van Dijk J Gert, Gagaouzova Boriana S, de Jong Jelle S Y, van Rossum Ineke A, van Houwelingen Marc J, Kerkhof Fabian I, Reijntjes Robert H, Paton Julian F R, de Lange Frederik J, Thijs Roland D
Department of Neurology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands.
Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.
Europace. 2025 Mar 28;27(4). doi: 10.1093/europace/euaf047.
We studied the blood pressure (BP) decrease after carotid sinus massage to study cardioinhibition (CI) and arterial vasodepression (aVD), whether CI and aVD occur independent of one another, and how the BP decrease ends.
We measured BP, heart rate (HR), stroke volume, and total peripheral resistance (TPR) retrospectively in carotid sinus massage cohorts in two Dutch syncope centres. Cardioinhibition and aVD were defined as HR and TPR decreasing below 3 SD under pre-massage baseline means. We used the logratio method to analyse changes relative to baseline and tested whether CI and aVD occurred together more often than through chance and whether the responses depended on massage duration and on corrective BP increases. Cardioinhibition occurred in 48% and aVD in 30% of 244 massages of 90 persons. Cardioinhibition and aVD did not occur together more often than randomly. Compared with aVD, CI occurred more often, earlier, faster, and shorter with a larger maximal but similar overall BP-decreasing effect. Longer massage duration yielded a larger BP decrease through stronger aVD. The BP decrease evoked corrective increases of HR and TPR.
Cardioinhibition appears as a phasic response to the onset of massage, independent of aVD, which is a more latent response sensitive to ongoing massage. Blood pressure corrections probably depend on the contralateral carotid sinus and aortic baroreceptors. The BP decrease after sinus massage may in part depend on the efficacy of corrective responses.
我们研究了颈动脉窦按摩后血压（BP）下降情况，以探讨心脏抑制（CI）和动脉血管减压（aVD），CI和aVD是否相互独立发生，以及血压下降是如何结束的。
我们对荷兰两个晕厥中心的颈动脉窦按摩队列进行回顾性测量血压、心率（HR）、每搏输出量和总外周阻力（TPR）。心脏抑制和aVD定义为HR和TPR下降至按摩前基线平均值以下3个标准差。我们使用对数比率法分析相对于基线的变化，并测试CI和aVD同时发生的频率是否高于偶然情况，以及反应是否取决于按摩持续时间和血压的纠正性升高。在90人的244次按摩中，48%发生了心脏抑制，30%发生了aVD。心脏抑制和aVD同时发生的频率并不高于随机情况。与aVD相比，CI发生得更频繁、更早、更快且持续时间更短，最大血压下降幅度更大，但总体血压下降效果相似。更长的按摩持续时间通过更强的aVD导致更大的血压下降。血压下降引起HR和TPR的纠正性升高。
心脏抑制表现为对按摩开始的阶段性反应，独立于aVD，aVD是对持续按摩更敏感的潜在反应。血压纠正可能取决于对侧颈动脉窦和主动脉压力感受器。窦房结按摩后血压下降可能部分取决于纠正反应的效果。
