Effects of aging on reflex autonomic nervous response induced by orthostatic maneuvers

Background: Baroreflex sensitivity (BRS), exercise pressor reflex (EPR), and aging influence the autonomic nervous response associated with orthostatic maneuvers. Standing significantly increases heart rate (HR), with an initial increase (1.ΔHR) due to EPR and a secondary, more gradual increase (2.ΔHR) due to BRS. HR then decreases (3.ΔHR), which is also attributable to BRS. Thus far, however, few data are available regarding the interdependence of these variables. Methods and Results: Ninety-five healthy volunteers (mean age 37 ± 11 years, range 10-70 years; 50 women) underwent continuous noninvasive measurements of beat-to-beat blood pressure, HR, and spontaneous BRS in the supine (10 minutes) and upright (10 minutes) positions. After tilt, 1.ΔHR, 2.ΔHR, and 3.ΔHR were calculated from the HR recording. From the 1^st to the 6^th decade BRS, 2.ΔHR and 3.ΔHR decreased with normal aging ([BRS 11.88 ± 7.97 ms/mmHg to 1.81 ms/mmHg, P = 0.006], 2.ΔHR [16.75 ± 3.40 beats to 5.33 ± 2.52 beats, P = 0.002], 3.ΔHR [52.25 ± 5.91 beats to 11.33 ± 4.04 beats, P < 0.001]). However, no such association was noted between 1.ΔHR and age (21.25 ± 9.35 beats to 12.00 ± 7.21 beats, ns). BRS while standing was correlated with 1.ΔHR (r = 0.432, P < 0.001). Conclusions: EPR, in contrast to BRS, was not significantly influenced by normal aging. Furthermore, not only was BRS influenced by EPR, as is generally acknowledged, but EPR and BRS were interrelated. These observations offer new insights into the complex interactions of orthostasis-induced physiological autonomic reflexes associated with normal aging.