Background
There is a dearth and inconsistency of data on the role of the autonomic nervous system
(ANS) in the development of arterial hypotension. Also, little is known about the
involvement of endothelial factors in the development of this disease. The aim of
the study was to investigate the role of the ANS and endothelial factors or vasoregulators
in the development of primary arterial hypotension (PAH) in children.
Methods
The cardiointervalography and clino-orthostatic test results of 113 children with
PAH were compared with 88 healthy children of comparable age (7–11 years). Serum endothelial
factors (nitric oxide and endothelins) of all children were measured.
Results
The findings revealed that children with PAH had higher activity of the sympathetic
(p < 0.001) and parasympathetic (p < 0.001) divisions of the ANS at the initial (resting) position of clino-orthostatic
test. The activity of these divisions of the autonomic nervous system correlated with
the activity of a cardiac pacemaker. The change of position from horizontal into vertical
was accompanied by a rise only in sympathetic activity (p < 0.001). However, there was a decline in the sympathetic nervous system (p < 0.001) compared to the indices of the initial (resting) position registered in the
tenth minute of the vertical position. The parasympathetic division of the ANS based
on heart rate variability showed high activity in all positions of the clino-orthostatic
test in the patients with PAH compared with healthy children. The activity of the
parasympathetic nervous system was associated with increased synthesis of endothelial
factors (nitric oxide and endothelins) in blood.
Conclusions
The inadequate response of the autonomic nervous system to the clino-orthostatic test
in children with PAH is associated with disorders of both divisions of the autonomic
nervous system as well as vascular endothelial factors.
Keywords
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Article info
Publication history
Published online: July 03, 2018
Accepted:
June 24,
2018
Received:
January 21,
2018
Identification
Copyright
© 2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
