Arterial Baroreflex Function in Older Adults with Neurocardiogenic Syncope

Overview

Journal Clin Invest Med

Specialty General Medicine

Date 2009 Jun 2

PMID 19480734

Citations 2

Authors

Kenneth M Madden

Chris Lockhart

Affiliations

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Abstract

Purpose: Neurocardiogenic syncope (formerly vasovagal) accounts for large numbers of falls in older adults and the mechanisms are poorly understood. This study examined the differences in baseline arterial baroreflex function in older adults with and without a neruocardiovascular response to orthostatic stress.

Methods: Subjects were divided into two groups based on the presence (TT+ group) or absence (TT- group) of a neurocardiovascular response to upright tilting (70 degree head-up tilt for 10 minutes after 400 micrograms of sublingual nitroglycerin). A neurocardiovascular response was defined as presyncopal symptoms (lightheadedness) in association with at least a 30 mm Hg decrease in blood pressure. Before being divided into groups, baroreflex function was assessed using the spontaneous baroreflex method (baroreflex sensitivity, BRS). This method involves the analysis of "spontaneous" swings in blood pressure and heart rate that are mediated by the arterial baroreflexes.

Results: 42 older adults (mean age 70.3+/-0.7 yr) were recruited, of which 18 were in the TT+ and 24 were in the TT- group. At baseline, the TT+ group demonstrated increased arterial baroreflex sensitivity in response to negative blood pressure sequences only (BRSdown, 11.2+/-1.9 vs. 7.3+/-1.0 ms/mm Hg, P=0.011). During tilt, the TT+ group demonstrated a much larger decrease in overall arterial baroreflex sensitivity than the TT- group (-6.8+/-1.2 vs. -3.2+/-0.9 ms/mm Hg, P=0.012). There was a negative correlation between BRSdown and length of tilt table test (r=-0.329, P=0.041) in the TT+ subjects.

Conclusion: Older adults with neurocardiogenic syncope have exaggerated arterial baroreflex sensitivity at baseline.

Citing Articles

An uncommon cause of syncope.

Campagna D, Amaradio M, Battaglia E, Demma S, Russo C, Polosa R Intern Emerg Med. 2015; 11(3):425-9.

PMID: 26407606 DOI: 10.1007/s11739-015-1317-2.

The relationship between orthostatic hypotension and falling in older adults.

Shaw B, Claydon V Clin Auton Res. 2013; 24(1):3-13.

PMID: 24253897 DOI: 10.1007/s10286-013-0219-5.

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