El Khadiri Chaima, Bokov Plamen, Dudoignon Benjamin, Benzouid Chérine, Koehl Bérengère, Hogan Julien, Delclaux Christophe
Department of Physiology, AP-HP, Robert Debré Hospital, Paris, France.
Medicine and Pharmacy Faculty of Rabat, Abdelmalek Essaadi University, Rabat, Morocco.
Am J Hypertens. 2025 May 15;38(6):389-397. doi: 10.1093/ajh/hpaf025.
The objective of our case-control study was to evaluate the determinants of childhood cardio-vagal baroreflex failure and exaggerated orthostatic pressor response, which are risk factors for subsequent hypertension.
Four groups of children were matched for sex and age: 12 with congenital central hypoventilation syndrome (autonomic nervous system dysfunction), 12 with chronic kidney disease (frequently abnormal blood pressure [BP]), 12 with sickle cell disease (frequently abnormal orthostatic BP), and 24 control children (preterm birth with normal BP). The children underwent tonometry evaluation (aortic systolic BP) and continuous BP and ECG measurements in supine and standing positions, allowing ambulatory BP monitoring and the computation of heart rate variability indices, baroreflex sensitivity (BRS), and orthostatic systolic BP response.
Supine and standing BRS correlated significantly with aortic systolic BP (ρ = -0.34, ρ = -0.52, respectively), daytime systolic BP (ρ = -0.33, ρ = -0.54, respectively), low frequencies power in similar body positions (supine: ρ = 0.68, standing: ρ = 0.65), and high frequencies (HF) power (ρ = 0.78, ρ = 0.76, respectively). Orthostatic BP response correlated significantly with standing BRS (ρ = -0.38) and standing HFnu (ρ = -0.46). In multivariate analyses, only supine and standing HF power remained independently associated with the respective BRS, while standing HFnu and standing BRS were independently associated with the orthostatic pressor response.
Defective parasympathetic modulation's detrimental effect on baroreflex sensitivity and the orthostatic pressor response in childhood is evident, regardless of the underlying pathology.
我们这项病例对照研究的目的是评估儿童心脏迷走神经压力反射衰竭和直立性升压反应过度的决定因素，这些都是后续发生高血压的危险因素。
四组儿童按性别和年龄进行匹配：12名患有先天性中枢性低通气综合征（自主神经系统功能障碍），12名患有慢性肾病（血压[BP]常异常），12名患有镰状细胞病（直立性BP常异常），以及24名对照儿童（出生时早产但BP正常）。这些儿童接受了眼压测量评估（主动脉收缩压），并在仰卧位和站立位进行连续的BP和心电图测量，从而实现动态血压监测以及心率变异性指数、压力反射敏感性（BRS）和直立性收缩压反应的计算。
仰卧位和站立位的BRS与主动脉收缩压显著相关（分别为ρ = -0.34，ρ = -0.52），与日间收缩压显著相关（分别为ρ = -0.33，ρ = -0.54），与相似体位下的低频功率显著相关（仰卧位：ρ = 0.68，站立位：ρ = 0.65），与高频（HF）功率显著相关（分别为ρ = 0.78，ρ = 0.76）。直立性BP反应与站立位BRS显著相关（ρ = -0.38），与站立位HFnu显著相关（ρ = -0.46）。在多变量分析中，只有仰卧位和站立位的HF功率仍分别与各自的BRS独立相关，而站立位HFnu和站立位BRS与直立性升压反应独立相关。
无论潜在病理情况如何，儿童期副交感神经调节缺陷对压力反射敏感性和直立性升压反应的有害影响是明显的。
