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Autonomic regulation in different hypertensive phenotypes - the HELIUS study.
D Collard1, E M C Vriend1,2, H Galenkamp2
1Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
Blood Pressure
|October 20, 2023
Summary
Isolated systolic hypertension (ISH) in younger individuals shows normal sympathetic activity. However, other hypertension types (IDH, SDH) and all hypertension in older adults indicate increased sympathetic control, suggesting autonomic dysfunction in hypertension phenotypes.
Area of Science:
- Cardiology
- Autonomic Nervous System Research
- Hypertension Phenotyping
Background:
- Hypertension phenotypes (ISH, IDH, SDH) have distinct prognoses and potential links to sympathetic activity.
- Cardiac autonomic function assessment may reveal differential associations with hypertension types.
Purpose of the Study:
- To investigate the relationship between cardiac autonomic function and different hypertension phenotypes.
- To determine if sympathetic activity varies across isolated systolic, diastolic, and combined hypertension.
Main Methods:
- Utilized continuous finger blood pressure (BP) recordings from 10,221 multi-ethnic HELIUS study participants (18-70 years).
- Assessed cross-correlation baroreflex sensitivity (xBRS) and heart rate variability (HRV) as measures of autonomic function.
- Classified hypertension into ISH, IDH, and SDH, analyzing differences stratified by age and sex using regression analysis.
Main Results:
- In younger adults, isolated systolic hypertension (ISH) showed no significant difference in xBRS compared to normotensives.
- Isolated diastolic hypertension (IDH) and combined systolic-diastolic hypertension (SDH) in younger individuals, and all phenotypes in older adults, exhibited significantly lower xBRS.
- Heart rate variability (HRV) patterns mirrored xBRS in men but not in women.
Conclusions:
- ISH in younger individuals is not linked to increased sympathetic drive, unlike IDH and SDH.
- Increased sympathetic control is associated with IDH and SDH in younger participants and all hypertensive phenotypes in older adults.
- Autonomic dysregulation may explain prognostic differences observed among hypertension phenotypes.
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