Braune S, Auer A, Schulte-Mönting J, Schwerbrock S, Lücking C H
Department of Neurology, University of Freiburg, Germany.
Clin Auton Res. 1996 Feb;6(1):3-15. doi: 10.1007/BF02291400.
In 137 healthy volunteers between 18 and 85 years of age, blood pressure (BP) and heart rate (HR) were measured continuously with the Finapres device during active change of posture (ACP), i.e. standing upright, passive tilt (PT, i.e. head-up tilt), Valsalva manoeuvre (VM), deep breathing (DB), isometric muscle exercise (IME) and a mental arithmetic task (MA). Mean HR activation was attenuated with increasing age in all manoeuvres, but was unrelated to sex. In non-orthostatic challenge procedures like MA and IME mean BP increases were independent of age and sex, despite lower increases in HR in the elderly. This points to a preserved sympathetic efferent activity. Following a forced fall in BP during ACP, PT and VM, the initial responses and maintenance values of BP showed a significant age-related decrease. This finding was strongly related to lower BP values in males compared with females, which became more pronounced with increasing age. Further studies to investigate age-related changes in the activation of the various components of the cardiovascular regulation need to consider the mode of activation of the autonomic nervous system and sex as factors of influence. Normal ranges, and also some new points in time not previously measurable, were calculated for all standard autonomic tests based on the continuous measurement of BP and HR. The minimum length of time necessary to assess the cardiovascular responses during ACP and PT was found to be 60 s. The upper time limits for reaching maximum activation during IME and MA were 3.5 min and 1 min, respectively. Age had a relevant influence on the lower limits of normal of all HR parameters and of some BP measurements during PT, ACP and VM. Sex was found to have no relevant impact on normal ranges. Over 65 years of age the normal values for HR activation during VM and DB hardly exceeded baseline values. The possibility of increasing the sensitivity of detection of autonomic dysfunction by measuring BP continuously must be approached with caution, as sufficient sensitivity was only reached at the lower limits of normal during late phase II of the VM. The initial increase of HR after ACP and the BP values after 60 s standing time proved to be the parameters with the best sensitivity for detecting an affection of the regulation of HR and BP over the whole range of age.
在137名年龄在18至85岁之间的健康志愿者中，使用Finapres设备在姿势主动改变（ACP）期间连续测量血压（BP）和心率（HR），姿势主动改变包括直立站立、被动倾斜（PT，即头高位倾斜）、瓦尔萨尔瓦动作（VM）、深呼吸（DB）、等长肌肉运动（IME）和心算任务（MA）。在所有动作中，平均心率激活随年龄增长而减弱，但与性别无关。在MA和IME等非直立性挑战程序中，平均血压升高与年龄和性别无关，尽管老年人的心率升高幅度较小。这表明交感神经传出活动得以保留。在ACP、PT和VM期间血压被迫下降后，血压的初始反应和维持值显示出与年龄相关的显著下降。这一发现与男性血压值低于女性密切相关，且随着年龄增长愈发明显。进一步研究心血管调节各组成部分激活的年龄相关变化时，需要将自主神经系统的激活模式和性别作为影响因素加以考虑。基于对BP和HR的连续测量，计算了所有标准自主神经测试的正常范围以及一些以前无法测量的新时间点。发现评估ACP和PT期间心血管反应所需的最短时间为60秒。IME和MA期间达到最大激活的时间上限分别为3.5分钟和1分钟。年龄对PT、ACP和VM期间所有HR参数以及一些BP测量的正常下限有显著影响。发现性别对正常范围无显著影响。65岁以上人群在VM和DB期间HR激活的正常值几乎未超过基线值。通过连续测量BP来提高自主神经功能障碍检测灵敏度的可能性必须谨慎对待，因为只有在VM第二阶段后期的正常下限才能达到足够的灵敏度。ACP后HR的初始升高以及站立60秒后的BP值被证明是在整个年龄范围内检测HR和BP调节受影响的最敏感参数。
