Skip to main content
Download PDF
  • Research Article
  • Open access
  • Published:

Altered Central Hemodynamics in Individuals with Down Syndrome

Artery Research volume 25, pages 107–112 (2019)Cite this article

Abstract

Background

Individuals with Down Syndrome (DS) have autonomic dysfunction impacting regulation of heart rate, Blood Pressure (BP), and peripheral vasoconstriction. This may alter central hemodynamics through different wave reflections. We investigated central hemodynamics including wave reflection during rest and a sympathoexcitatory stimulus [Lower Body Negative Pressure (LBNP)] in individuals with DS and controls.

Methods

Radial applanation tonometry was performed on participants with and without DS before and during 5-min LBNP stimulus of −20 mmHg. Waveforms were calibrated to mean and diastolic BP. Generalized transfer function was used to estimate aortic pressures [Systolic Blood Pressure (aSBP), Diastolic Blood Pressure (aDBP), mean pressure (aMAP), pulse pressure (aPP)], Augmentation Index (AIx), augmentation index normalized for HR (AIx@75), Augmentation Pressure (AP), Reflection Index (RIx), Time to Reflection (Tr), forward and reflected wave magnitude (Pf and Pb).

Results

Fifteen individuals with DS (male n = 12, age 24 ± 4 years, BMI 28 ± 5 kg/m2) and 16 control participants (male n = 12, age 24 ± 4 years, BMI 25 ± 5 kg/m2) participated. Baseline differences showed greater AP, higher AIx and AIx@75, a greater RIx, shorter Tr and larger Pb in individuals with DS (p < 0.05). In response to LBNP, interaction effects were observed for AIx, AIx@75, AP, RIx and Pb, due to reductions in the outcomes in response to LBNP for individuals with DS with no change in the controls.

Conclusion

These results show that central hemodynamics and wave reflections are different in individuals with DS at rest and in response to LBNP, probably as a result of anatomical differences and reduced peripheral vasoconstrictive control during LBNP.

Highlights

  • Individuals with DS exhibit greater central hemodynamic load at rest.

  • Individuals with DS have greater indices of wave reflections at rest.

  • Individuals with DS maintained blood pressure during LBNP with reduced wave reflection.

References

  1. Glasson EJ, Jacques A, Wong K, Bourke J, Leonard H. Improved survival in down syndrome over the last 60 years and the impact of perinatal factors in recent decades. J Pediatr 2016;169:214.e1–20.e1.

    Google Scholar 

  2. Oppewal A, Schoufour JD, van der Maarl HJK, Evenhuis HM, Hilgenkamp TIM, Festen DA. Causes of mortality in older people with intellectual disability: results from the HA-ID study. Am J Intellect Dev Disabil 2018;123:61–71.

    Google Scholar 

  3. Ylä-Herttuala S, Luoma J, Nikkari T, Kivimäki T. Down’s syndrome and atherosclerosis. Atherosclerosis 1989;76:269–72.

    Google Scholar 

  4. Parra P, Costa R, de Asúa DR, Moldenhauer F, Suárez C. Atherosclerotic surrogate markers in adults with down syndrome: a case-control study. J Clin Hypertens (Greenwich) 2017;19:205–11.

    Google Scholar 

  5. Versacci P, Di Carlo D, Digilio MC, Marino B. Cardiovascular disease in down syndrome. Curr Opin Pediatr 2018;30:616–22.

    Google Scholar 

  6. Shields N, Plant S, Warren C, Wollersheim D, Peiris C. Do adults with down syndrome do the same amount of physical activity as adults without disability? A proof of principle study. J Appl Res Intellect Disabil 2018;31:459–65.

    Google Scholar 

  7. Hilgenkamp TIM, van Wijck R, Evenhuis HM. Subgroups associated with lower physical fitness in older adults with ID: results of the HA-ID study. Res Dev Disabil 2014;35:439–47.

    Google Scholar 

  8. Esposito PE, MacDonald M, Hornyak JE, Ulrich DA. Physical activity patterns of youth with down syndrome. Intellect Dev Disabil 2012;50:109–19.

    Google Scholar 

  9. Baynard T, Pitetti KH, Guerra M, Unnithan VB, Fernhall B. Age-related changes in aerobic capacity in individuals with mental retardation: a 20-yr review. Med Sci Sports Exerc 2008;40:1984–9.

    Google Scholar 

  10. Bertapelli F, Pitetti K, Agiovlasitis S, Guerra-Junior G. Overweight and obesity in children and adolescents with Down syndrome—prevalence, determinants, consequences, and interventions: a literature review. Res Dev Disabil 2016;57:181–92.

    Google Scholar 

  11. Capone GT, Chicoine B, Bulova P, Stephens M, Hart S, Crissman B, et al. Co-occurring medical conditions in adults with Down syndrome: a systematic review toward the development of health care guidelines. Am J Med Genet A 2018;176:116–33.

    Google Scholar 

  12. Draheim CC, Geijer JR, Dengel DR. Comparison of intima-media thickness of the carotid artery and cardiovascular disease risk factors in adults with versus without the Down syndrome. Am J Cardiol 2010;106:1512–6.

    Google Scholar 

  13. Rodrigues AN, Coelho LC, Goncalves WLS, Gouvea SA, Vasconcellos MJR, Cunha RS, et al. Stiffness of the large arteries in individuals with and without down syndrome. Vasc Health Risk Manag 2011;7:375–81.

    Google Scholar 

  14. Fernhall B, Mendonca GV, Baynard T. Reduced work capacity in individuals with down syndrome: a consequence of autonomic dysfunction? Exerc Sport Sci Res 2013;41:138–47.

  15. Zamani P, Jacobs DR, Segers P, Duprez DA, Brumback L, Kronmal RA, et al. Reflection magnitude as a predictor of mortality: the multi-ethnic study of atherosclerosis. Hypertension 2014;64:958–64.

    Google Scholar 

  16. Avolio AP, Van Bortel LM, Boutouyrie P, Cockcroft JR, McEniery CM, Protogerou AD, et al. Role of pulse pressure amplification in arterial hypertension: experts’ opinion and review of the data. Hypertension 2009;54:375–83.

    Google Scholar 

  17. Chirinos JA, Segers P. Noninvasive evaluation of left ventricular afterload: part 1: pressure and flow measurements and basic principles of wave conduction and reflection. Hypertension 2010;56:555–62.

    Google Scholar 

  18. Townsend RR, Wilkinson IB, Schiffrin EL, Avolio AP, Chirinos JA, Cockcroft JR, et al. Recommendations for improving and standardizing vascular research on arterial stiffness: a scientific statement from the American Heart Association. Hypertension 2015;66:698–722.

    Google Scholar 

  19. Goulopoulou S, Baynard T, Collier S, Giannopoulou I, Figueroa A, Beets M, et al. Cardiac autonomic control in individuals with down syndrome. Am J Ment Retard 2006;111:27–34.

    Google Scholar 

  20. Figueroa A, Collier SR, Baynard T, Giannopoulou I, Goulopoulou S, Fernhall B. Impaired vagal modulation of heart rate in individuals with Down syndrome. Clinical autonomic research 2005;15:45–50.

    Google Scholar 

  21. Baynard T, Pitetti KH, Guerra M, Fernhall B. Heart rate variability at rest and during exercise in persons with down syndrome. Arch Phys Med Rehabil 2004;85:1285–90.

    Google Scholar 

  22. Agiovlasitis S, Collier SR, Baynard T, Echols GH, Goulopoulou S, Figueroa A, et al. Autonomic response to upright tilt in people with and without Down syndrome. Res Dev Disabil 2010;31:857–63.

    Google Scholar 

  23. Guerra M, Llorens N, Fernhall B. Chronotropic incompetence in persons with down syndrome. Arch Phys Med Rehabil 2003;84:1604–8.

    Google Scholar 

  24. Fernhall B, Otterstetter M. Attenuated responses to sympatho-excitation in individuals with Down syndrome. J Appl Physiol 2003;94:2158–65.

    Google Scholar 

  25. Fernhall B, Baynard T, Collier SR, Figueroa A, Goulopoulou S, Kamimori GH, et al. Catecholamine response to maximal exercise in persons with down syndrome. Am J Cardiol 2009;103:724–6.

    Google Scholar 

  26. Hilgenkamp TIM, Wee SO, Schroeder EC, Baynard T, Fernhall B. Peripheral blood flow regulation in response to sympathetic stimulation in individuals with down syndrome. Artery Res 2018;24:16–21.

    Google Scholar 

  27. Karamanoglu M, O’Rourke MF, Avolio AP, Kelly RP. An analysis of the relationship between central aortic and peripheral upper limb pressure waves in man. Eur Heart J 1993;14:160–7.

    Google Scholar 

  28. Pauca AL, O’Rourke MF, Kon ND. Prospective evaluation of a method for estimating ascending aortic pressure from the radial artery pressure waveform. Hypertension 2001;38:932–7.

    Google Scholar 

  29. Kelly A, Magge SN, Walega R, Cochrane C, Pipan ME, Zemel BS, et al. Cross-sectional study of arterial stiffness in adolescents with Down syndrome. J Pediatr 2019;212:79.e1–86.e1.

    Google Scholar 

  30. Westerhof BE, Guelen I, Westerhof N, Karemaker JM, Avolio A. Quantification of wave reflection in the human aorta from pressure alone: a proof of principle. Hypertension 2006;48: 595–601.

    Google Scholar 

  31. Butlin M, Qasem A, Avolio AP. Estimation of central aortic pressure waveform features derived from the brachial cuff volume displacement waveform. Conf Proc IEEE Eng Med Biol Soc 2012;2012:2591–4.

    Google Scholar 

  32. Nürnberger J, Keflioglu-Scheiber A, Opazo Saez AM, Wenzel RR, Philipp T, Schäfers RF. Augmentation index is associated with cardiovascular risk. J Hypertens 2002;20:2407–14.

    Google Scholar 

  33. Janner JH, Godtfredsen NS, Ladelund S, Vestbo J, Prescott E. The association between aortic augmentation index and cardiovascular risk factors in a large unselected population. J Hum Hypertens 2012;26:476–84.

    Google Scholar 

  34. Khan MH, Sinoway LI, MacLean DA. Effects of graded LBNP on MSNA and interstitial norepinephrine. Am J Physiol Heart Circ Physiol 2002;283:H2038–H44.

    Google Scholar 

  35. Hughes WE, Casey DP. Aortic wave reflection during orthostatic challenges: influence of body position and venous pooling. Am J Hypertens 2017;30:166–72.

    Google Scholar 

  36. Alexander M, Petri H, Ding Y, Wandel C, Khwaja O, Foskett N. Morbidity and medication in a large population of individuals with down syndrome compared to the general population. Dev Med Child Neurol 2016;58:246–54.

    Google Scholar 

  37. Draheim CC, McCubbin JA, Williams DP. Differences in cardiovascular disease risk between nondiabetic adults with mental retardation with and without down syndrome. Am J Ment Retard 2002;107:201–11.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Integrative Physiology Laboratory, Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 West Taylor Street, AHSB (MC 517), 60612, Chicago, IL, USA

    Thessa Irena Maria Hilgenkamp, Elizabeth Cornellia Schroeder, Sang Ouk Wee, Georgios Grigoriadis, Alexander Jacob Rosenberg, Tracy Baynard & Bo Fernhall

  2. University of Nevada, Las Vegas, 4505 South Maryland Parkway, 89154, Las Vegas, NV, USA

    Thessa Irena Maria Hilgenkamp

  3. California State University San Bernardino, 5500 University Parkway, 92407, San Bernardino, CA, USA

    Sang Ouk Wee

  4. University of North Texas Health Science Center, 3500 Camp Bowie Blvd, 76107, Fort Worth, TX, USA

    Alexander Jacob Rosenberg

Authors
  1. Thessa Irena Maria Hilgenkamp
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elizabeth Cornellia Schroeder
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sang Ouk Wee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Georgios Grigoriadis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alexander Jacob Rosenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tracy Baynard
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bo Fernhall
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thessa Irena Maria Hilgenkamp.

Additional information

Peer review under responsibility of the Association for Research into Arterial Structure and Physiology

Data availability statement: Data is available upon request.

Rights and permissions

This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hilgenkamp, T.I.M., Schroeder, E.C., Wee, S.O. et al. Altered Central Hemodynamics in Individuals with Down Syndrome. Artery Res 25, 107–112 (2019). https://doi.org/10.2991/artres.k.191204.001

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2991/artres.k.191204.001

Keywords

Artery Research

ISSN: 1876-4401

Contact us