Introduction: Altered profile of RR variability and reduced baroreflex gain, as autonomic proxies, are observed in hypertensive individuals. Aim: To assess whether using logistic models and cross-validation techniques autonomic proxies can be used to identify clinical hypertensive and normotensive groups. Methods: An observational study on 405 individuals (155 mild hypertensive and 250 controls). We used four steps for statistical analysis: preliminary descriptive statistics; logistic regression modelling; detection of best parsimonious set of variables; and concordance analysis between clinical and autonomic hypertension profile. Results: Accuracy index (rate of correct identifications of normotensive and hypertensive states), computed on each of the four gradually more complex logistic models (from A to D), reached its highest value (82.7%), in the most complete model D, including autonomic nervous system indices (RR variability and baroreflex gain), age and sex. Measures of predictive performance increased from the simplest model to the most complex one [model D, positive predictive value (PPV) = 0.767, negative predictive value (NPV) = 0.866], with higher specificity than sensitivity. A parsimonious set of autonomic proxies (Mean RR, Delta_RRLFnu – i.e. change from rest to standing up – baroreflex gain combined with age and sex) led to an accuracy index of 80.5%, thus proving to have discriminant and predictive powers in detecting hypertension very similar to the whole set of the explicative variables comprised in the complete model D. Conclusion: The clinical value of the observation that the information collectively carried by a small subset of indirect autonomic proxies may identify either hypertensive or normotensive groups needs to be further investigated.

Lucini, D., Solaro, N., Pagani, M. (2014). May autonomic indices from cardiovascular variability help identify hypertension?. JOURNAL OF HYPERTENSION, 32(2), 363-373 [10.1097/HJH.0000000000000020].

May autonomic indices from cardiovascular variability help identify hypertension?

SOLARO, NADIA;
2014

Abstract

Introduction: Altered profile of RR variability and reduced baroreflex gain, as autonomic proxies, are observed in hypertensive individuals. Aim: To assess whether using logistic models and cross-validation techniques autonomic proxies can be used to identify clinical hypertensive and normotensive groups. Methods: An observational study on 405 individuals (155 mild hypertensive and 250 controls). We used four steps for statistical analysis: preliminary descriptive statistics; logistic regression modelling; detection of best parsimonious set of variables; and concordance analysis between clinical and autonomic hypertension profile. Results: Accuracy index (rate of correct identifications of normotensive and hypertensive states), computed on each of the four gradually more complex logistic models (from A to D), reached its highest value (82.7%), in the most complete model D, including autonomic nervous system indices (RR variability and baroreflex gain), age and sex. Measures of predictive performance increased from the simplest model to the most complex one [model D, positive predictive value (PPV) = 0.767, negative predictive value (NPV) = 0.866], with higher specificity than sensitivity. A parsimonious set of autonomic proxies (Mean RR, Delta_RRLFnu – i.e. change from rest to standing up – baroreflex gain combined with age and sex) led to an accuracy index of 80.5%, thus proving to have discriminant and predictive powers in detecting hypertension very similar to the whole set of the explicative variables comprised in the complete model D. Conclusion: The clinical value of the observation that the information collectively carried by a small subset of indirect autonomic proxies may identify either hypertensive or normotensive groups needs to be further investigated.
Articolo in rivista - Articolo scientifico
autonomic regulation, baroreflex, clinical prevention, heart rate variability, statistical modelling
English
2014
32
2
363
373
none
Lucini, D., Solaro, N., Pagani, M. (2014). May autonomic indices from cardiovascular variability help identify hypertension?. JOURNAL OF HYPERTENSION, 32(2), 363-373 [10.1097/HJH.0000000000000020].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/50191
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