Key result
Device-guided breathing produced a significantly greater decrease in pulse wave velocity compared to nifedipine (1.3 vs 0.7 m/s, p=0.022) despite a smaller reduction in mean arterial pressure.
Why the study?
Effects of short-term interventions on large artery stiffness have mainly been explained by BP changes, but interventions altering sympathetic activity may exert pressure-independent effects on PWV in hypertension.
Do short-term interventions like lower limb venous occlusion and device guided breathing modulate arterial stiffness independently of blood pressure in patients with essential hypertension?
RCT (n=70)
Random order
No
Do short-term interventions like lower limb venous occlusion and device guided breathing modulate arterial stiffness independently of blood pressure in patients with essential hypertension?
Absolute Event Rate: 1.3% vs 0.7%
p-value: p=0.022
Arterial stiffness can be modulated independently of blood pressure in patients with hypertension, likely through sympathetic activity influencing smooth muscle tone.
May support sympathetic effects on PWV beyond BP; leaves open clinical relevance pending larger trials.
Background Effects of short-term interventions on large artery stiffness assessed by pulse wave velocity (PWV) have mainly been explained by concomitant changes in blood pressure (BP). However, lower body negative pressure (LBNP), which increases sympathetic activity (SA) has a specific effect on PWV in healthy volunteers [1]. Methods We examined effects of lower limb venous occlusion (LVO), a similar intervention to LBNP that reduces BP but increases SA and device guided breathing (DBG), which reduces both BP and SA, on PWV in patients with essential hypertension ( n = 70 after LVO, n = 45 after DGB and LVO in random order). The short acting calcium channel antagonist nifedipine was used as a control for changes in BP. Results LVO produced a small but significant reduction in mean arterial pressure of 1.8 (95% confidence-intervals, 0.3–3.4) mmHg. Despite this, aortic and carotid-femoral PWV increased during LVO by 0.8 (0.2–1.4) m/s and 0.7 (0.3–1.05) m/s respectively. When comparing effects of DGB with nifedipine ( n = 19), nifedipine produced a greater reduction in mean arterial pressure compared to DGB (reduction of 13.4 (10.2–17.7) mmHg and 7.7 (6.4–9.0) mmHg respectively, p = 0.009 between the two) but the decrease in PWV was less than that observed with DGB (0.7 (0.1–1.5) m/s and 1.3 (0.8–1.8) m/s respectively, p = 0.022 between the two). Conclusion Arterial stiffness can be modulated independently of BP in patients with hypertension. The mechanism could involve alterations in SA influencing the tone of smooth muscle in the aortic wall.
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Faconti et al. (2019) conducted an RCT in Essential hypertension (n=70). Device guided breathing (DGB) vs. Nifedipine was evaluated on Decrease in pulse wave velocity (PWV) (p=0.022). Device-guided breathing produced a significantly greater decrease in pulse wave velocity compared to nifedipine (1.3 vs 0.7 m/s, p=0.022) despite a smaller reduction in mean arterial pressure.
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