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Reduced vascular excitatory responses to cardiopulmonary unloading in hypertensive patients with left ventricular diastolic dysfunction

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Abstract

Physiological consequences of altered peak left ventricular diastolic filling rate in hypertension have not yet been fully assessed. The hypothesis that altered left ventricular diastolic filling rate interferes with inhibitory cardiopulmonary reflexes was tested. Normalized peak left ventricular diastolic filling rate was calculated from radionuclide ventriculography. Haemodynamic changes during lower body negative pressure (−5 to −40 mmHg) in nine hypertensive patients with slow normalized left ventricular filling rate (Group A) were compared with 16 hypertensive patients with normal normalized peak left ventricular diastolic filling rate and ten normal volunteers of the same age group. Baseline total peripheral resistance was higher in essential hypertension compared to normals but did not differ significantly between the two hypertensive groups. For data analysis, the levels of lower body negative pressure were grouped as low levels of −5 to −10, and −15 to −20 mmHg, an intermediate level of −25 mmHg, and high levels of −30 to −40 mmHg; the change in total peripheral resistance (from baseline) was less prominent in Group A compared to Group B and to normals (−1.4 ± 1.7 [SE], −0.06 ± 1.4, 1.1 ± 1.2 and 4.5 ± 2 u·M2 in Group A at the four consecutive levels of lower body negative pressure vs. 0.9 ± 0.7, 3.8 ± 0.9, 7.2 ± 1.6, and 8.2 ± 1.4 in Group B, and 2.0 ± 0.7, 3.3 ± 0.8, 4.9 ± 0.8, and 5.6 ± 1.0 in normals). The reductions in central venous pressure and in pulmonary wedge pressure were not significantly different among the three groups at the different levels of lower body negative pressure, but the reduction in cardiac output was smaller in patients with reduced dv/dt ratio than in the other two groups. The responses to the cold pressor test were similar in all subjects. We conclude that patients with essential hypertension and diastolic dysfunction have impaired total peripheral resistance responses to lower body negative pressure. This abnormality may reflect an alteration in cardiac baroreflexes secondary to left ventricular diastolic dysfunction, an influence of baseline sympathetic activity on the observed vascular responsiveness to lower body negative pressure, or primary differences among groups in the changes in cardiac output induced by similar levels of lower body negative pressure.

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References

  1. Ouereshi S, Wagner HN Jr, Alderson PO, Housholder DF, Douglass KH, Lotter MG, Nickoloff EL, Tanabe M, Knowles LG. Evaluation of left ventricular function in normal persons and patients with heart disease.J Nucl Med 1978;19: 135–141.

    PubMed  Google Scholar 

  2. Fouad FM, Tarazi RC, Gallagher JH, Maclntyre WJ, Cook SA. Abnormal left ventricular relaxation in hypertensive patients.Clin Sci 1980;59: 411s-414s.

    PubMed  Google Scholar 

  3. Dreslinski GR, Frohlich ED, Dunn FG, Messerli FH, Suarez DH, Reisin E. Echocardiographic diastolic ventricular abnormality in hypertensive heart disease: atrial emptying index.Am J Cardiol 1981;47: 1087–1090.

    PubMed  Google Scholar 

  4. Hartford M, Wikstrand J, Wallentin I, Ljungman S, Wilhelmsen L, Berglund G. Diastolic function of the heart in untreated primary hypertension.Hypertension 1984;6: 329–338.

    PubMed  Google Scholar 

  5. Thoren P, Noresson E, Rickstein SE. Resetting of cardiac C-fiber endings in the spontaneously hypertensive rat.Acta Physiol Scand 1979;107: 13–18.

    PubMed  Google Scholar 

  6. Frohlich ED, Tarazi RC, Ulrych M, Dustan HP, Page IH. Tilt test for investigating a neural component in hypertension: its correlation with clinical characteristics.Circulation 1967;36: 387–393.

    PubMed  Google Scholar 

  7. Fouad FM, Tarazi RC, Bravo EL. Dihydroergotamine in idiopathic orthostatic hypotension: short-term intramuscular and long-term oral therapy.Clin Pharmacol Ther 1981;30: 782–789.

    PubMed  Google Scholar 

  8. Cody RJ Jr, Tarazi RC, Bravo EL, Fouad FM. Haemodynamics of orally-active converting enzyme inhibitor (SQ 14225) in hypertensive patients.Clin Sci Mole Med 1978;55: 453–459.

    Google Scholar 

  9. Tarazi RC, Ibrahim MM, Dustan HP, Ferrario CM. Cardiac factors in hypertension.Circ Res 1974;34 (suppl I): I-213–I-221.

    Google Scholar 

  10. Fouad FM, Maclntyre WJ, Tarazi RC. Noninvasive measurement of cardiopulmonary blood volume. Evaluation of the centroid method.J Nucl Med 1981;22: 205–211.

    PubMed  Google Scholar 

  11. Pitt B, Strauss HW. Evaluation of ventricular function by radioisotope technics.N Engl J Med 1977;296: 1097–1099.

    PubMed  Google Scholar 

  12. Fouad FM, Slominski JM, Tarazi RC. Left ventricular diastolic function in hypertension: relation to left ventricular mass and systolic function.J Am Coll Cardiol 1984;3: 1500–1506.

    PubMed  Google Scholar 

  13. Fouad FM. Left ventricular diastolic function in hypertensive patients.Circulation 1987;75 (suppl I, Part 2): I-48–I-55.

    Google Scholar 

  14. Fouad-Tarazi FM. Left ventricular diastolic dysfunction and cardiovascular regulation in hypertension.Am J Med 1989;87: (suppl 6B) 42S-44S.

    PubMed  Google Scholar 

  15. Magorien DJ, Shaffer P, Bush C, Magorien RD, Kolibash AJ, Unverferth DV, Bashore TM. Hemodynamic correlated for timing intervals, ejection rate and filling rate derived from the radionuclide angiographic volume curve.Am J Cardiol 1984;53: 567–571.

    PubMed  Google Scholar 

  16. Smith VE, Katz AM. Relaxation abnormalities part II: clinical aspects.Hosp Prac 1984;19: 149–155, 159–160, 164–169.

    Google Scholar 

  17. Inouye I, Massie B, Loge D, Topic N, Silverstein D, Simpson P, Tubau J. Abnormal left ventricular filling: an early finding in mild to moderate systemic hypertension.Am J Cardiol 1984;53: 120–126.

    PubMed  Google Scholar 

  18. Sahn DJ, Demaria A, Kisslo J, Weyman A. Recommendation regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements.Circulation 1978;58: 1072–1083.

    PubMed  Google Scholar 

  19. Devereux RB. Detection of left ventricular hypertrophy by M-mode echocardiography. Anatomic validation, standardization, and comparison to other methods.Hypertension 1987;9 (suppl II): II-19–II-26.

    Google Scholar 

  20. Mark AL, Kerber RE. Augmentation of cardiopulmonary baroreflex control of forearm vascular resistance in borderline hypertension.Hypertension 1982;4: 39–46.

    PubMed  Google Scholar 

  21. Ferguson DW, Abboud FM, Mark AL. Selective impairment of baroreflex-mediated vasoconstrictor responses in patients with ventricular dysfunction.Circulation 1984;69: 451–460.

    PubMed  Google Scholar 

  22. Smyth HS, Sleight P, Pickering GW. Reflex regulation of arterial pressure during sleep in man.Circ Res 1969;24: 109–121.

    PubMed  Google Scholar 

  23. Bravo EL, Tarazi RC, Fouad FM, Textor SC, Gifford RW Jr, Vidt DG. Blood pressure regulation in pheochromocytoma.Hypertension 1982;4 (suppl III, Part 2): III-193–III-199.

    Google Scholar 

  24. Dixon WJ, Massey FJ.Introduction to Statistical Analysis. New York: McGraw Hill, 1969.

    Google Scholar 

  25. Madkour MA, Fouad-Tarazi FM. Influence of left ventricular diastolic function on vascular and humoral responses to head-up posture in hypertension.Am Heart J 1989;118: 531–538.

    PubMed  Google Scholar 

  26. Kostreva DR, Castaner A, Kampine JP. Reflex effects of hepatic baroreceptors on renal and cardiac sympathetic nerve activity.Am J Physiol 1980;238: R390-R394.

    PubMed  Google Scholar 

  27. Abboud FM. Role of cardiac afferent nerves in regulation of circulation during coronary occlusion and heart failure. In: Abboud FM, Fozzard HA, Gilmore JP, Reis DJ, eds.Disturbances in Neurogenic Control of the Circulation. Bethesda, MD: American Physiological Society, 1981.

    Google Scholar 

  28. Kostreva DR, Seagard JL, Castaner A, Kampine JP. Reflex effects of renal afferents on the heart and kidney.Am J Physiol 1981;241: R286-R292.

    PubMed  Google Scholar 

  29. Bishop VS, Malliani A, Thoren P. Cardiac mechanoreceptors. In: Shepherd JT, Abboud FM, eds.Handbook of Physiology, Section 2: The Cardiovascular System, Vol. III: Peripheral Circulation and Organ Blood Flow, Part 2. Bethesda, MD: American Physiological Society, 1983.

    Google Scholar 

  30. Guzzetti S, Piccaluga E, Casati R, Cerutti S, Lombardi F, Pagani M, Malliani A. Sympathetic predominance in essential hypertension: a study employing spectral analysis of heart rate variability.J Hypertension 1988;6: 711–717.

    Google Scholar 

  31. Floras JS, Aylward PE, Abboud FM, Mark AL. Inhibition of muscle sympathetic nerve activity in humans by arginine vasopressin.Hypertension 1987;10: 409–416.

    PubMed  Google Scholar 

  32. Heesch CM, Miller BM, Thames MO, Abboud FM. Effects of calcium channel blockers on isolated carotid baroreceptors and baroreflex.Am J Physiol 1983;14: H653-H661.

    Google Scholar 

  33. Grassi G, Giannattasio C, Clerous J, Cuspidi C, Sampieri L, Bolla GB, Mancia G. Cardiopulmonary reflex before and after regression of left ventricular hypertrophy in essential hypertension.Hypertension 1988;12: 227–237.

    PubMed  Google Scholar 

  34. Wallin BG, Delius W, Hagbarth KE. Comparison of sympathetic nerve activity in normotensive and hypertensive subjexts.Circ Res 1973;33: 9–21.

    PubMed  Google Scholar 

  35. Victor RG, Pryor SL, Secher NH, Mitchell JH. Effects of partial neuromuscular blockade on sympathetic nerve responses to static exercise in humans.Circ Res 1989;65: 468–476.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Heart and Hypertension Research, The Cleveland Clinic Foundation, FF1-02b, 9500 Euclid Avenue, 44195-5069, Cleveland, OH, USA

    M. Aziz Madkour MD & Fetnat M. Fouad-Tarazi MD

  2. Department of Hypertension/Nephrology, The Cleveland Clinic Foundation, FF1-02b, 9500 Euclid Avenue, 44195-5069, Cleveland, OH, USA

    Luis Bedoya MD

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  1. M. Aziz Madkour MD
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  2. Luis Bedoya MD
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  3. Fetnat M. Fouad-Tarazi MD
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Madkour, M.A., Bedoya, L. & Fouad-Tarazi, F.M. Reduced vascular excitatory responses to cardiopulmonary unloading in hypertensive patients with left ventricular diastolic dysfunction. Clinical Autonomic Research 2, 243–255 (1992). https://doi.org/10.1007/BF01819545

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