Klinische Neurophysiologie 2018; 49(03): 143-151
DOI: 10.1055/a-0626-6219
Review
© Georg Thieme Verlag KG Stuttgart · New York

Der Baroreflex: Physiologie, klinische Bedeutung und Diagnostik

Baroreflex: Physiology, Clinical Relevance and Diagnostic Procedures
Alexander Steger
1   I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München
,
Alexander Müller
1   I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München
,
Daniel Sinnecker
1   I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München
,
Michael Dommasch
1   I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München
,
Helene H. Heidegger
2   Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, LMU München
,
Katharina M. Huster
1   I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München
,
Petra Barthel
1   I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München
,
Karl-Ludwig Laugwitz
1   I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München
,
Georg Schmidt
1   I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München
› Author Affiliations
Further Information

Publication History

Publication Date:
25 July 2018 (online)

Zusammenfassung

Der Baroreflex ist ein Mechanismus zur Aufrechterhaltung der kardiovaskulären Homöostase. Ein Anstieg des Blutdruckes führt, vermittelt durch das vegetative Nervensystem, gegenregulatorisch zu einem Abfall der Herzfrequenz und zu einer Dilatation der Widerstandsgefäße und umgekehrt. Dadurch werden überschießende Blutdruckschwankungen verhindert. Das Ausmaß der Baroreflexantwort ist ein starker und unabhängiger Prädiktor für Überleben und kardiale Ereignisse. Bei Erkrankungen des Herzkreislaufsystems liegt häufig ein pathologisch abgeschwächter Baroreflex vor. Adäquates Therapieansprechen dieser Patienten kann neben einer verbesserten Prognose mit einer Normalisierung der Baroreflexantwort einhergehen. Eine quantitative Beschreibung der Baroreflexantwort auf Blutdruckschwankungen ist die Baroreflexsensitivität (BRS). Es existieren verschiedene Methoden zur Bestimmung der Baroreflexsensitivität. Um die flächendeckende Implementierung dieser Verfahren in der klinischen Routine voranzutreiben, werden in Zukunft eine Optimierung in Bezug auf Messbarkeit und Reliabilität, die Etablierung von Referenzwerten sowie große prospektive Validierungsstudien vonnöten sein.

Abstract

The baroreflex is a key homeostatic mechanism of the cardiovascular system mediated by the autonomous nervous system. An increase of arterial blood pressure leads to a decrease of heart rate and arterial resistance and vice versa. This mechanism prevents excessive fluctuations and maintains a stable steady state of arterial blood pressure. The extent of baroreflex activity is a strong and independent risk predictor of mortality and adverse cardiac events. Diseases of the cardiovascular system are commonly linked to reduced baroreflex function. Good therapy response under these conditions correlates not only with an improved prognosis but also with a significant improvement of baroreflex function. Baroreflex sensitivity (BRS) is the quantitative description of the baroreflex gain in response to blood pressure changes. So far, several approaches have been proposed to assess baroreflex sensitivity. To render BRS assessment feasible in daily clinical routine, the following requirements will have to be addressed: optimization of the methods in terms of measurability and reliability; establishment of reference values; large prospective clinical validation trials.

 
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