A Comparative Assessment of Two Techniques for Investigating Initial Cardiovascular Reflexes Under Acute Orthostatic Stress

Overview

Journal Eur J Appl Physiol

Specialty Physiology

Date 2003 Jul 29

PMID 12883894

Citations 11

Authors

Caroline A Rickards

David G Newman

Affiliations

Soon will be listed here.

Abstract

The physiological differences between active and passive changes in posture have been previously established. This study determined the extent of the differences in the initial cardiovascular responses to the passive head-up tilt (HUT) and the active squat-stand test (SST). Eleven females and 13 males underwent one +75 degrees HUT and one SST. Beat-to-beat diastolic blood pressure (DBP), systolic blood pressure (SBP), mean arterial pressure (MAP) and heart rate (HR) were determined non-invasively. Data were recorded 10 s prior to (control) and 30 s after tilt or stand (event). Blood pressure and HR responses were analysed by calculating the deviation from control at 10 s (T10), 20 s (T20) and 30 s (T30) after the onset of each test. The DBP response (reflecting changes in systemic vascular resistance) at T10 was -10 (2) mmHg [mean (SEM)] for the HUT and -25 (2) mmHg for the SST ( P<0.01). DBP returned to control levels by T30 for the HUT, but remained depressed for the SST. MAP responses directly reflected these changes in DBP. HR significantly increased from control values ( P<0.001) for the HUT [+14 (1) bpm] and the SST [+16 (1) bpm], and remained elevated for the entire 30-s period for both tests. This study demonstrates that although the magnitude of the initial blood pressure decrease is greater for the active SST compared with the passive HUT, the reflex compensatory response is no different, making the SST a greater challenge for the cardiovascular reflexes.

Citing Articles

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References

de Mey C, Enterling D . Noninvasive assessment of cardiac performance by impedance cardiography: disagreement between two equations to estimate stroke volume. Aviat Space Environ Med. 1988; 59(1):57-62. View

Kautzner J, Hartikainen J, Camm A, Malik M . Arterial baroreflex sensitivity assessed from phase IV of the Valsalva maneuver. Am J Cardiol. 1996; 78(5):575-9. DOI: 10.1016/s0002-9149(96)00370-0. View

Borst C, Wieling W, van Brederode J, Hond A, de Rijk L, Dunning A . Mechanisms of initial heart rate response to postural change. Am J Physiol. 1982; 243(5):H676-81. DOI: 10.1152/ajpheart.1982.243.5.H676. View

Raczak G, la Rovere MT , Pinna G, Maestri R, SWIATECKA G . Assessment of baroreflex sensitivity in patients with preserved and impaired left ventricular function by means of the Valsalva manoeuvre and the phenylephrine test. Clin Sci (Lond). 2000; 100(1):33-41. View

HYATT K, Jacobson L, Schneider V . Comparison of 70 degrees tilt, LBNP, and passive standing as measrues of orthostatic tolerance. Aviat Space Environ Med. 1975; 46(6):801-8. View

Hanson P, Slane P, Rueckert P, Clark S . Squatting revisited: comparison of haemodynamic responses in normal individuals and heart transplantation recipients. Br Heart J. 1995; 74(2):154-8. PMC: 483991. DOI: 10.1136/hrt.74.2.154. View

Marfella R, Giugliano D, Di Maro G, Acampora R, Giunta R, DOnofrio F . The squatting test. A useful tool to assess both parasympathetic and sympathetic involvement of the cardiovascular autonomic neuropathy in diabetes. Diabetes. 1994; 43(4):607-12. DOI: 10.2337/diab.43.4.607. View

Charloux A, Lonsdorfer-Wolf E, Richard R, Lampert E, Oswald-Mammosser M, Mettauer B . A new impedance cardiograph device for the non-invasive evaluation of cardiac output at rest and during exercise: comparison with the "direct" Fick method. Eur J Appl Physiol. 2000; 82(4):313-20. DOI: 10.1007/s004210000226. View

Convertino V, Tripp L, Ludwig D, Duff J, Chelette T . Female exposure to high G: chronic adaptations of cardiovascular functions. Aviat Space Environ Med. 1998; 69(9):875-82. View

10.

Bland J, Altman D . Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986; 1(8476):307-10. View

11.

El-Sayed H, Hainsworth R . Relationship between plasma volume, carotid baroreceptor sensitivity and orthostatic tolerance. Clin Sci (Lond). 1995; 88(4):463-70. DOI: 10.1042/cs0880463. View

12.

Lipsitz L, Mukai S, Hamner J, Gagnon M, Babikian V . Dynamic regulation of middle cerebral artery blood flow velocity in aging and hypertension. Stroke. 2000; 31(8):1897-903. DOI: 10.1161/01.str.31.8.1897. View

13.

Ward R, DANZIGER F, BONICA J, Allen G, TOLAS A . Cardiovascular effects of change of posture. Aerosp Med. 1966; 37(3):257-9. View

14.

Ferrara M, De Gennaro L, Bertini M . Time-course of sleep inertia upon awakening from nighttime sleep with different sleep homeostasis conditions. Aviat Space Environ Med. 2000; 71(3):225-9. View

15.

Gotshall R, Davrath L, Sadeh W, Coonts C, Luckasen G, Downes T . Validation of impedance cardiography during lower body negative pressure. Aviat Space Environ Med. 1999; 70(1):6-10. View

16.

Rickards C, Newman D . The effect of low-level normobaric hypoxia on orthostatic responses. Aviat Space Environ Med. 2002; 73(5):460-5. View

17.

Fulco C, Cymerman A, Rock P, FARESE G . Hemodynamic responses to upright tilt at sea level and high altitude. Aviat Space Environ Med. 1985; 56(12):1172-6. View

18.

Rossberg F, PENAZ J . Initial cardiovascular response on change of posture from squatting to standing. Eur J Appl Physiol Occup Physiol. 1988; 57(1):93-7. DOI: 10.1007/BF00691245. View

19.

Richard R, Lonsdorfer-Wolf E, Charloux A, Doutreleau S, Buchheit M, Oswald-Mammosser M . Non-invasive cardiac output evaluation during a maximal progressive exercise test, using a new impedance cardiograph device. Eur J Appl Physiol. 2001; 85(3-4):202-7. DOI: 10.1007/s004210100458. View

20.

Spodick D, Lance V . Comparative orthostatic responses: standing vs. head-up tilt. Aviat Space Environ Med. 1977; 48(5):432-3. View