Dataset Information

Sympathetic Overactivation From Supine to Upright Is Associated With Orthostatic Hypertension in Children and Adolescents.

ABSTRACT: There are no prior publications or submissions with any overlapping information, including studies and patients. The study data have not been presented as an abstract or poster before the submission. Objectives: The study was conducted to analyze the changes of baroreflex sensitivity and heart rate variability from supine to upright standing in children and adolescents with orthostatic hypertension to explore whether and how the autonomic nerve regulation was involved in the development of pediatric orthostatic hypertension. Methods: This case-control study included twenty-five children with orthostatic hypertension (the patient group) and twenty-six healthy controls (the control group). All subjects underwent a standing test, during which their hemodynamic parameters were continuously monitored by a Finapres Medical System, and baroreflex sensitivity and heart rate variability were calculated. Results: The demographic characteristics, supine baroreflex sensitivity, and supine heart rate variability including time domain and frequency domain indices did not differ between the patients with orthostatic hypertension and healthy subjects (P > 0.05). However, a more obvious drop of baroreflex sensitivity and a greater increase of low frequency/high frequency ratio from supine to upright were observed in subjects with orthostatic hypertension compared with those in the healthy children (P < 0.001 and P < 0.01, respectively). Changes of baroreflex sensitivity were negatively related to mean arterial pressure changes from supine to upright in all subjects (P < 0.01), and the increases in low frequency/high frequency ratio from supine to standing were positively correlated with those in mean arterial pressure in the study subjects (P < 0.001). Conclusion: Upright sympathetic overactivation is associated with pediatric orthostatic hypertension.

SUBMITTER: Hu Y

PROVIDER: S-EPMC7047410 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Sympathetic Overactivation From Supine to Upright Is Associated With Orthostatic Hypertension in Children and Adolescents.

Hu Yang Y Wang Yuanyuan Y He Bing B Wang Yaru Y Han Zhenhui Z Tao Chunyan C Li Hongxia H Jiang Yi Y Tang Chaoshu C Du Junbao J

Frontiers in pediatrics 20200221

There are no prior publications or submissions with any overlapping information, including studies and patients. The study data have not been presented as an abstract or poster before the submission. <b>Objectives:</b> The study was conducted to analyze the changes of baroreflex sensitivity and heart rate variability from supine to upright standing in children and adolescents with orthostatic hypertension to explore whether and how the autonomic nerve regulation was involved in the development o ...[more]

PMID: 32154199

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Project description:Background/Hypothesis: Cardiopulmonary exercise testing (CPET) is used in the assessment of function and prognosis of cardiopulmonary health in children with cardiac and pulmonary diseases. Techniques, such as cardiac MRi, and PET-scan, can be performed simultaneously with exercise testing. Thus, it is desirable to have a broader knowledge about children's normal cardiopulmonary function in different body postures and exercise modalities. The aim of this study was to investigate the effect of different body positions on cardiopulmonary function in healthy subjects performing CPETs. Materials and Methods: Thirty-one healthy children aged 9, 12, and 15 years did four CPETs: one treadmill test with a modified Bruce protocol and three different bicycle tests with different body postures, sitting, tilted 45°, and lying flat (0°). For the bicycle tests, a 20-watt ramp protocol with a pedal frequency of 60 ± 5 rotations per minute was used. Continous ECG and breath-by-breath V . O 2 measurements was done throughout the tests. Cardiac structure and function including aortic diameter were evaluated by transthoracic echocardiography prior to the tests. Doppler measurements of the blood velocity in the ascending aorta were measured prior to and during the test. Prior to every test, the participants performed pulmonary function tests with maximum voluntary ventilation test. Results: There is a significantly (p < 0.05) lower peak V . O 2 in all bicycle tests compared with the treadmill test. There is lower corrected peak V . O 2 (ml kg-0.67 min-1), but not relative peak V . O 2 (ml kg-1 min-1), in the supine compared with the upright bicycle test. There are no differences in peak stroke volume or cardiac output between the bicycle modalities when calculated from aortic blood flow. Peak heart rate decreases from both treadmill to upright bicycle and from upright bicycle to the supine test (0°). Conclusion: There are no differences in peak cardiac output between the upright bicycle test and supine bicycle tests. Heart rate and corrected peak V . O 2 are lower in the supine test (0°) than the upright bicycle test. In the treadmill test, it is a higher absolute and relative peak V . O 2 . Despite the latter differences, we are convinced that both upright and supine bicycle tests are apt in the clinical setting when needed.

Project description:Orthostatic hypotension (OH) often co-exists with hypertension. As increasing age affects baroreflex sensitivity, it loses its ability to reduce blood pressure when lying down. Therefore, supine hypertension may be an important indicator of baroreflex function. This study examines (i) the association between OH and future falls in community-dwelling older adults and (ii) if these associations persist in those with co-existing OH and baseline hypertension, measured supine and seated. Data from 1500 community-dwelling adults aged ≥65 years from The Irish Longitudinal Study on Ageing (TILDA) were used. Continuous beat-to-beat blood pressure was measured using digital photoplethysmography during an active stand procedure with OH defined as a drop in systolic blood pressure (SBP) ≥20 mmHg and/or ≥10 mm Hg in diastolic blood pressure (DBP) within 3 minutes of standing. OH at 40 seconds (OH40) was used as a marker of impaired early stabilisation and OH sustained over the second minute (sustained OH) was used to indicate a more persistent deficit, similar to traditional OH definitions. Seated and supine hypertension were defined as SBP ≥140 mm Hg or DBP ≥90 mm Hg. Modified Poisson models were used to estimate relative risk of falls (recurrent, injurious, unexplained) and syncope occurring over four year follow-up. OH40 was independently associated with recurrent (RR = 1.30, 95% CI = 1.02,1.65), injurious (RR = 1.43, 95% CI = 1.13,1.79) and unexplained falls (RR = 1.55, 95% CI = 1.13,2.13). Sustained OH was associated with injurious (RR = 1.55, 95% CI = 1.18,2.05) and unexplained falls (RR = 1.63, 95% CI = 1.06,2.50). OH and co-existing hypertension was associated with all falls outcomes but effect sizes were consistently larger with seated versus supine hypertension. OH, particularly when co-existing with hypertension, was independently associated with increased risk of future falls. Stronger effect sizes were observed with seated versus supine hypertension. This supports previous findings and highlights the importance of assessing orthostatic blood pressure behaviour in older adults at risk of falls and with hypertension. Observed associations may reflect underlying comorbidities, reduced cerebral perfusion or presence of white matter hyperintensities.

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Sympathetic Overactivation From Supine to Upright Is Associated With Orthostatic Hypertension in Children and Adolescents.

Publications

Sympathetic Overactivation From Supine to Upright Is Associated With Orthostatic Hypertension in Children and Adolescents.

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