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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Physiol. | doi: 10.3389/fphys.2019.01111

Increased respiratory modulation of blood pressure in hypertensive patients

 Lin Xie1,  Xiaohui Di1, Fadong Zhao1, Jie Yao1, Zhiheng Liu2, Chaomin Li2, Binbin Liu1, Xiaoni Wang1 and Jianbao Zhang1*
  • 1Xi'an Jiaotong University, China
  • 2No. 451 Hospital of Chinese People's Liberation Army, China

Objective: Although the important role of respiratory modulation of the cardiovascular system in the development of hypertension has been demonstrated in animal studies, little research has assessed this modulation in essential hypertensive patients. We aimed to explore whether respiratory-related variations in cardiovascular variables are changed in hypertensive patients and their potential relationships with the respiratory pattern.
Methods: Respiration, ECG, and beat-to-beat blood pressure (BP) were simultaneously measured in 46 participants (24 hypertensive patients and 22 normotensive participants) during rest and a mental arithmetic task (MAT). Respiratory-triggered averaging and orthogonal subspace projection methods were used to assess the respiratory modulations of BP and heart rate (HR). Respiratory parameters including inspiratory time, expiratory time, respiratory rate and their variabilities were also characterized.
Results: The inspiratory time, expiratory time, respiratory rate and their variabilities were not different between hypertensive and normotensives. Additionally, the modulation of HR by respiration was also similar between the two groups. Hypertensive patients exhibited an amplified respiratory modulation of systolic BP (SBP), as assessed from the amplitude of respiratory-related changes and the percentage of the power of respiratory-related variation, and also reflected from the temporal pattern of respiratory modulation of SBP. The exaggerated respiratory-related variation of SBP in hypertensive patients accounted for ≈23% of the total power of SBP, producing an absolute change of ≈4.5 mmHg in SBP. MAT was characterized by decreased inspiratory time and increased variabilities of expiratory time and respiratory rate with no changes in the amplitude of respiratory modulations.
Conclusion: Hypertensive patients had excessive respiratory modulation of SBP, despite having similar respiratory pattern with normotensives. These findings highlight the importance of respiratory influence in BP variation and suggest that respiratory modulation of SBP may have prognostic information for cardiovascular events in hypertensive patients.

Keywords: Blood Pressure, respiratory related variation, orthogonal subspace projection, mental stress, respiratory variability

Received: 21 May 2019; Accepted: 12 Aug 2019.

Copyright: © 2019 Xie, Di, Zhao, Yao, Liu, Li, Liu, Wang and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Mx. Jianbao Zhang, Xi'an Jiaotong University, Xi'an, China, zhangjb@mail.xjtu.edu.cn