İbrahim BAŞHAN, Abdullah TEKİN, Hatice Göknur TEKİN

The Effect of Autonomic Neural Control on the Cardiovascular System in Patients with Depression

Purpose: In this study, we aimed to examine hearth rate recovery, systolic blood pressure response to exercise and heart rate variability to reveal the effect of autonomic autonomic neural control on the cardiovascular system in depressed individuals. Methods: A total of 151 patients; (49 out of 75 healthy controls and 54 out of 76 patients with depression were females) were associated to age, sex and physical activity. We examined the difference between heart rate at peak exercise and heart rate recovery at related minute. Systolic blood pressure at 2nd and 3rd min of recovery was divided into the systolic blood pressure at peak exercise in order to determine blood pressure recovery indices. Results: Heart rate recovery at first minute was significantly lower in the depression group compared to the control group (p <0.0001). The resting systolic blood pressure was similar in both groups (p = 0.762). Systolic blood pressure during peak exercise was significantly higher in the depression group compared to the control group (p <0.0001). In the depressive patient group, the systolic blood pressure recovery index was significantly higher at 2nd and 3rd minutes than the control group (p <0.0001, p = 0.015). Time domain and frequency domain parameters significantly decreased compared to the controls. Conclusion: This study demonstrates that depression is characterized with decreased heart rate recovery, exaggerated systolic blood pressure response to exercise and attenuated heart rate variability. These results may also propose alterations in autonomic neuronal control of the cardiovascular system in depression.Amaç: Bu çalışmada, depresyonlu bireylerde otonomik nöral kontrolün kardiyovasküler sistem üzerindeki etkisini ortaya çıkarmak için, kalp atım hızı düzelmesini, egzersize verilen sistolik kan basıncı cevabını ve kalp hızı değişkenliğini incelemeyi amaçladık. Yöntem: Toplam 151 hasta (75 sağlıklı kontrolün 49'u ve depresyonlu 76 hastanın 54'ü kadın) yaş, cinsiyet ve fiziksel aktivite ile ilişkilendirildi. Pik egzersizde kalp atış hızı ile ilgili dakikada gerçekleşen kalp hızı toparlanması arasındaki farkı inceledik. Toparlanmanın 2. ve 3. dakikasındaki sistolik kan basıncı, pik egzersizdeki sistolik kan basıncına bölünerek kan basıncı toparlanma endeksleri belirlendi. Bulgular: Depresyon grubunda birinci dakikadaki kalp hızı toparlanması kontrol grubuna göre anlamlı derecede düşük bulundu (p <0.0001). İstirahat sistolik kan basıncı her iki grupta da benzerdi (p = 0.762). Pik egzersiz sırasında sistolik kan basıncı depresyon grubunda kontrol grubuna göre anlamlı derecede yüksekti (p <0.0001). Depresif hasta grubunda sistolik kan basıncının toparlanma indeksi kontrol grubuna göre 2. ve 3. dakikalarda daha yüksekti (p <0.0001, p = 0.015). Zaman etki alanı ve frekans alanı parametreleri, kontrollere kıyasla önemli ölçüde azaldı. Sonuç: Bu çalışma, depresyonun azalmış kalp hızı toparlanması, egzersize abartılı sistolik kan basıncı cevabı ve azalmış kalp hızı değişkenliği ile karakterize olduğunu göstermektedir. Bu sonuçlar depresyonda kardiyovasküler sistemin otonomik nöral kontrolünde değişiklikler olabileceğini ön görmektedir.

Keywords:

Depression, hearth rate recovery,

PDF

___

1. Nicholson A, Kuper H, Hemingway H. Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. Eur Heart J 2006;27:2763–2774.
2. Carney RM, Freedland KE, Miller GE, Jaffe AS. Depression as a risk factor for cardiac mortality and morbidity: a review of potential mechanisms. J Psychosom Res 2002;53:897 - 902.
3. Connerney I, Shapiro PA, McLaughlin JS, Bagiella E, Sloan RP. Relation between depression after coronary artery bypass surgery and 12-month outcome: a prospective study. Lancet 2001;358:1766 - 71.
4. Carney RM, Freedland KE, Rich MW, Jaffe AS. Depression as a risk factor for cardiac events in established coronary heart disease: a review of possible mechanisms. Ann Behav Med 1995;17:142 -9.
5. Carney RM, Freedland KE, Eisen SA, Rich MW, Jaffe AS. Major depression and medication adherence in elderly patients with coronary artery disease. Health Psychol 1995;14:88 - 90.
6. Writing Committee for the ENRICHD Investigators. Effects of treating depression and low perceived social support on clinical events after myocardial infarction: The Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. JAMA 2003;289:3106 –16.
7. Lown B, Verrier RL. Neural activity and ventricular fibrillation. N Engl J Med 1976;294:1165-1170.
8. Imai K, Sato H, Hori M, Kusuoka H, Ozaki H, Yokoyama H et al. Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure. J Am Coll Cardiol 1994;24:1529-35
9. Cole CR, Foody JM, Blackstone EH, Lauer MS. Heart rate recovery after submaximal exercise testing as a predictor of mortality in a cardiovascularly healthy cohort. Ann Intern Med 2000;132:552-5
10. Kitaoka H, Takata J, Furuno T, Yamasaki F, Chikamori T, Doi YL. Delayed recovery of postexercise blood pressure in patients with chronic heart failure. Am J Cardiol 1997;79:1701-4
11. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J 1996;17:354-81
12. American College of Sports Medicine. ACSM’s Guideliness for Exercise Testing and Prescription. Williams & Wilkins 1995. p.153-240
13. International Physical Activity Questionnairs (IPAQ): Short Last 7 Days Self-Administered Format For Use With Young And Middle-Aged Adults. The final version of IPAQ from the 2000/01 Reliability and Validity Study. Completed May 2001. Available from: http://www.sdp.univ.fvg.it/sites/default/files/IPAQ_English_self-admin_short.pdf.
14. Ellis K, Pothier CE, Blackstone EH, Lauer MS. Is systolic blood pressure recovery after exercise a predictor of mortality? Am Heart J 2004;147:287-92.
15. Dlin RA, Hanne N, Silverberg DS, Bar-Or O. Follow-up of normotensive men with exaggerated blood pressure response to exercise. Am Heart J 1983;106:316-20.
16. Brosschot JF, Gerin W, Thayer JF. The perseverative cognition hypothesis: Areview of worry, prolonged stress-related physiological activation and health. J Psychosom Res. 2006;60(2):113-24.
17. Forslund L, Bjorkander I, Ericson M, Held C, Kahan T, Rehnqvist N et al. Prognostic implications of autonomic function assessed by analyses of catecholamines and heart rate variability in stable angina pectoris. Heart 2002;87:415-22.
18. Sandercock GR, Bromley PD, Brodie DA. The reliability of short-term measurements of heart rate variability. Int J Cardiol 2005;103:238-47.
19. Lombardi F. Clinical implications of present physiological understanding of HRV components. Card Electrophysiol Rev 2002;6:245-9.
20. Stein PK. Assessing heart rate variability from real-world Holter reports. Card Electrophysiol Rev 2002;6:239-44.
21. Kemp AH, Quintana DS, Gray MA, Felmingham KL, Brown K, Gatt JM. Impact of depression and antidepressant treatment on heart rate variability: A review and meta-analysis. Biol Psychiatry 2010;67: 1067–1074.
22. Hughes JW, York KM, Li Q, Freedland KE, Carney RM, Sheps DS. Depressive symptoms predict heart rate recovery after exercise treadmill testing in patientswith coronary artery disease: Results from the Psychophysiological Investigation of Myocardial Ischemia study. Psychosom Med 2008;70:456–460.
23. Von Kanel R, Saner H, Kohls S, Barth J, Znoj H, Saner G, Schmid J. Relation of heart rate recovery to psychological distress and quality of life in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil 2009;16:645–650. 24. Gordon JL, Ditto B, Lavoie KL, Pelletier R, Campbell TS, Arsenault A, et al. The effect of major depression on post-exercise cardiovascular recovery. Psychophysiology 2011;48:1604–1609
25. Thayer JF. Vagal tone and the inflammatory reflex. Cleve Clin J Med 2009;76(2):23-26