Assessing the Cardiovagal Baroreflex
Abrupt decreases and increases in systolic arterial blood pressure produce baroreflex mediated shortening and lengthening, respectively, of the R-R interval. This phenomenon, otherwise known as the cardivagal baroreflex, is best described by the sigmoid relationship between R-R interval length and systolic blood pressure. The linear portion of this relationship is used to derive the slope or gain of the cardiovagal baroreflex. Importantly, lower levels of cardiovagal baroreflex have been associated with poor orthostatic tolerance and an increased cardiovascular disease-related mortality. The most commonly used and accepted technique to assess cardiovagal barorelex gain is the modified Oxford techinique. Bolus injections of sodium nitroprusside followed by phenylephrine HCL are used to decrease and raise blood pressure ~15 mmHg, respectively. The baroreflex control of the cardiac vagal outflow can then be assessed by the relation of the R-R interval to systolic blood pressure. However, the modified Oxford technique does not always reveal the nonlinear nature of baroreflex relations. The reasons for this has been unclear. Thus, analysis of baroreflex gain when nonlinearities are not revealed is problematic. Five classifications of baroreflex trials have been identified: acceptable, threshold-heavy, saturation-heavy, linear-heavy, and random trials. A new method of gain estimation was developed that combines the strengths of the current methods of gain estimation with the knowledge of the classifications of baroreflex trials. Using this method, cardiovagal baroreflex gain assessment can be maximized if threshold-heavy, saturation-heavy, and random trials are filtered out of the analysis and the manual method is used to estimate gain on the remaining trials. In addition, a link seems to exist between the variability of delta and the variability in baroreflex gain between different subjects.