Age-related changes in phase-space distribution of ABPM data in normotensive and hypertensive patients.

The data collected by ambulatory blood pressure monitoring have been studied in the phase-space of R-R interval and blood pressure and their individual distribution quantified by the slope of the regression line through 24-h values. This slope has been termed "ambulatory autonomic reciprocity index" and abbreviated as AARIs and AARId, the "s" and "d" indicating the relation with systolic and diastolic blood pressure respectively. Ambulatory monitoring was performed in 200 normotensive (NT: 135 females) and 200 untreated hypertensive patients (HT: 59 females). The AARIs was: NT: -6.04±2.7 and HT: -4.69±2.4ms/mmHg, respectively (p<0.001); the AARId was: -7.04±2.9 for NT and -5.79±2.8 for HT subjects (p<0.001). When distributed by decades of life the steepest AARIs occurred at the 20-29 decade, while the flattest at the 60-69 decade. At the 60-69 decade and above, the AARIs was similar in both groups (ANOVA o.w. NT: p<0.001; HT: p<0.01). AARIs and AARId were strongly correlated with 24-h variability of R-R interval, either 24-h standard deviation or coefficient of variation (p<0.001), and poorly correlated with 24-h variability of blood pressure. These data suggest that the AARI, when seen in the context of the "Autonomic Space", may be viewed as a 24-h period index of centrally driven cardiovagal function. Being based on both blood pressure and heart rate measurements, the AARI may become clinically useful to address life style changes and pharmacological treatment of hypertensive patients towards optimal results.

The 24 h blood pressure-R-R interval relation in ambulatory monitoring.

The present study was aimed at investigating whether the blood pressure-R-R interval relation obtained by ABPM may give useful information about autonomic control in the 24 h period. To this purpose ABPM was performed in 60 healthy young subjects (30 females and 30 males, mean age 21.8+/-1.0 years) and the collected variables were copied to a software program to convert heart rate into R-R interval values, for statistical analysis and graphic representation. The following data were calculated: 1) day and night means+/-SD; 2) difference and percent difference in mean night less mean day R-R interval (Delta y), diastolic and systolic blood pressures (Delta x) and their Delta y/Delta x ratios; 3) intercept (a_24 h), slope (b_24 h) and r coefficient (r_24 h) of the linear regressions of 24 h R-R interval over diastolic and systolic blood pressure values. In all subjects night, with respect to day, was characterized by R-R interval lengthening and blood pressure lowering. Despite this common pattern, day and night means and SDs, night and day differences, Delta y/Delta x ratios, a_24 h and b_24 h were different from individual to individual, but they were characteristic and reproducible in 20 out of the 21 subjects in which ABPM was repeated twice. Subjects could thus be classified according to their Delta y/Delta x ratios and slope (b_24 h). The 24 h blood pressure-R-R interval relation as calculated from ABPM yields individually characteristic indices of circadian sympatho-vagal reciprocity. This novel approach may be helpful in characterizing the 24 h autonomic control of several groups of patients.

A thermodynamic model of the sympathetic and parasympathetic nervous systems.

In light of the nonequilibrium thermodynamics by I. Prigogine, the autonomic nervous system as a whole may be viewed as a dissipative structure progressively assembled in the course of evolution, plastically and rhythmically interfaced between forebrain, internal and external environments, to regulate energy, matter and information exchanges. In the present paper, this hypothesis is further pursued to verify whether the two main divisions of the autonomic nervous system, the sympathetic and parasympathetic systems, may support different types of exchange with the external environment. Previous data from hypothalamic stimulation experiments, studies of locus coeruleus function and available data on behavioral functional organization indicate that (1) tight engagement with the external environment, (2) high level of energy mobilization and utilization and (3) information mainly related to exteroceptive sensory stimulation characterize a behavioral prevalence of sympathoadrenal activation. On the other hand, (1) disengagement from the external environment, (2) low levels of internal energy and (3) dominance of proprioceptive information characterize a behavioral prevalence of vagal tone. Behavioral matter exchanges such as feeding, drinking, micturition and defecation are equally absent at the extreme of sympathoadrenal and vagally driven behaviors. The autonomic nervous system as a whole is genetically determined, but the sympathoadrenal system has been mainly designed to organize the visceral apparatus for an action to be performed by the biological system in the external environment and to deal with the novelty of task and of the environment, while the functional role of the parasympathetic is to prepare the visceral apparatus for an action to be performed by the biological system on itself, for recovery and self-protection (homeostasis), and is reinforced by repetition of phylo- and ontogenetically determined patterns. The available clinical data further support this interpretation indicating that an increased sympathetic and a decreased vagal tone may represent a consistent risk factor for cardiovascular diseases.

Factors influencing acute ischaemia-induced renal hypertension in rats.

OBJECTIVE: To verify if the acute hypertension that occurs after reversal of complete renal ischaemia is related to the duration of ischaemia, is different in one-kidney (1K) and two-kidney (2K) rats, and is prevented by angiotensin receptor blockade. METHODS: Four groups of Sprague-Dawley rats anaesthetized with pentobarbitone were studied before, during and after a reversible, complete renal ischaemia achieved by functional right nephrectomy. RESULTS: In 1K rats (group 1, n = 21), reopening of right renal hilum after functional right nephrectomy of 180, 60 and 30 min was followed by peak increases in systolic blood pressure of 76.0 10.1 mmHg, 36.5 10.0 mmHg and 18.4 4.4 mmHg, respectively (mean SEM). In 2K rats (group 2, n = 21), functional right nephrectomy of 180, 60 and 30 min was followed by smaller increases in blood pressure of 49.8 7.6 mmHg, 5.9 3.3 mmHg and 8.3 2.1 mmHg, respectively. Plasma renin activity was directly related to the duration of functional right nephrectomy, and was greater in 1K rats. In group 3, irbesartan administered to 1K rats (n = 8) during functional right nephrectomy almost completely prevented the development of hypertension upon reopening. In group 4, labetalol injected intravenously in 1K rats (n = 3) did not prevent the blood pressure surge at reopening (49.2 8.5 mmHg). CONCLUSIONS: An experimental acute renal hypertension may be elicited both in 1K and in 2K rats and for functional right nephrectomy of 30, 60 and 180 min duration. The increase in blood pressure is proportional to the duration of functional right nephrectomy and greater in 1K than in 2K rats. The experimental acute renal hypertension is due to acute release of renin and generation of endogenous angiotensin II, and is specifically prevented by the angiotensin II type 1 receptor blocker, irbesartan, but not by labetalol.

The visceral nervous system and its environments.

Starting from the observation of the relationships of the biological system with its environments and of the genetically determined neuronal properties of plasticity and rhythmicity, it is possible to propose a new hypothesis about the functional role and organization of the visceral nervous system based on the physical model of the Dissipative Structure by I. Prigogine. The similarily between the visceral nervous system function and this model is supported by the following observations: (1) The visceral nervous system is a complex system, composed of many interacting units, which works away from thermodynamic equilibrium; (2) the functional organization of the nervous system is strongly dependent on internal and external environmental stimuli; (3) it is characterized by the presence of rhythms and periodic behaviors and (4) the internal order of the system is maintained in the continuous interplay between function, structure and fluctuations. On the basis of the present hypothesis, a few general principles can be formulated: (1) the higher brain centers, the fluid matrix and the external world, are the visceral nervous system natural environments; (2) with which it is plastically interfaced as a thermodynamic dissipative structure; (3) its main functional role is to regulate, distribute and maintain ordered exchanges of matter, energy and information between these environments. The present is a general interpretation of the operations of the visceral nervous system as a whole. In the frame of this interpretation the hypotheses so far formulated, including the homeostatic theory, can be viewed as the description of discrete and complementary aspects of the visceral nervous system functions.