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December 9, 2019Hypertension18 citationsOpen Access

Sex Differences in the Sympathetic Neural Recruitment and Hemodynamic Response to Head-Up Tilt in Older Hypertensives

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MBMark B. BadrovYOYoshiyuki OkadaJYJeung‐Ki Yoo

Key Result

Older hypertensive women displayed exaggerated pressor and peripheral vasoconstrictor responses to orthostasis versus hypertensive men, driven by augmented sympathetic neural recruitment (P<0.001).

Study Design

Type

Cross-Sectional (n=48)

Structured PICO

Do older hypertensive women display augmented pressor responses and aberrant sympathetic neural discharge patterning in response to orthostatic stress compared to older hypertensive men?

P
Population
48 older hypertensive and normotensive men and women evaluated for hemodynamic and sympathetic neural responses to graded head-up tilt.
E
Exposure
Graded head-up tilt (30° for 5 minutes and 60° for 20 minutes)
C
Comparator
Baseline (supine; 3 minutes) and comparisons between sex and blood pressure status groups
O
Outcome
Blood pressure, heart rate, cardiac index, total peripheral resistance, and muscle sympathetic nerve activitysurrogate

Older hypertensive women display exaggerated pressor and peripheral vasoconstrictor responses to orthostasis compared to men, driven by augmented and aberrant sympathetic neural recruitment.

Main Result

p-value: p=<0.001

Abstract

This study tested the hypothesis that older hypertensive women display augmented pressor responses and aberrant sympathetic neural discharge patterning in response to orthostatic stress versus older hypertensive men. We evaluated, in older hypertensive and normotensive men and women (n=12 each group), blood pressure, heart rate, cardiac index (acetylene rebreathing), total peripheral resistance, and muscle sympathetic nerve activity (microneurography) at baseline (supine; 3 minutes) and during graded head-up tilt (30° for 5 minutes and 60° for 20 minutes). Sympathetic action potential discharge patterns were studied using wavelet-based methodology. In the upright posture, systolic and diastolic blood pressure responses were greater in hypertensive women versus hypertensive men and normotensive women ( P <0.05). No differences existed in the heart rate, stroke index, or cardiac index response between groups; however, the total peripheral resistance response throughout graded head-up tilt was markedly greater in hypertensive women ( P <0.01). Yet, the increase in integrated muscle sympathetic nerve activity burst frequency and burst incidence were similar between hypertensive women and men in the supine and upright postures. However, the increase in the mean action potential content per integrated burst and recruitment of previously dormant, larger-sized action potentials during 60° head-up tilt was greater in hypertensive women versus hypertensive men and normotensive women ( P <0.001). Therefore, total sympathetic action potential firing frequency was markedly greater in hypertensive women throughout 60° head-up tilt ( P <0.001). In conclusion, older hypertensive women displayed exaggerated pressor and peripheral vasoconstrictor responses to orthostasis versus hypertensive men, under conditions of augmented and aberrant sympathetic neural recruitment, rather than increased burst frequency, in the upright posture.

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Cite This Study

Badrov et al. (2019) conducted a cross-sectional in Hypertension (n=48). Female sex in older hypertensives vs. Male sex in older hypertensives and normotensive women was evaluated on Total sympathetic action potential firing frequency during 60° head-up tilt (p=<0.001). Older hypertensive women displayed exaggerated pressor and peripheral vasoconstrictor responses to orthostasis versus hypertensive men, driven by augmented sympathetic neural recruitment (P<0.001).

synapsesocial.com/papers/6a71b64c6c240de38cdc356ahttps://doi.org/10.1161/hypertensionaha.119.14009
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