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Published on: February 14, 2021
Parasympathetic Modulation is Correlated With Baroreflex Sensitivity and Orthostatic Pressor Response in Childhood
Chaima El Khadiri1,2, Plamen Bokov3, Benjamin Dudoignon3
1Department of Physiology, AP-HP, Robert Debré Hospital, Paris, France.
Insights
Childhood cardio-vagal baroreflex failure and exaggerated orthostatic pressor response are linked to autonomic nervous system dysfunction. This study highlights defective parasympathetic modulation as a key factor, regardless of the specific condition.
Area of Science:
- Cardiovascular physiology
- Autonomic nervous system function
- Pediatric health
Background:
- Childhood cardio-vagal baroreflex (CVBR) dysfunction and exaggerated orthostatic pressor response are risk factors for adult hypertension.
- Understanding the determinants of these conditions in children is crucial for early intervention.
Purpose of the Study:
- To evaluate the determinants of childhood CVBR failure.
- To assess the factors contributing to an exaggerated orthostatic pressor response in children.
- To investigate the relationship between autonomic dysfunction and cardiovascular responses in pediatric populations.
Main Methods:
- A case-control study matched four groups of children by age and sex: congenital central hypoventilation syndrome, chronic kidney disease, sickle cell disease, and healthy controls.
- Evaluations included tonometry, continuous blood pressure (BP) and ECG monitoring in supine and standing positions.
- Analysis involved ambulatory BP monitoring, heart rate variability indices, baroreflex sensitivity (BRS), and orthostatic systolic BP response computation.
Main Results:
- Supine and standing BRS significantly correlated with aortic systolic BP, daytime systolic BP, and heart rate variability power in low and high frequencies.
- Orthostatic BP response showed significant correlations with standing BRS and high-frequency normalized units (HFnu).
- Multivariate analyses identified high-frequency power as independently associated with BRS, and HFnu and BRS with orthostatic pressor response.
Conclusions:
- Defective parasympathetic modulation detrimentally affects childhood baroreflex sensitivity and orthostatic pressor response.
- These effects are evident irrespective of the underlying pediatric pathology.
- Findings underscore the importance of parasympathetic function in cardiovascular regulation during childhood.
Background:
The objective of our case-control study was to evaluate the determinants of childhood cardio-vagal baroreflex failure and exaggerated orthostatic pressor response, which are risk factors for subsequent hypertension.
Methods:
Four groups of children were matched for sex and age: 12 with congenital central hypoventilation syndrome (autonomic nervous system dysfunction), 12 with chronic kidney disease (frequently abnormal blood pressure [BP]), 12 with sickle cell disease (frequently abnormal orthostatic BP), and 24 control children (preterm birth with normal BP). The children underwent tonometry evaluation (aortic systolic BP) and continuous BP and ECG measurements in supine and standing positions, allowing ambulatory BP monitoring and the computation of heart rate variability indices, baroreflex sensitivity (BRS), and orthostatic systolic BP response.
Results:
Supine and standing BRS correlated significantly with aortic systolic BP (ρ = -0.34, ρ = -0.52, respectively), daytime systolic BP (ρ = -0.33, ρ = -0.54, respectively), low frequencies power in similar body positions (supine: ρ = 0.68, standing: ρ = 0.65), and high frequencies (HF) power (ρ = 0.78, ρ = 0.76, respectively). Orthostatic BP response correlated significantly with standing BRS (ρ = -0.38) and standing HFnu (ρ = -0.46). In multivariate analyses, only supine and standing HF power remained independently associated with the respective BRS, while standing HFnu and standing BRS were independently associated with the orthostatic pressor response.
Conclusions:
Defective parasympathetic modulation's detrimental effect on baroreflex sensitivity and the orthostatic pressor response in childhood is evident, regardless of the underlying pathology.
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