Nonlinearities and asymmetries of the human cardiovagal baroreflex

To determine whether an approach such as the modified Oxford technique can consistently produce data that reveal the nonlinear nature of the cardiovagal baroreflex and to ascertain whether the model parameters provide unique insight into baroreflex function, we retrospectively examined 91 baroreflex trials (38 subjects, 27 men and 11 women, ages 22-72 yr). The modified Oxford technique (bolus sodium nitroprusside followed by bolus phenylephrine) was used to perturb blood pressure, and the resulting systolic blood pressure-R-R interval responses were plotted and modeled using a linear, a four-parameter symmetric, and a five-parameter asymmetric model. Several issues, such as the effect of data averaging, various approaches to gain estimation, and the predictive value of model parameters, were examined during reflex modeling. Sigmoid models accounted for a greater amount of the variance than did the linear model: linear r2=0.81+/-0.01, four-parameter r2=0.90+/-0.08, and five-parameter r2=0.90+/-0.08 (P<0.05, linear vs. sigmoid models). Data averaging did not affect model fits. Although the four gain estimates (linear remodel, 1st derivative, peak, and set point) were statistically related, the set point gain was significantly lower than other estimates (P<0.05). Subgroup comparisons between young and older healthy subjects revealed differences in all indexes of cardiovagal baroreflex gain, as well as R-R interval operating range and curvature parameters. In conclusion, the modified Oxford technique consistently reveals the nonlinear nature of the human cardiovagal baroreflex. Moreover, of the parameters produced by the symmetric sigmoid model, only the response range provides unique information beyond that of reflex gain.