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Continuous 24-hour assessment of the neural regulation of systemic arterial pressure and RR variabilities in ambulant subjects.
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1990
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HypertensionBlood Pressure VariabilityBlood PressureSystemic Arterial PressureElectrophysiological EvaluationClinical PhysiologySympathetic Nervous SystemRr IntervalApplied PhysiologyNeurologyCardiologyBlood Flow MeasurementCardiovascular ImagingBlood Pressure MonitoringHealth SciencesSleepAutonomic SystemAmbulant SubjectsCerebral Blood FlowNervous SystemSympathetic ActivityNeurophysiologyPhysiologySpectral AnalysisElectrophysiologyCardiovascular PhysiologyCentral Nervous SystemContinuous 24-Hour AssessmentMedicineAnesthesiology
The study tested whether human neural control of circulation changes continuously and predictably over 24 hours. Dynamic 24‑hour recordings of arterial pressure and ECG were obtained from 18 hospitalized ambulatory patients and 28 nonhospitalized subjects, and spectral analysis of systolic arterial pressure and RR interval variability quantified sympathetic and vagal modulation of the sinus node and vasomotor tone. Markers of sympathetic activity decreased and vagal activity increased during the night, rose rapidly upon waking, and the early‑morning surge in sympathetic activity with vagal withdrawal likely explains the higher cardiovascular event rate in the morning.
In this study, we tested the hypothesis that the neural control of circulation in humans undergoes continuous but in part predictable changes throughout the day and night. Dynamic 24-hour recordings were obtained in two groups of ambulant subjects. In 18 hospitalized patients free to move, direct high-fidelity arterial pressures and electrocardiograms were recorded, and in an additional 28 nonhospitalized subjects, only electrocardiograms were obtained. Spectral analysis of systolic arterial pressure and of RR interval variabilities provided quantitative markers of sympathetic and vagal control of the sinus node and of sympathetic modulation of vasomotor tone. With this approach, the low-frequency (approximately 0.1 Hz) component of RR interval and systolic arterial pressure variabilities is considered a marker primarily of sympathetic activity, whereas the high-frequency (approximately 0.25 Hz) component of RR interval variability, related to respiration, seems to be a marker primarily of vagal activity. We observed a pronounced and consistent reduction in the markers of sympathetic activity and an increase in those of vagal activity during the night. In the invasive studies, while the subjects were still lying in bed after waking up, the markers of sympathetic activity rose rapidly and concomitantly with a simultaneous vagal withdrawal. Noninvasive studies confirmed the early morning rise of the markers of sympathetic activity and the circadian pattern of sympathovagal balance. These data indicate that the ominously increased rate of cardiovascular events in the morning hours may reflect the sudden rise of sympathetic activity and the reduction of vagal tone.