Changes in autonomic regulation induced by physical training in mild hypertension.

TLDR

The authors propose the index alpha as a quantitative marker of baroreceptor gain changes induced by physical training in mild hypertension and across a 24‑hour ambulatory period. They studied 11 mildly hypertensive subjects, measuring the heart period–systolic arterial pressure gain in unfit and fit states using an open‑loop regression during phenylephrine‑induced pressure rises and a closed‑loop spectral analysis to derive the index alpha. Training raised the resting heart period–systolic arterial pressure gain but markedly reduced it during bicycle exercise, while hypertensive subjects displayed a lower resting index alpha that fluctuated diurnally, being lower during the day and higher at night.

Abstract

The adaptive effects of physical training on cardiovascular control mechanisms were studied in 11 subjects with mild hypertension. In these subjects we assessed the gain of the heart period-systolic arterial pressure relationship in the unfit and the fit state by using 1) an open loop approach, whereby the gain is expressed by the slope of the regression of heart period as a function of systolic arterial pressure, during a phenylephrine-induced pressure rise and 2) a closed loop approach with proper simplification, whereby the gain is expressed by the index alpha, obtained through simultaneous spectral analysis of the spontaneous variabilities of heart period and systolic arterial pressure. Both methods indicated that training significantly increased the gain of the relationship between heart period and systolic arterial pressure at rest and reduced arterial pressure and increased heart period significantly. This gain was drastically reduced during bicycle exercise both in the unfit and fit state. In a second group of normotensive (n = 7; systolic pressure, 133 +/- 3 mm Hg) and hypertensive (n = 7; systolic pressure, 180 +/- 10 mm Hg) subjects undergoing 24-hour diagnostic continuous electrocardiographic and high fidelity arterial pressure monitoring, the index alpha was significantly reduced in the hypertensive group at rest. Furthermore, when analyzed continuously over the entire 24-hour period, this index underwent minute-to-minute changes with lower values during the day and higher values during the night. We propose the index alpha as a quantitative indicator of the changes in the gain of baroreceptor mechanisms occurring with physical training in mild hypertension and during a 24-hour period in ambulatory subjects.