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Published on: February 14, 2021
Spontaneous baroreflex sensitivity: toward an ideal index of cardiovascular risk in hypertension?
Pierre Lantelme1, Fouad Khettab, Marc-Antoine Custaud
1Service de Cardiologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon et Faculté de Médecine Lyon-Nord, Lyon, France. pierrelantelme@hotmail.com
Insights
Cardiac baroreflex sensitivity (BRS) integrates the long-term impact of cardiovascular risk factors. This makes BRS a valuable tool for more accurately predicting cardiovascular events and assessing patient risk.
Area of Science:
- Cardiology
- Hypertension Research
- Vascular Physiology
Background:
- Classical cardiovascular risk factors like blood pressure and cholesterol have variable impacts over time.
- Integrating the cumulative effects of these risk factors is crucial for accurate cardiovascular event prediction.
- Cardiac baroreflex sensitivity (BRS) is explored as a potential integrative marker.
Purpose of the Study:
- To determine if cardiac baroreflex sensitivity (BRS) correlates with cardiovascular risk factors.
- To assess BRS as a candidate for an integrative variable in cardiovascular risk assessment.
- To compare BRS with left ventricular mass (LVM), pulse wave velocity (PWV), and creatinine in relation to risk factors.
Main Methods:
- 302 hypertensive subjects underwent 24-h blood pressure monitoring and BRS assessment using two methods in two positions.
- Evaluations included echocardiography, electrocardiogram for left ventricular hypertrophy (LVH), and PWV measurements.
- Biological tests comprised serum lipids, glucose, creatinine, proteinuria, and urinary microalbumin.
Main Results:
- Two BRS measurement methods showed strong correlation (P < 0.001).
- BRS correlated significantly with age, 24-h systolic BP, heart rate, and serum cholesterol (P < 0.001 to P < 0.05).
- BRS also showed univariate correlations with LVM index (r = -0.21, P < 0.05) and PWV (r = -0.27, P < 0.001).
Conclusions:
- BRS appears to integrate the long-term effects of multiple cardiovascular risk factors.
- BRS may serve as a valuable parameter for more precise cardiovascular event risk assessment.
- This supports the utility of BRS in clinical practice for risk stratification.
Objective:
Estimating the risk entailed by classical risk factors like blood pressure (BP) or serum cholesterol may be difficult because of their variability and the often unknown duration of exposure. Having variables integrating the impact of those classical risk factors on the cardiovascular system would probably aid the prediction of cardiovascular events. The present study aimed at determining whether cardiac baroreflex sensitivity (BRS), correlates with several risk factors and thus is a good candidate for being such an integrative variable. As a comparison, left ventricular mass (LVM), pulse wave velocity (PWV), and creatinine were also tested for association with risk factors.
Design:
A total of 302 subjects referred for hypertension, were considered. They had a 24-h BP recording and a determination of BRS by two different methods (sequence and alpha coefficient), in two different positions (lying and standing). They were also tested for the presence of left ventricular hypertrophy (LVH) (by echocardiography and electrocardiogram) and had a PWV measurement. Biological testing included serum lipids, blood glucose, creatinine, proteinuria and urinary excretion of microalbumin.
Results:
There was a strong correlation between the two methods of BRS measurement in each position (P < 0.001). BRS determined by the sequence method in the lying position was correlated significantly and independently with age, 24-h systolic BP, heart rate, and serum cholesterol with P values < 0.001, < 0.001, < 0.01, and < 0.05, respectively. In an univariate analysis, BRS was also correlated with echocardiographic LVM index (r = -0.21, P < 0.05) and PWV (r = -0.27, P < 0.001), which possibly reflects its dependence on both vascular and cardiac damages.
Conclusion:
The present study supports the hypothesis that BRS could encompass the impact over time of several risk factors on the cardiovascular system. Thus, it may constitute a valuable parameter in assessing more precisely the risk of cardiovascular events.
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