Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Behavioral Medicine
Published in: Annals of Behavioral Medicine 3/2017

01-06-2017 | Original Article

Autonomic Cardiovascular Control and Executive Function in Chronic Hypotension

Authors: Stefan Duschek, PhD, Alexandra Hoffmann, MSc, Gustavo A. Reyes del Paso, PhD, Ulrich Ettinger, PhD

Published in: Annals of Behavioral Medicine | Issue 3/2017

Login to get access

Abstract

Background

Chronic low blood pressure (hypotension) is characterized by complaints such as fatigue, reduced drive, dizziness, and cold limbs. Additionally, deficits in attention and memory have been observed. Autonomic dysregulation is considered to be involved in the origin of this condition.

Purpose

The study explored autonomic cardiovascular control in the context of higher cognitive processing (executive function) in hypotension.

Methods

Hemodynamic recordings were performed in 40 hypotensive and 40 normotensive participants during execution of four classical executive function tasks (number-letter task, n-back task, continuous performance test, and flanker task). Parameters of cardiac sympathetic control, i.e., stroke volume, cardiac output, pre-ejection period, total peripheral resistance, and parasympathetic control, i.e., respiratory sinus arrhythmia and baroreflex sensitivity, were obtained.

Results

The hypotensive group exhibited lower stroke volume and cardiac output, as well as higher pre-ejection period and baroreflex sensitivity during task execution. Increased error rates in hypotensive individuals were observed in the n-back and flanker tasks. In the total sample, there were positive correlations of error rates with pre-ejection period, baroreflex sensitivity and respiratory sinus arrhythmia, and negative correlations with cardiac output.

Conclusions

Group differences in stroke volume, cardiac output, and pre-ejection period suggest diminished beta-adrenergic myocardial drive during executive function processing in hypotension, in addition to increased baroreflex function. Although further research is warranted to quantify the extent of executive function impairment in hypotension, the results from correlation analysis add evidence to the notion that higher sympathetic inotropic influences and reduced parasympathetic cardiac influences are accompanied by better cognitive performance.
Literature
1.
De Buyzere M, Clement DL, Duprez D. Chronic low blood pressure: a review. Cardiovasc Drug Ther. 1998; 12: 29–35.CrossRef
2.
Duschek S, Schandry R. Reduced brain perfusion and cognitive performance due to essential hypotension. Clin Auton Res. 2007; 17: 69–76.CrossRefPubMed
3.
Duschek S, Dietel A, Schandry R, Reyes del Paso GA. Increased sensitivity to heat pain in chronic low blood pressure. Eur J Pain. 2009; 13: 28–34.CrossRefPubMed
4.
Weisz N, Schandry R, Jacobs A, Mialet J, Duschek S. Early contingent negative variation of the EEG and attentional flexibility are reduced in hypotension. International J Psychophysiol. 2002; 45: 253–60.CrossRef
5.
Duschek S, Matthias E, Schandry R. Essential hypotension is accompanied by deficits in attention and working memory. Behav Med. 2005; 30: 149–158.CrossRefPubMed
6.
WHO. Arterial hypertension. Technical Report Series No. 628. Genova: World Health Organisation; 1978.
7.
Covassin N, de Zambotti M, Cellini N, Sarlo M, Stegagno L. Cardiovascular down-regulation in essential hypotension: relationships with autonomic control and sleep. Psychophysiology. 2013; 50: 767–776.CrossRefPubMed
8.
Duschek S, Heiss H, Buechner B, Werner NS, Schandry R, Reyes del Paso GA. Hemodynamic determinants of chronic hypotension and their modification through vasopressor application. J Physiol Sci. 2009; 59: 105–112.CrossRefPubMed
9.
Covassin N, de Zambotti M, Cellini N, Sarlo M, Stegagno L. Nocturnal cardiovascular activity in essential hypotension: evidence of differential autonomic regulation. Psychosom Med. 2012; 74: 952–960.CrossRefPubMed
10.
de Zambotti M, Covassin N, Cellini N, Sarlo M, Torre J, Stegagno L. Hemodynamic and autonomic modifications during sleep stages in young hypotensive women. Biol Psychol. 2012; 91: 22–27.CrossRefPubMed
11.
Hassan S, Turner, P. Systolic time intervals: a review of the method in the non-invasive investigation of cardiac function in health, disease and clinical pharmacology. Postgrad Med J. 1983; 59: 423–434.CrossRefPubMedPubMedCentral
12.
Malliani A, Pagani, M, Lombardi F, Cerutti S. Cardiovascular neural regulation explored in the frequency domain. Circulation. 1991; 84: 482–492.CrossRefPubMed
13.
Reyes del Paso GA, Langewitz W, Mulder LJM, van Roon A, Duschek S. The utility of low frequency heart rate variability as an index of sympathetic cardiac tone: a review with emphasis on a re-analysis of previous studies. Psychophysiology. 2013; 50: 477–487.CrossRefPubMed
14.
Berntson GG, Quigley KS, Lozano D. Cardiovascular psychophysiology. In: Cacioppo JT, Tassinary LG, Berntson GG, eds. Handbook of Psychophysiology. Cambridge: Cambridge University Press; 2007: 182–210.CrossRef
15.
Duschek S, Dietel A, Schandry R, Reyes del Paso GA. Increased baroreflex sensitivity and reduced cardiovascular reactivity in chronic low blood pressure. Hypertens Res. 2008; 31: 1873–1878.CrossRefPubMed
16.
Reyes del Paso GA, Langewitz W, Robles H, Perez N. A between-subjects comparison of respiratory sinus arrythmia and baroreceptor cardiac reflex sensitivity as non-invasive measures of tonic parasympathetic cardiac control. Int J Psychophysiol. 1996; 22: 163–171.CrossRef
17.
Levy MN, Pappano AJ. Cardiovascular Physiology. Philadelphia: Mosby Elsevier; 2007.
18.
Stegagno L, Angrilli A, Costa M, Palomba D. Deficit cognitivi e ipotensione arteriosa: un´ indagine cronopsycofisiologica. Giornale Italiano di Psicologia. 1996; 23: 837–859.
19.
Duschek S, Weisz N, Schandry R. Reduced cognitive performance and prolonged reaction time accompany moderate hypotension. Clin Auton Res. 2003; 3: 427–432.
20.
Duschek S, Meinhardt J, Schandry R. Reduced cortical activity due to chronic low blood pressure: an EEG study. Biol Psychol. 2006; 72: 241–250.CrossRefPubMed
21.
Duschek S, Schandry R. Cognitive performance and cerebral blood flow in essential hypotension. Psychophysiology. 2004; 41: 905–913.CrossRefPubMed
22.
Costa M, Stegagno L, Schandry R, Bitti, PER. Contingent negative variation and cognitive performance in hypotension. Psychophysiology. 1998; 35: 737–744.CrossRefPubMed
23.
Duschek S, Schandry R. Deficient adjustment of cerebral blood flow to cognitive activity due to chronically low blood pressure. Biol Psychol. 2006; 72: 311–317.CrossRefPubMed
24.
Sarlo M, de Zambotti M, Gallicchio G, Devigili A, Stegagno L. Impaired cerebral and systemic hemodynamics under cognitive load in young hypotensives: a transcranial Doppler study. J Behav Med. 2013; 36: 134–142.CrossRefPubMed
25.
Miyake A, Friedman NP, Emerson MJ, Witzki AH, Howerter A, Wager TD. The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: a latent variable analysis. Cognitive Psychol. 2000; 41: 49–100.CrossRef
26.
Zahn D, Adams J, Krohn J, Wenzel M, Mann CG, Gomille LK, Jacobi-Scherbening V, Kubiak T. Heart rate variability and self-control—a meta-analysis. Biol Psychol. 2016; 115: 9–26.CrossRefPubMed
27.
Duschek S, Muckenthaler M, Reyes del Paso GA. Relationships between features of cardiovascular control and cognitive performance. Biol Psychol. 2009; 81: 110–117.CrossRefPubMed
28.
Reyes del Paso GA, González MI, Hernández JA, Duschek S, Gutiérrez N. Tonic blood pressure modulated the relationship between baroreceptor cardiac reflex sensitivity and cognitive performance. Psychophysiology. 2009: 46: 932–938.CrossRef
29.
Duschek S, Wörsching J, Reyes del Paso GA. Interactions between autonomic cardiovascular regulation and cortical activity: a CNV study. Psychophysiology. 2013; 50: 388–397.CrossRefPubMed
30.
Duschek S, Werner NS, Reyes del Paso GA. The behavioral impact of baroreflex function: a review. Psychophysiology. 2013; 50: 1183–1193.CrossRefPubMed
31.
Reyes del Paso GA, González MI, Hernández JA. Comparison of baroreceptor cardiac reflex sensitivity estimates from inter-systolic and ECG R-R intervals. Psychophysiology. 2010: 47: 1102–1108.
32.
Rogers RD, Monsell S. Costs of a predictable switch between simple cognitive tasks. J Experiment Psychol Gen. 1995; 124: 207–231.CrossRef
33.
Jonides J, Smith EE. The architecture of working memory. In: Rugg MD, ed. Cognitive Neuroscience. Cambridge: MIT Press; 1997: 243–276.
34.
Cornblatt BA, Risch NJ, Faris G, Friedman D, Erlenmeyer-Kimling L. The continuous performance test, identical pairs version (CPT-IP): I. New findings about sustained attention in normal families. Psychiatry Res. 1988; 26: 223–238.CrossRefPubMed
35.
Eriksen BA, Eriksen CW. Effects of noise letters upon identification of a target letter in a non-search task. Percept Psychophys. 1974; 16:143–149. CrossRef
36.
Oldfield RC. The assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia. 1997; 9: 97–113.CrossRef
37.
Raaijmakers E, Faes TJ, Scholten RJ, Goovaerts HG, Heethaar RM. A meta-analysis of published studies concerning the validity of thoracic impedance cardiography. Ann N Y Acad Sci. 1999; 873:121–127.CrossRefPubMed
38.
Parati G, Ongaro G, Bilo G, Glavina F, Castiglioni P, Di Rienzo M, Mancia G. Non-invasive beat-to-beat blood pressure monitoring: new developments. Blood Press Monit. 2003; 8: 31–36.CrossRefPubMed
39.
Niskanen JP, Tarvainen MP, Ranta-aho PO, Karjalainen PA. Software for advanced HRV analysis. Comput Meth Prog Bio. 2004; 76: 73–81.CrossRef
40.
Denver JW, Reed SF, Porges SW. Methodological issues in the quantification of respiratory sinus arrhythmia. Biol Psychol. 2007; 74: 286–294.CrossRefPubMed
41.
Reyes del Paso GA. A program to assess baroreceptor cardiac reflex function. Behav Res Methods. 1994; 26: 62–64.CrossRef
42.
Steptoe A, Vögele C. Cardiac baroreceptor reflex function during postural change assessed using non-invasive spontaneous sequence analysis in young men. Cardiovasc Res. 1990; 24: 627–632.CrossRefPubMed
43.
Parlow J, Viale JP, Annat G, Hughson R, Quintin L. Spontaneous cardiac baroreflex in humans: comparison with drugs-induced responses. Hypertension. 1995; 25: 1058–1068.CrossRefPubMed
44.
Rosseel I. Lavaan: an R package for structural equation modeling. J Stat Softw. 2012; 48: 1–36.CrossRef
45.
Kenny J, Plappert T, Doubilet P, Salzman D, Sutton M. Effects of heart rate on ventricular size, stroke volume, and output in the normal human fetus: a prospective Doppler echocardiographic study. Circulation. 1987; 76: 52–58.CrossRefPubMed
46.
Stegagno L, Patritti D, Duschek S, Herbert B, Schandry R. Cerebral blood flow in essential hypotension during emotional activation. Psychophysiology. 2007; 44: 226–232.CrossRefPubMed
47.
Schuepbach D, Boeker H, Duschek S, Hell D. Rapid cerebral hemodynamic modulation during mental planning and movement execution: evidence of time-locked relationship with complex behavior. Clin Neurophysiol. 2007; 118: 2254–2262.CrossRefPubMed
48.
Duschek S, Schuepbach D, Schandry R. Time-locked association between rapid cerebral blood flow modulation and attentional performance. Clin Neurophysiol. 2008; 119: 1292–1299.CrossRefPubMed
49.
Duschek S, Heiss H, Schmidt FH, Werner N, Schuepbach D. Interactions between systemic hemodynamics and cerebral blood flow during attentional processing. Psychophysiology. 2010; 47: 1159–1166PubMed
50.
Duschek S, Reyes del Paso GA. Quantification of cardiac baroreflex function at rest and during autonomic stimulation. J Physiol Sci. 2007; 57: 259–268.CrossRefPubMed
51.
Carthy ER. Autonomic dysfunction in essential hypertension: a systematic review. Ann Med Surg. 2013; 3: 2–7.CrossRef
52.
Ducher M, Fauvel JP, Cerrutti C. Risk profile in hypertension genesis: a five-year follow-up study. Am J Hypertens. 2006; 19: 775–781.CrossRefPubMed
53.
Duschek S, Wörsching J, Reyes del Paso GA. Autonomic cardiovascular regulation and cortical tone. Clin Physiol Func Imaging. 2013; 35: 383–392.CrossRef
54.
Friedman NP, Miyake A. The relations among inhibition and interference control functions: a latent-variable analysis. J Exp Psychol Gen. 2004; 133: 101–115.CrossRefPubMed
55.
Chmura J, Nazar K, Kaciuba-Uscilko H. Choice reaction time during graded exercise in relation to blood lactate and plasma catecholamine thresholds. Int J Sports Med. 1994; 15: 172–176.CrossRefPubMed
56.
Yagi Y, Coburn KL, Estes KM, Arruda JE. Effects of aerobic exercise and gender on visual and auditory P300, reaction time, and accuracy. Eur J Appl Physiol. 1999; 80: 402–408.CrossRef
57.
Duschek S, Hadjamu M, Schandry R. Enhancement of cerebral blood flow and cognitive performance due to pharmacological blood pressure elevation in chronic hypotension. Psychophysiology. 2007; 44: 145–53.CrossRefPubMed
58.
Duschek, S., Hadjamu, M. & Schandry, R.. Dissociation between cortical activation and cognitive performance in the pharmacological treatment of chronic hypotension. Biol Psychol. 2007; 75: 277–85.CrossRefPubMed
59.
Esteban-Cornejo I, Tejero-Gonzalez C, Sallis JF, Veiga OL. Physical activity and cognition in adolescents: a systematic review. J Sci Med Sport. 2015; 18: 534–539.CrossRefPubMed
60.
Sharma S, Merghani A, Mont L. Exercise and the heart: the good, the bad, and the ugly. Eur Heart J. 2015;36:1445–1553.CrossRefPubMed
61.
Duschek S, Heiss H, Werner N, Reyes del Paso GA. Modulations of autonomic cardiovascular control following alpha-adrenergic treatment in chronic hypotension. Hypertens Res. 2009; 32: 938–943.CrossRefPubMed
62.
Reyes del Paso GA, González MI. Modification of baroreceptor cardiac reflex function by biofeedback. Appl Psychophysiol Biofeedback. 2004; 29: 197–211.CrossRef
Metadata
Title
Autonomic Cardiovascular Control and Executive Function in Chronic Hypotension
Authors
Stefan Duschek, PhD
Alexandra Hoffmann, MSc
Gustavo A. Reyes del Paso, PhD
Ulrich Ettinger, PhD
Publication date
01-06-2017
Publisher
Springer US
Published in
Annals of Behavioral Medicine / Issue 3/2017
Print ISSN: 0883-6612
Electronic ISSN: 1532-4796
DOI
https://doi.org/10.1007/s12160-016-9868-7

Other articles of this Issue 3/2017

Annals of Behavioral Medicine 3/2017 Go to the issue

Original Article

Maintaining Healthy Behavior: a Prospective Study of Psychological Well-Being and Physical Activity

Original Article

Depression and Smoking Cessation: Evidence from a Smoking Cessation Clinic with 1-Year Follow-Up

Original Article

Latent Inhibition Reduces Nocebo Nausea, Even Without Deception

Original Article

Bidirectional, Temporal Associations of Sleep with Positive Events, Affect, and Stressors in Daily Life Across a Week

Brief Report

Fidelity Moderates the Association Between Negative Condom Attitudes and Outcome Behavior in an Evidence-Based Sexual Risk Reduction Intervention for Female Sex Workers

Original Article

Assessing the Effects of Interpersonal and Intrapersonal Behavior Change Strategies on Physical Activity in Older Adults: a Factorial Experiment