Prolonged, Untreated Autonomic Dysfunction May Ultimately Lead to Heart Failure.

Background. There is extensive evidence for a significant correlation between high Pulse Pressure (PP) and the occurrence of cardiovascular events, including Heart Failure (HF), both in normotensive and hypertensive subjects. HF is a known predictor of mortality risk in HF patients. PP is affected by the two Autonomic branches: the Parasympathetics and the Sympathetics (P&S). Autonomic dysfunction is strongly associated with abnormal PPs. Objective. Here, we propose a possible P&S mechanism which is known to lead to abnormal BPs and, if prolonged, abnormal PPs: Sympathetic Withdrawal (SW), which leads to Orthostatic dysfunction, which may lead to poor coronary perfusion and decreased diastolic BP, which may lead to increased resting systolic BP, which often rises as a compensatory against poor coronary and cerebral perfusion, which leads to widening of PP, which may indicate HF. Methods. SW is measured with P&S Monitoring (Physio PS, Inc., Atlanta, GA), serially for 9445 patients (4731 female, 50.1%; average age 68.9 yrs, range 40 to 100 y/o; average BMI 28.9 #/in2). PP & HF are determined in the classical manner. Results. Patients’ LVEFs are within normal limits. HF is the primary diagnoses in 35.2%. SW is prevalent, 56.1% (p