Autonomes Nervensystem und Barorezeptorenreflex als kardiovaskuläre Risikofaktoren
Journal für Hypertonie - Austrian Journal of Hypertension 2003; 7 (Sonderheft 1): 4-7
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Keywords: Autonomes Nervensystem, Barorezeptor, Beat-to-beat-Blutdruckmessung, Hypertonie, Sympathikus
Completely noninvasive methods allow the automatic assessement of sympathetic and parasympathetic drive to the heart and of the sympathetic drive to resistance vessels: Power spectral analysis of the heart rate interval and of the spontaneously occurring variations of blood pressure provide not only the information about the modulation of autonomic tone induced by physiological or pharmacological manoeuvres but also enable the non-invasive assessement of baroreceptor reflex sensitivity from spontaneously occurring blood pressure and heart rate interval ramps. The method of choice for the noninvasive blood pressure measurement represents the vascular unloading technique. It is sufficiently precise to detect the minimal beat to beat blood pressure variations accurately. Other methods like applanation tonometry obviously do not suffice for that purpose. Recent studies have demonstrated that baroreceptor reflex sensitivity and the LF band of heart rate variability are able to predict cardiovascular mortality in patients with coronary heart disease after myocardial infarction and also in patients with chronic heart failure. Only fully automatic methods (e.g. as exemplified in the Task Force™ Monitor of CNSystems, Austria), which do not need the attendance of a doctor, have a chance to take this methodology out of the laboratory and into clinical practice. Risk stratification according to these methods will enable the appropriate choice of antiarrhythmic therapy and a more economic selection of patients for the implantation of ICDs.