A SYSTEMATIC REVIEW AND META-ANALYSIS ON PHYSIOLOGICAL MODULATION OF BARORECEPTOR SENSITIVITY BY ANTIHYPERTENSIVE DRUGS
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Keywords
Baroreceptor sensitivity; Baroreflex; Antihypertensive drugs; Autonomic regulation; Hypertension; Systematic review; Meta-analysis
Abstract
Background: Baroreceptor sensitivity (BRS) plays a critical role in short-term blood pressure regulation and cardiovascular autonomic control. Impaired BRS is commonly observed in hypertension and is associated with increased cardiovascular risk. Antihypertensive drugs lower blood pressure through diverse pharmacological mechanisms that may differentially influence baroreflex function; however, the physiological effects of these agents on BRS have not been comprehensively synthesized.
Objective: To systematically evaluate and quantitatively synthesize the effects of major classes of antihypertensive drugs on baroreceptor sensitivity in adult humans.
Methods: A systematic literature search was conducted in PubMed/MEDLINE, Embase, Cochrane CENTRAL, and Web of Science in accordance with PRISMA 2020 guidelines. Randomized controlled trials, crossover studies, and observational studies assessing baroreceptor sensitivity in adults receiving antihypertensive therapy were included. Baroreceptor sensitivity was measured using pharmacological, spontaneous sequence, or spectral analysis techniques. Risk of bias was assessed using the Cochrane RoB 2.0 tool and ROBINS-I. A random-effects meta-analysis was performed, with heterogeneity quantified using the I² statistic. Subgroup analyses were conducted based on antihypertensive drug class and BRS assessment method.
Results: Antihypertensive therapy was associated with an overall improvement in baroreceptor sensitivity compared with baseline or control conditions. Renin–angiotensin system inhibitors and central sympatholytic agents consistently demonstrated significant enhancement of baroreflex function, likely mediated by improved arterial compliance and reduced sympathetic activity. Beta-blockers and calcium-channel blockers showed variable or modest effects, influenced by drug-specific physiological actions and the method of BRS assessment. Diuretics exhibited minimal impact on baroreceptor sensitivity. Moderate heterogeneity was observed across studies, attributable to differences in study design, treatment duration, and BRS measurement techniques.
Conclusion: Antihypertensive drugs exert class-specific physiological effects on baroreceptor sensitivity. Agents that improve arterial compliance or suppress sympathetic activity are most effective in enhancing baroreflex function, whereas other classes demonstrate neutral or variable effects. These findings underscore the importance of autonomic modulation as a complementary therapeutic target in hypertension and support a physiology-driven approach to antihypertensive drug selection. Further standardized and long-term studies are required to clarify the prognostic significance of baroreflex improvement.
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Vivek Tejvir Yadav
Associate Professor, Department of Pharmacology, Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh, India. Email: dr_vivek16@yahoo.co.in
Monali Kar
Assistant Professor, Department of Community Medicine, IMS & SUM Hospital, Kalinga Nagar, Bhubaneswar, Odisha, India.
Akshaya Khattri
PG Resident, Department of Microbiology, Chirayu Medical College & Hospital, Bhopal, Madhya Pradesh, India.
