DOI: 10.1097/01.hjh.0000163137.59341.c3

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PMID: 15775773

Issn Print: 0263-6352

Publication Date: 2005/04/01


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Mechanical and neural components of the cardiac baroreflex: new insights into complex physiology

Gianfranco Parati; Pierre Lantelme

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Author Information: Department of Clinical Medicine, Prevention and Applied Biotechnology, University of Milano-Bicocca, Milan

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Excerpt

The arterial baroreflex is known to represent a mechanism of fundamental importance for short-term blood pressure homeostasis in daily life. It is also deeply involved in the pathophysiology of several cardiovascular diseases [1–5], where its impairment may contribute to the appearance of clinical complications [6–14].
This has stimulated a progressive increase in the interest towards the evaluation of baroreflex function in man and, in particular, towards the assessment of cardiac baroreflex modulation. The latter can now be explored either through conventional laboratory methods, or by means of more modern approaches, aimed at quantifying the sensitivity of cardiac baroreflex regulation through computer analysis of spontaneously occurring fluctuations in blood pressure, coupled with linearly related changes in heart rate, with no need of any direct or indirect interference with spontaneous baroreflex function [13,15–20] (Table 1).
However, at variance from the relatively simple, although mostly indirect, nature of the methods available to explore baroreflex function in humans, the arterial baroreflex remains a highly complex cardiovascular control mechanism, in which cardiac, vascular respiratory and cerebral components involved in short-term blood pressure regulation are deeply interconnected [1] (Fig. 1). Evidence on the clinical implications of alterations occurring at different levels in the baroreflex arch has been provided by several studies. These include observations on alterations at the carotid artery level, based on baroreflex measurements obtained before and after carotid surgery demonstrating a change in baroreflex function after carotid thromboendoarterectomy [21]. They also include observations on alterations of baroreceptor signal processing in the central nervous system, exemplified by data on baroreflex impairment after acute stroke [22], an impairment that was also shown to predict mortality after stroke [23]. Finally, they include observations on alterations at the effector organs level, exemplified by the demonstration that cardiac hypertrophy is associated with a perturbation of arterial baroreflex function [14].

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