The aim of this study was to analyse the changes of baroreflex sensitivity (BRS) and their relation to changes of heart rate and blood pressure in medical students during moderate psychological stress brought about by oral examination. The changes of BRS during the stress were compared with the changes during light physical exercise. Thirty three students were examined 30 min before and 30 min after the exam. Thirty-nine students of control group were examined at rest and during light exercise. Blood pressure was noninvasively recorded by Peňáz method at rate-controlled breathing (0.33 Hz). The BRS [ms/mm Hg] and BRSf [Hz/mm Hg] were calculated by spectral analysis of spontaneous fluctuations of blood pressure and inter-beat intervals (IBI). BRS before examination (7.12 ms/mm Hg) was significantly lower than after the oral exam (8.77 ms/mm Hg, p<0.05). The difference between BRS in the test group after the oral exam and the control group at rest (10.78 ms/mm Hg) was not significant. BRS during light exercise (7.44 ms/mm Hg) corresponded to the value during psychological stress. The values of BRSf did not change during psychological stress (before: 0.0182 Hz/mm Hg; after: 0.0182 Hz/mm Hg) and exercise (rest: 0.0158 Hz/mm Hg; exercise: 0.0144 Hz/mm Hg). Correlation between BRS or BRSf and blood pressure were not found. A significant negative correlation (r = -0.404, p<0.05) between BRSf and the increase of diastolic blood pressure during stress was observed. It is concluded that BRSf remained constant during psychological stress and exercise, and differed essentially from that in hypertensive subjects.
The spectral analysis technique was applied for noninvasive assessment of heart-rate baroreflex sensitivity (BRS). The coherence between fluctuation of blood pressure and heart rate at 0.1 Hz and at respiratory frequency is high. This fact enables the assessment of BRS by means of calculating the modulus (or gain) of the transfer function between variations in blood pressure and heart rate. The noninvasive continuous blood pressure registration according to Peňáz was used. During voluntarily controlled breathing intervals, the amplitude of 0.1 Hz and respiratory peaks in the spectra of heart rate and blood pressure changed markedly. Nevertheless, the average sensitivity of the baroreflex (modulus) changed insignificantly. This result indicated that the stability of BRS can be advantageous for the use of BRS in clinical practice. The difference between the modulus at 0.1 Hz and at the breathing rate indicates that baroreflex is only one of the factors causing respiratory arrhythmia. We also compared the determination of BRS by spectral analysis with the following alternative method: both lower extremities were occluded for 5 minutes. The release of pressure in the occluding cuffs decreased blood pressure which was followed by a baroreceptor-mediated increase of heart rate. Both methods correlated, but more detailed analysis revealed the role of the low pressure receptors in BRS determined by spectral analysis.