Cardiovascular reflex tests: Assessment of age-adjusted normal range

doi:10.1016/0022-510X(86)90074-2

Journal of the Neurological Sciences

Volume 75, Issue 3, October 1986, Pages 263-274

https://doi.org/10.1016/0022-510X(86)90074-2 Get rights and content

Abstract

To assess the relationship between aging and autonomic control of heart rate and blood pressure, cardiovascular reflex tests were performed in 70 healthy volunteers in the age range 25–71 years. R-R interval variation, heart rate change with deep breathing, $3015$ ratio and blood pressure response to standing appeared significantly declining with age. For each test we calculated the P_0.99 and P_0.01 confidence limits for individual observations. On the other hand, Valsalva ratio and the blood pressure response to sustained handgrip appeared to be unrelated to age.

These results suggest that there is an age-dependent degradation of the mechanisms involved in the cardiovascular reflexes. The assessment of age-adjusted normal values improves the criteria for delineating abnormal from normal results in individual testing of autonomic function.

References (40)

G. Duncan et al.
Evidence of vagal neuropathy in chronic alcoholics
Lancet
(1980)
D.J. Ewing et al.
Vascular reflexes in diabetic autonomic neuropathy
Lancet
(1973)
A.H. Glassman et al.
Clinical characteristics of imipramine-induced orthostatic hypotension
Lancet
(1979)
M.A. Pfeifer et al.
Differential changes of autonomic nervous system function with age in man
Amer. J. Med.
(1983)
P. Armitage
Statistical Methods in Medical Research
(1971)
V.S. Baldwa et al.
Heart rate response to Valsalva manoeuvre — Reproducibility in normals and relation to variation in resting heart rate in diabetics
Brit. Heart J.
(1977)
R. Bannister
Autonomic Failure — A Textbook of Clinical Disorders of the Autonomic Nervous System
(1983)
T.D. Bird et al.
Autonomic nervous system function in genetic neuromuscular disorders
Arch. Neurol. (Chic.)
(1984)
A.P. Brooks
Abnormal vascular reflexes in Charcot-Marie-Tooth disease
J. Neurol. Neurosurg. Psychiat.
(1980)
F.I. Caird et al.
Effect of posture on blood pressure in the elderly
Brit. Heart J.
(1973)

B.F. Clarke et al.

Diabetic autonomic neuropathy

Diabetologia

(1979)

K.J. Collins et al.

Accidental hypothermia and impaired temperature homeostasis in the elderly

Brit. Med. J.

(1977)

K.J. Collins et al.

Functional changes in autonomic nervous responses with ageing

Age Ageing

(1980)

D.J. Ewing

Practical bedside investigation of diabetic autonomic failure

D.J. Ewing et al.

Cardiovascular responses to sustained handgrip in normal subjects and in patients with diabetes mellitus — A test of autonomic function

Clin. Sci. Mol. Med.

(1974)

D.J. Ewing et al.

Peripheral motor nerve function in diabetic autonomic neuropathy

J. Neurol. Neurosurg. Psychiat.

(1976)

D.J. Ewing et al.

Immediate heart rate response to standing — Simple test for autonomic neuropathy in diabetes

Brit. Med. J.

(1978)

D.J. Ewing et al.

Cardiac autonomic neuropathy in diabetes — Comparison of measures of R-R interval variation

Diabetologia

(1981)

A.N. Exton-Smith

Disturbances of autonomic regulation

B. Gribbin et al.

Effect of age and high blood pressure on baroreflex sensitivity in man

Circ. Res.

(1971)

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Although the central autonomic network (CAN) has been well researched in animal models, the CAN in humans is still unclear, especially for cardiovascular control. This study aimed to investigate which areas of the cerebral cortices are associated with the peripheral cardiac autonomic control involved in the CAN in uremic patients with autonomic dysfunction and normal controls. The central and peripheral autonomic network in 19 uremic patients with significant autonomic dysfunction and 24 age- and sex-matched controls [mean age ± standard deviation (SD), 55.16 ± 10.45 years and 55.42 ± 5.42 years, respectively] were evaluated by simultaneous spectral analysis of electroencephalography (EEG) and electrocardiography recording (ECG), along with serial autonomic tests [autonomic questionnaire and orthostatic blood pressure (BP) change]. Only frequency-domain heart rate variability (f-HRV) during the deep-breathing stage could differentiate the two groups. Although there is no significant difference in f-HRV during the quiet-breathing stage, different patterns of central oscillation and their correlation with peripheral cardiac autonomic indices could be found for the two groups. Although the power of specific EEG bands under electrode T3 and T6 correlated significantly with the power of peripheral HRV indices in the control group, those under electrodes P3 and Pz had significant correlations in the uremic group suggesting a role of functional connectivity between them. In addition, sympathetic activity is correlated with slow wave EEG (theta/delta) power whereas parasympathetic activity is correlated with fast wave EEG (beta) power. In conclusion, there is functional connectivity between the parietal cortex and the peripheral cardiac autonomic system (PAN) in uremics and the pattern of central autonomic connectivity differs between uremic patients with autonomic dysfunction and normal controls.
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Some investigators advocate the seated position for this test as the cardiovascular effects are likely to be greater (Ewing and Clarke, 1982; Wieling and van Lieshout, 1990). A decline in the Valsalva ratio with age has been reported in some (Persson and Solders, 1983; O'Brien et al., 1986; Low et al., 1990) although not all (Ewing et al., 1985; Vita et al., 1986) studies. In addition, a false-positive test may occur in patients with impaired sympathetic nervous system function due to attenuation of the HR increase in phase II (van Lieshout et al., 1989).
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We aimed to derive normative data for cardiovascular autonomic function tests (AFT) in an older population using new measures. The AFT were performed in 48 healthy control subjects. The average heart rate (HR) response to deep breathing (DB) (HR_DB), Valsalva ratio (VR), magnitude of the HR and blood pressure (BP) response of different phases of the Valsalva maneuver, BP recovery times (PRT 100 and PRT 50) and HR and BP changes on head-up tilting were calculated. The mean age (±standard deviation) of study participants was 58 ± 14.5 years (range 20–82 years), of whom 29 (60%) were men. The systolic blood pressure (SBP) early phase 2 amplitude showed an inverse relationship with age (p = 0.03). There was a trend for progressive attenuation of SBP late phase 2 amplitude with age (p = 0.09). The systolic BP recovery time was not affected by age, gender or body mass index. We concluded that age has a significant effect on most AFT variables. Age and gender did not influence the systolic BP recovery time; hence, systolic BP recovery time could be useful in the evaluation of adrenergic failure.
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In this study, the percentage increase of MAP (13% in control and 8% in PD subjects) was less than previous studies showing 18% and 19.2% increase in MAP [20,22]. A possible explanation for this contradiction may be age-dependent degradation of cardiovascular reflexes [40]. The mean age of our study subjects (65 in control and 68 in PD subjects) was older than the subjects of the previous studies (34 and 29) [20,22].
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^☆: This study was supported by the Italian Ministry of Education.

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Cardiovascular reflex tests: Assessment of age-adjusted normal range☆

Abstract

Lancet

Lancet

Lancet

Amer. J. Med.

Statistical Methods in Medical Research

Heart rate response to Valsalva manoeuvre — Reproducibility in normals and relation to variation in resting heart rate in diabetics

Brit. Heart J.

Autonomic Failure — A Textbook of Clinical Disorders of the Autonomic Nervous System

Autonomic nervous system function in genetic neuromuscular disorders

Arch. Neurol. (Chic.)

Abnormal vascular reflexes in Charcot-Marie-Tooth disease

J. Neurol. Neurosurg. Psychiat.

Effect of posture on blood pressure in the elderly

Brit. Heart J.

Diabetic autonomic neuropathy

Diabetologia

Accidental hypothermia and impaired temperature homeostasis in the elderly

Brit. Med. J.

Functional changes in autonomic nervous responses with ageing

Age Ageing

Practical bedside investigation of diabetic autonomic failure

Cardiovascular responses to sustained handgrip in normal subjects and in patients with diabetes mellitus — A test of autonomic function

Clin. Sci. Mol. Med.

Peripheral motor nerve function in diabetic autonomic neuropathy

J. Neurol. Neurosurg. Psychiat.

Immediate heart rate response to standing — Simple test for autonomic neuropathy in diabetes

Brit. Med. J.

Cardiac autonomic neuropathy in diabetes — Comparison of measures of R-R interval variation

Diabetologia

Disturbances of autonomic regulation

Effect of age and high blood pressure on baroreflex sensitivity in man

Circ. Res.