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Heart 2001;86:643-648 ( December )

Cardiovascular medicine

Development of a new method for assessing the cardiac baroreflex: response to downward tilting in patients with diabetes mellitus M Nakagawaa, N Takahashib, T Ooieb, K Yufub, M Harab, M Watanabea, S Nobea, H Yonemochia, I Katsuragib, T Okedab, T Sakatab, T Saikawaa

a Department of Laboratory Medicine Oita Medical University, 1-1 Idaigaoka, Hasama, Oita 879-5593, Japan, b First Department of Internal Medicine, Oita Medical University

Correspondence to: Dr Nakagawa mikinak{at}oita-med.ac.jp

Accepted 8 August 2001

OBJECTIVE---To investigate the clinical value of a new non-invasive method for assessing baroreflex sensitivity using downward tilting.
PATIENTS---34 patients with diabetes mellitus, mean (SD) age, 53.6 (11.8) years.
DESIGN---Arterial blood pressure and ECG were recorded simultaneously while the patients were on a tilt table. After 20 minutes at a 70° upright tilt, the patients were returned to the supine position at a speed of 3.2°/s (downward tilting baroreflex sensitivity test, DT-BRS). A beat to beat systolic blood pressure increase associated with a corresponding lengthening of the RR interval was noted during downward tilting. Baroreflex sensitivity was also assessed using the conventional method of an intravenous injection of phenylephrine (Phe-BRS). Heart rate variability was analysed during rest and tilting.
RESULTS---The slope of the regression line for systolic blood pressure v RR interval during downward tilting was highly correlated with Phe-BRS (r = 0.83, p < 0.0001). Both DT-BRS and Phe-BRS were correlated with the high frequency (HF) component of resting heart rate variability (p < 0.005) and with the ratio of the low frequency to the high frequency component (LF/HF) during upright tilting (p < 0.005). DT-BRS and Phe-BRS were also correlated with the difference between rest and tilting values of HF and LF/HF (p < 0.005).
CONCLUSIONS---DT-BRS provides a physiological, non-invasive method for determining baroreflex sensitivity and may be a useful index of reflex cardiac vagal and sympathetic function in patients with diabetes mellitus.


Keywords: baroreflex sensitivity; downward tilting; heart rate variability; diabetes

© 2001 by Heart


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