (E/E'sept), independently from other clinical and echocardiographic variables related to the low-frequency component of BRS during tilting. In conclusion, the LV diastolic function indices have independent associations with BRS parameters obtained at rest and during orthostatic stress in LVH+ patients receiving long-term pharmacological intervention.
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References
Paulus WJ, Tschope C, Sanderson JE, Rusconi C, Flachskampf FA, Rademakers FE et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J 2007; 28: 2539–2550.
Laitinen T, Niskanen L, Geelen G, Lansimies E, Hartikainen J . Age dependency of cardiovascular autonomic responses to head-up tilt in healthy subjects. J Appl Physiol 2004; 96: 2333–2340.
Makowski K, Gielerak G, Cholewa M, Kramarz E, Michalkiewicz D, Kamiński G et al. Autonomic nervous system and left ventricular hypertrophy in essential hypertension. Kardiol Pol 2002; 57: 520–531.
Radaelli A, Bernardi L, Valle F, Leuzzi S, Salvucci F, Pedrotti L et al. Cardiovascular autonomic modulation in essential hypertension. Effect of tilting. Hypertension 1994; 24: 556–563.
Giannattasio C, Cattaneo BM, Seravalle G, Grassi G, Mancia G . Left ventricular hypertrophy and the cardiogenic reflex in man. J Hypertens 1991; 9: 43–50.
Muller-Brunotte R, Kahan T, Malmqvist K, Ring M, Edner M . Tissue velocity echocardiography shows early improvement in diastolic function with irbesartan and atenolol therapy in patients with hypertensive left ventricular hypertrophy. Results from the Swedish Irbesartan Left Ventricular Hypertrophy Investigation vs Atenolol (SILVHIA). Am J Hypertens 2006; 19: 927–936.
Devereux RB, Wachtel K, Gerdts E, Boman K, Nieminen MS, Papademetriou V et al. Prognostic significance of left ventricular mass change during treatment of hypertension. JAMA 2004; 292: 2350–2356.
Kane GC, Karon BL, Mahoney DW, Redfield MM, Roger VL, Burnett JC et al. Progression of left ventricular diastolic dysfunction and risk of heart failure. JAMA 2011; 306: 856–863.
Fagard R, Pardaens K . Left ventricular diastolic function predicts outcome in uncomplicated hypertension. Am J Hypertens 2001; 14: 504–508.
Wang M, Yip GWK, Wang AYM, Zhang Y, Ho PY, Tse MK et al. Tissue Doppler imaging provides incremental prognostic value in patients with systemic hypertension and left ventricular hypertrophy. J Hypertens 2005; 23: 183–191.
Lantelme P, Khettab F, Custaud MA, Rial MO, Joanny C, Gharib C et al. Sontaneous baroreflex sensitivity: toward an ideal index of cardiovascular risk in hypertension? J Hypertens 2002; 20: 935–944.
Ormezzano O, Cracowski JL, Quesada JL, Pierre H, Mallion JM, Baguet JP . Evaluation of the prognostic value of BARoreflex sensitivity in hypertensive patients: the EVABAR study. J Hypertens 2008; 26: 1373–1378.
Grassi G, Seravalle G, Quarti-Trevano F, Dell’Oro R, Arenare F, Spaziani D et al. Sympathetic and baroreflex cardiovascular control in hypertension-related left ventricular dysfunction. Hypertension 2009; 53: 205–209.
Milan A, Caserta MA, Del Colle S, Dematteis A, Morello F, Rabbia F et al. Baroreflex sensitivity correlates with left ventricular morphology and diastolic function in essential hypertension. J Hypertens 2007; 25: 1655–1664.
Mancia G, de Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G et al. 2007 Guidelines for the management of arterial hypertension. The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25: 1105–1187.
Devereux RB, Reichek N . Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation 1977; 55 (4): 613–618.
Hammond IW, Devereux RB, Alderman MH, Lutas EM, Spitzer MC, Crowley JS et al. The prevalence and correlates of echocardiographic left ventricular hypertrophy among employed patients with uncomplicated hypertension. J Am Coll Cardiol 1986; 7: 639–650.
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18: 1440–1463.
Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 2009; 22: 107–133.
Parati G, Di Rienzo M, Bertinieri G, Pomidossi G, Casadei R, Groppelli A et al. Evaluation of the baroreceptor-heart rate reflex by 24-h intra-arterial blood pressure monitoring in humans. Hypertension 1988; 12: 214–222.
Gerritsen J, TenVoorde BJ, Dekker JM, Kostense PJ, Bouter LM, Heethaar RM . Baroreflex sensitivity in the elderly: influence of age, breathing, and spectral methods. Clin Sci (Colch) 2000; 99: 371–381.
Hastie T, Tibshirani R, Friedman J . MARS: multivariate adaptive regression splines. In: Hastie T, Tibshirani R, Friedman J, (eds). The Elements of Statistical Learning: Data Mining, Inference, and Prediction. Springer: New York, NY 2nd edn 2009 pp 321–329.
Mostarda C, Moraes-Silva IC, Moreira ED, Medeiros A, Piratello AC, Consolim-Colombo FM et al. Baroreflex sensitivity impairment is associated with cardiac diastolic dysfunction in rats. J Cardiac Fail 2011; 17: 519–525.
Schlaich MP, Sobotka PA, Krum H, Lambert EA, Esler MD . Renal sympathetic nerve ablation for the treatment of uncontrolled hypertension. N Engl J Med 2009; 361: 932–934.
Heusser K, Tank J, Engeli S, Diedrich A, Menne J, Eckert S et al. Carotid baroreceptor stimulation, sympathetic activity, baroreflex function, and blood pressure in hypertensive patients. Hypertension 2010; 55: 619–626.
Bisognano JD, Kaufman CL, Bach DS, Lovett EG, de Leeuw P and DEBuT-HT and Rheos Feasibility Trial Investigators. Improved cardiac structure and function with chronic treatment using an implantable device in resistant hypertension: results from European and United States trials of the Rheos system. J Am Coll Cardiol 2011; 57: 1787–1788.
Brandt MC, Mahfoud F, Reda S, Schirmer SH, Erdmann E, Bohm M et al. Renal sympathetic denervation reduces left ventricular hypertrophy and improves cardiac function in patients with resistant hypertension. J Am Coll Cardiol 2012; 59: 901–909.
Wang W, Schultz HD, Ma R . Cardiac sympathetic afferent sensitivity is enhanced in heart failure. Am J Physiol 1999; 277: H812–H817.
Gao L, Schultz HD, Patel KP, Zucker IH, Wang W . Augmented input from cardiac sympathetic afferents inhibits baroreflex in rats with heart failure. Hypertension 2005; 45: 1173–1181.
Levick SP, Murray DB, Janicki JS, Brower GL . Sympathetic nervous system modulation of inflammation and remodeling in the hypertensive heart. Hypertension 2010; 55: 270–276.
Barbieri R, Triedman JK, Saul P . Heart rate control and mechanical cardiopulmonary coupling to assess central volume: a systems analysis. Am J Physiol Regul Integr Comp Physiol 2002; 283: 1210–R1220.
Iwasaki K, Zhang R, Perhonen MA, Zuckerman JH, Levine BD . Reduced baroreflex control of heart period after bed rest is normalized by acute plasma volume restoration. Am J Physiol Regul Integr Comp Physiol 2004; 287: 1256–1262.
Pagani M, Montano N, Porta A, Malliani A, Abboud FM, Birkett C et al. Relationship between spectral components of cardiovascular variabilities and direct measures of muscle sympathetic nerve activity in humans. Circulation 1997; 95: 1441–1448.
Charkoudian N, Joyner MJ, Johnson C, Eisenach J, Dietz N, Wallin BG . Balance between cardiac output and sympathetic nerve activity in resting humans: role in arterial pressure regulation. J Physiol 2005; 568: 315–321.
Dokainish H, Nguyen JS, Sengupta R, Pillai M, Alam M, Bobek J et al. Do additional echocardiographic variables increase the accuracy of E/e’ for predicting left ventricular filling pressure in normal ejection fraction? An echocardiographic and invasive hemodynamic study. J Am Soc Echocardiogr 2010; 23: 156–161.
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Makowski, K., Gielerak, G., Kramarz, E. et al. Left ventricular diastolic dysfunction is associated with impaired baroreflex at rest and during orthostatic stress in hypertensive patients with left ventricular hypertrophy. J Hum Hypertens 27, 465–473 (2013). https://doi.org/10.1038/jhh.2013.10
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DOI: https://doi.org/10.1038/jhh.2013.10
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