Annals of Clinical Neurophysiology

  • 제12권2호
  • /
  • Pages.61-65
  • /
  • 2010
  • /
  • 2508-691X(pISSN)
  • /
  • 2508-6960(eISSN)
대한임상신경생리학회 (The Korean Society of Clinical Neurophysiology)
권호 표지

기립성 저혈압 진단에 있어 기립경사검사와 누운 자세에서 측정한 자발성 압수용기반사 민감도의 상관관계

Correlation between Head-Up Tilt Test and Spontaneous Baroreflex Sensitivity in a Supine Position on the Diagnosis of Orthostatic Hypotension

  • 하은옥 (경상대학교 의학전문대학원 신경과학교실) ;
  • 김영수 (경상대학교 의학전문대학원 신경과학교실) ;
  • 박기종 (경상대학교 의학전문대학원 신경과학교실) ;
  • 김수경 (경상대학교 의학전문대학원 신경과학교실) ;
  • 강희영 (경상대학교 의학전문대학원 신경과학교실) ;
  • 최낙천 (경상대학교 의학전문대학원 신경과학교실) ;
  • 권오영 (경상대학교 의학전문대학원 신경과학교실) ;
  • 임병훈 (경상대학교 의학전문대학원 신경과학교실) ;
  • 유남태 (성균관대학교 의과대학 창원삼성병원 신경과)
  • Ha, Eun-Ok (Department of Neurology, Gyeongsang National University School of Medicine) ;
  • Kim, Young-Soo (Department of Neurology, Gyeongsang National University School of Medicine) ;
  • Park, Ki-Jong (Department of Neurology, Gyeongsang National University School of Medicine) ;
  • Kim, Soo-Kyoung (Department of Neurology, Gyeongsang National University School of Medicine) ;
  • Kang, Hee-Young (Department of Neurology, Gyeongsang National University School of Medicine) ;
  • Choi, Nack-Cheon (Department of Neurology, Gyeongsang National University School of Medicine) ;
  • Kwon, Oh-Young (Department of Neurology, Gyeongsang National University School of Medicine) ;
  • Lim, Byeong-Hoon (Department of Neurology, Gyeongsang National University School of Medicine) ;
  • Yoo, Nam-Tae (Department of Neurology, Changwon Samsung Hospital, Sungkyunkwan University School of Medicine)
  • 투고 : 2010.08.09
  • 심사 : 2010.12.01
  • 발행 : 2010.12.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: Orthostatic hypotension (OH) refers to a fall in systolic blood pressure (BP) of 20 mmHg or more, or in diastolic BP of 10 mm Hg or more within 3 minutes of standing up. The head-up tilt test (HUT) is the most useful, but potentially invasive test for the diagnosis of OH. The purpose of this study was to identify the usefulness of spontaneous baroreflex sensitivity (sBRS). Methods: Ninety one patients with orthostatic intolerance, in whom the HUT data were available, were included in the study. Patients were classified into HUT-positive (group I) and HUT-negative (group II) group. Twenty five healthy volunteers served as normal controls, and were designated as group III. In all subjects, beat-to-beat BP and heart rate were recorded using BeatScope 1.1a. We collected the 50 sBRS data in each patient in a supine position. The average value of one to ten of 50 sBRS data was defined as sBRS10, one to twenty as sBRS20, one to thirty as sBRS 30, one to forty as sBRS 40, and one to fifty as sBRS 50. Differences in sBRS10 and sBRS50 levels were statistically analyzed and compared between groups I, II, and III. Results: No significant difference in the sBRS50 level was found between Groups II and III. sBRS50 was significantly lower in Group I than in Groups II and III (p<0.05), and the same pattern of differences was observed for sBRS40, sBRS30, sBRS20, and sBRS10. Conclusions: Patients with OH showed significantly lower sBRS levels than HUT-negative patients or normal controls. Our study implies that a supine-position sBRS would provide additional diagnostic information for OH.

키워드

참고문헌

  1. Kaufmann H. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure and multiple system atrophy. Clinical Autonomic Research 1996;6:125-126. https://doi.org/10.1007/BF02291236
  2. Weiss A, Grossman E, Beloosesky Y, Grinblat J. Orthostatic hypotension in acute geriatric ward: is it a consistent finding? Arch Internal Med 2002;162:2369-2373. https://doi.org/10.1001/archinte.162.20.2369
  3. Carlson JE. Assessment of orthostatic blood pressure: measurement technique and clinical applications. South Med J 1999;92:167-173. https://doi.org/10.1097/00007611-199902000-00002
  4. Benditt DG, Ferguson DW, Grubb BP, Kapoor WN, Kugler J, Lerman BB, et al. Tilt table testing for assessing syncope. American College of Cardiology. J Am Coll Cardiol 1996;28:263-275. https://doi.org/10.1016/0735-1097(96)00236-7
  5. Kapoor WN, Smith MA, Miller NL. Upright tilt testing in evaluating syncope: a comprehensive literature review 1. The Am J Med 1994;97:78-88. https://doi.org/10.1016/0002-9343(94)90051-5
  6. Wang CH, Lee CC, Cherng WJ. Coronary vasospasm induced during isoproterenol head-up tilt test. Am J Cardiol 1997;80:1508-1510. https://doi.org/10.1016/S0002-9149(97)00740-6
  7. Lacroix D, Kouakam C, Klug D, Guedon Moreau L, Vaksmann G, Kacet S, et al. asystolic cardiac arrest during head up tilt test: incidence and therapeutic implications. Pacing Clin Electrophysiology 1997;20:2746-2754. https://doi.org/10.1111/j.1540-8159.1997.tb05432.x
  8. Folino AF, Buja GF, Martini B, Miorelli M, Nava A. Prolonged cardiac arrest and complete AV block during upright tilt test in young patients with syncope of unknown origin-prognostic and therapeutic implications. Eur Heart J 1992;13: 1416-1421. https://doi.org/10.1093/oxfordjournals.eurheartj.a060076
  9. Parati G, Di Rienzo M, Mancia G. How to measure baroreflex sensitivity: from the cardiovascular laboratory to daily life. J Hypertens 2000;18:7-19. https://doi.org/10.1097/00004872-200018010-00003
  10. Kirchheim HR. Systemic arterial baroreceptor reflexes. Physiological Reviews 1976;56:100-177. https://doi.org/10.1152/physrev.1976.56.1.100
  11. Lage SG, Polak JF, O'Leary DH, Creager MA. Relationship of arterial compliance to baroreflex function in hypertensive patients. Am J Physiol 1993;265:232-237.
  12. Smyth HS, Sleight P, Pickering GW. Reflex regulation of arterial pressure during sleep in man: a quantitative method of assessing baroreflex sensitivity. Cir Res 1969;24:109-121. https://doi.org/10.1161/01.RES.24.1.109
  13. Gribbin B, Pickering TG, Sleight P, Peto R. Effect of age and high blood pressure on barorefiex sensitivity in man. Cir Res 1971;29:424-431. https://doi.org/10.1161/01.RES.29.4.424
  14. Laitinen T, Hartikainen J, Vanninen E, Niskanen L, Geelen G, Lansimies E. Age and gender dependency of baroreflex sensitivity in healthy subjects. J App Physiol 1998;84: 576-583. https://doi.org/10.1152/jappl.1998.84.2.576
  15. Friedrich C, Rudiger H, Schmidt C, Herting B, Prieur S, Junghanns S, et al. Baroreflex sensitivity and power spectral analysis in different extrapyramidal syndromes. J Neural Transm 2008;115:1527-1536. https://doi.org/10.1007/s00702-008-0127-3
  16. Nasr N, Pavy-Le Traon A, Larrue V. Baroreflex sensitivity is impaired in bilateral carotid atherosclerosis. Stroke 2005;36:1891-1895. https://doi.org/10.1161/01.STR.0000177890.30065.cb
  17. Frattola A, Parati G, Gamba P, Paleari F, Mauri G, Di Rienzo M, et al. Time and frequency domain estimates of spontaneous baroreflex sensitivity provide early detection of autonomic dysfunction in diabetes mellitus. Diabetologia 1997;40:1470-1475. https://doi.org/10.1007/s001250050851
  18. Thomson HL, Wright K, Frenneaux M. Baroreflex sensitivity in patients with vasovagal syncope. Circulation 1997;95:395-400. https://doi.org/10.1161/01.CIR.95.2.395
  19. Farquhar WB, Taylor JA, Darling SE, Chase KP, Freeman R. Abnormal baroreflex responses in patients with idiopathic orthostatic intolerance. Circulation 2000;102:3086-3091. https://doi.org/10.1161/01.CIR.102.25.3086
  20. Westerhof BE, Gisolf J, Stok WJ, Wesseling KH, Karemaker JM. Time-domain cross-correlation baroreflex sensitivity: performance on the EUROBAVAR data set. J Hypertens 2004;22:1371-1380. https://doi.org/10.1097/01.hjh.0000125439.28861.ed
  21. Gisolf J, Immink RV, Van Lieshout JJ, Stok WJ, Karemaker JM. Orthostatic blood pressure control before and after spaceflight, determined by time-domain baroreflex method. J Appl Physiol 2005;98:1682-1690. https://doi.org/10.1152/japplphysiol.01219.2004
  22. Moss AJ, Glaser W, Topol E. Atrial tachypacing in the treatment of a patient with primary orthostatic hypotension. N Engl J Med 1980;302:1456-1457. https://doi.org/10.1056/NEJM198006263022606
  23. La Rovere MT, Bigger JT Jr, Marcus FI, Mortara A, Schwartz PJ. Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) Investigators. Lancet 1998;351:478-484. https://doi.org/10.1016/S0140-6736(97)11144-8
  24. La Rovere MT, Specchia G, Mortara A, Schwartz PJ. Baroreflex sensitivity, clinical correlates, and cardiovascular mortality among patients with a first myocardial infarction. A prospective study. Circulation 1988;78:816-824 https://doi.org/10.1161/01.CIR.78.4.816
  25. Parati G, Mutti E, Frattola A, Castiglioni P, di Rienzo M, Mancia G. Beta-adrenergic blocking treatment and 24-hour baroreflex sensitivity in essential hypertensive patients. Hypertension 1994;23:992-996. https://doi.org/10.1161/01.HYP.23.6.992
  26. Dietrich A, Riese H, van Roon AM, Engelen K, Ormel J, Neeleman J, et al. Spontaneous baroreflex sensitivity in preadolescents. J Hypertens 2006;24:345-352. https://doi.org/10.1097/01.hjh.0000200517.27356.47
  27. Osculati G, Grassi G, Giannattasio C, Seravalle G, Valagussa F, Zanchetti A, et al. Early alterations of the baroreceptor control of heart rate in patients with acute myocardial infarction. Circulation 1990;81:939-948. https://doi.org/10.1161/01.CIR.81.3.939