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1 Mayo Clinic College of Medicine
2 Brunel University
3 Zhejiang University
4 Mayo Clinic & Foundation
* To whom correspondence should be addressed. E-mail: ramirezmarrero.farah{at}mayo.edu.
Orthostatic stress such as head-up tilt (HUT) elicits a wide range of heart rate (HR) and arterial pressure (AP) responses among healthy individuals. In this study, we evaluated cardiovascular dynamics in healthy subjects with different HR responses to HUT, but without autonomic dysfunction. We measured AP (brachial artery) and HR (ECG) during 5 min of 60°; HUT in 76 healthy normotensive individuals. We then chose individuals based on the extremes of HR responses to HUT (high =
HR
20 bpm and low =
HR
10 bpm; N=15 per group). Peak HR during HUT was 87±10 bpm in the high and 69±14 bpm in the low group (P < 0.05). High HR responders had lower systolic pressure at baseline (121±9 vs. 129±11 mmHg, P < 0.05) and during HUT (120±10 vs. 131±13 mmHg, P < 0.05), and higher plasma norepinephrine (NE) response to HUT (
NE: 156.9±17.8 vs. 89.0±17.2 pg/ml; P< 0.05). Delta NE during HUT was also significantly correlated with delta HR when all 76 subjects were included in a regression analysis (r = 0.39; P < 0.001). Pulse pressure was lower during HUT in high HR responders compared to low HR responders (45±1 vs. 55±2 mmHg, P<0.05). High HR responders also had larger fluctuations in systolic and pulse pressure during HUT (CV = 10.7±0.7 vs. 5.7±0.3 %; 7.9±0.5 vs. 4.1±0.4 %, respectively, P<0.05). Gender distribution was different between groups (high: 5F, 10 M; low: 10F, 5M). Higher HR with lower AP during HUT is consistent with normal baroreflex mechanisms of integration. Although inter-individual variability appears to be a fundamental part of cardiovascular regulation, the mechanisms of these differences and the gender discrepancy requires further investigation.
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