The broad objective is to examine the degree to which the regulation of blood pressure and heart rate changes during orthostatic stress can be modified by biofeedback and voluntary control procedures. A non-invasive tracking cuff system is used to measure systolic and diastolic blood pressure continuously while heart rate and respiration are simultaneously monitored. Healthy volunteers and patients with orthostatic hypotension are studied in sitting and standing conditions and while going from a sitting to a standing position. Blood pressure and/or heart rate feedback is presented to subjects by means of a computer display indicating beat-to-beat changes which may be compared with baseline or previous performance.
The specific aims are to examine in healthy subjects the degree to which postural cardiovascular changes can be controlled """"""""voluntarily"""""""", whether feedback is more effective than simple instructions only, whether different types of feedback procedures have different effects, how feedback results compare with the effects of other mental and physical strategies, whether control can be improved with repeated practice, and how orthostatic regulation varies according to age. Diabetic patients will be studied to characterize their degree of neuropathy using various tests of autonomic function, e.g. Valsalva, paced respiration, handgrip. A detailed examination will be made of the patients' response to orthostatic stress by itself and in combination with concurrent mental arithmetic and with concurrent handgrip. Out of this sample, patients will be selected with the most severe orthostatic hypotension to participate in a controlled clinical outcome study to determine whether the degree of hypotension can be modified by a biofeedback training method. Finally, several methodological issues will be investigated: comparison of different methods of assessing and quantifying arterial baroreceptor sensitivity, refinements in the blood pressure tracking system.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL031184-09
Application #
3342223
Study Section
Behavioral Medicine Study Section (BEM)
Project Start
1984-05-01
Project End
1994-12-31
Budget Start
1993-01-01
Budget End
1993-12-31
Support Year
9
Fiscal Year
1993
Total Cost
Indirect Cost
Name
University of California Los Angeles
Department
Type
Schools of Medicine
DUNS #
119132785
City
Los Angeles
State
CA
Country
United States
Zip Code
90095
Goldstein, I B; Shapiro, D (1996) Postprandial ambulatory blood pressure and heart rate effects in healthy elderly adults. Int J Psychophysiol 21:91-5
Uijtdehaage, S H (1994) A BASIC program for the peak-to-valley estimation of respiratory sinus arrhythmia. Int J Biomed Comput 35:169-92
Uijtdehaage, S H; Shapiro, D; Jaquet, F (1994) Effects of carbohydrate and protein meals on cardiovascular levels and reactivity. Biol Psychol 38:53-72
Goldstein, I B; Shapiro, D (1990) The beat-to-beat blood pressure response to postural change in young and elderly healthy adult males. J Behav Med 13:437-48
Goldstein, I B; Shapiro, D (1990) Cardiovascular response during postural change in the elderly. J Gerontol 45:M20-5
Goldstein, I B; Naliboff, B D; Shapiro, D et al. (1988) Beat-to-beat blood pressure response in asymptomatic IDDM subjects. Diabetes Care 11:774-9
Naliboff, B D; Goldstein, I B; Shapiro, D et al. (1988) Mental and physical stress as moderators of the postural response in insulin-dependent diabetic patients. Health Psychol 7:499-514
Weipert, D; Shapiro, D; Suter, T (1987) Family history of hypertension and cardiovascular responses to orthostatic stress. Psychophysiology 24:251-7
Weipert, D; Shapiro, D; Suter, T (1986) Diastolic blood pressure and heart rate biofeedback training during orthostatic stress. Psychophysiology 23:315-22