Baroreflex sensitivity as a target for nonpharmacological interventions in elderly patients with supine hypertension and orthostatic hypotension

Abstract Orthostatic hypotension (OH) and supine hypertension (SH) are physiological indicators of autonomic dysfunction that are associated with an increased risk of major cerebrocardiovascular events. Since pharmacological interventions do not restore normal baroreflex control, improving the efficacy of nonpharmacological interventions that are suitable for these at-risk populations is needed. Heart rate variability (HRV) biofeedback (HRVB) intervention is a safe option to effectively target cardiovascular autonomic regulation and the baroreflex in this patient population. The objective of this study was to determine in elderly patients the relationship between autonomic biomarkers known to be increased by HRVB and impaired baroreflex responses in patients with systolic OH (sOH) and/or SH. This is a retrospective study of 273 patients (144 women; Age: 65–94 yrs) evaluated with a standardized testing protocol of the Autonomic Reflex Screen from 2015 to 2022. Analyses were performed to determine HRV indices and adrenal (BRS a ) and vagal (BRS v ) baroreflex responses during the Valsalva maneuver (VM). The study demonstrated that sOH was associated with a reduction in HRV metrics and the BRS a , independent of SH. This study also demonstrated that SH was associated with a significant increase in Phase II E of the VM and a reduction in the BRS v , independent of sOH. Our results also showed that deficits in Phase II L of the VM were only observed in patients with sOH and concurrent SH. These findings suggest a significant relationship between biomarkers known to improve with HRVB (SDNN and LF-HRV) and deficits in hemodynamic fluctuations in VM contributing to sOH and SH.