Jaisri Goturu

Music versus lifestyle on the autonomic nervous system of prehypertensives and hypertensives--a randomized control trial.

OBJECTIVES Ragas of Indian music are said to be beneficial in normalizing blood pressure (BP). The objective of this study was to evaluate the effect of passive listening to relaxing raga on the autonomic functions of hypertensives and prehypertensives and provide scientific evidence. METHODS Ethical clearance was obtained from the institutional review board. A prospective, randomized controlled trial was done on hundred prehypertensives/stage I hypertensives, randomly divided into two groups (n=50 in each). Group 1 received music intervention along with lifestyle modifications while Group 2 received only lifestyle modifications (according to Joint national committee VII guidelines). Group 1 listened to raga bhimpalas played on flute for 15min daily for at least 5 days/week for 3 months. The main outcome measures were heart rate variability (HRV) (Power lab 15T, AD Instruments), BP and stress levels (State Trait anxiety inventory score). All HRV variables were log transformed for analysis. Statistical analysis was done using SPSS version 18.0 with P<0.05 being considered statistically significant. RESULTS Group 1 exhibited significant reduction in stress levels, diastolic BP and systolic BP decreased in Group 2 after intervention. Insignificant rise in parasympathetic parameters of HRV (SDNN, RMSSD, HF ms(2), HF nu) was seen after intervention in both the groups. We found significantly increased parasympathetic and lower sympathetic parameters (LF ms(2), LF nu, LF/HF) in Group 1 and 2 males and females of Group 2. The results suggest that females of Group 1 were least compliant with the given intervention. CONCLUSIONS Passive listening to Indian music along with conventional lifestyle modifications has a role in normalizing BP through autonomic function modification and thus can be used as a complementary therapy along with other lifestyle modifications.

Insight into relation between autonomic function and hypertension

I was very glad to read Erdogan et al. article [1]. Prehypertension confers higher cardiovascular risk [2] and was included in JNC VII to encourage patients and clinicians to intervene and prevent/delay development of hypertension [3]. Studies have shown beneficial effect of diet and lifestyle modification among prehypertensives [4,5]. This study [1] has used heart rate recovery (HRR) as a simple tool to test autonomic nervous system (ANS) function. Thus, HRR can serve as a good screening test among normotensives and prehypertensives. I commend the authors for this simple but innovative work. Attenuated HRR can predict endothelial dysfunction in coronary artery disease patients [6]. This study [1] also shows that autonomic dysfunction precedes the development of hypertension. There are hardly few studies which have assessed the autonomic function of prehypertensives. Normotensives with reduced heart rate variability (HRV) are at greater risk of developing hypertension [7]. Borderline hypertensives have increased sympathetic and decreased parasympathetic activity that correlates significantly with renin release [8]. A small study population and the lack of a larger control group are the twomajor limitations of this study as acknowledged by the author [1]. The sample size of each of the groups was not calculated based on any prior published data. Another limitation of this study [1] is the lack of data on the family history of hypertension among the subjects tested. A landmark study demonstrated decreased parasympathetic activity in normotensive subjects with a positive family history of hypertension [9]. They are also characterized by altered cardiovascular morphology [10] along with significantly different autonomic function [11]. The study [1] has not looked into the interaction of the autonomic function with the renin–angiotensin system, and other biomarkers. Angiotensin II may contribute to activation of sympathetic activity and suppression of parasymathetic activity [12]. High Plasma Renin Activity (PRA) is an independent determinant of diminished vagal activity [13]. Review on interaction between endothelium and ANS has shown that decreased HRV is associated with endothelial dysfunction [12]. Nitric oxide acts as a sympatholytic agent [14]. Reduced HRV triggers subclinical inflammation [15,16]. Inflammatory markers increase the incidence of prehypertension suggesting that prehypertension might be a pro-inflammatory condition [17]. Oxidative stress impairs endothelial function [18]. Vitamin E, antioxidant, reduces catechalamine levels and improves HRV [19]. Further studies are warranted to unravel the effect of biomarkers on autonomic function and a specific targeted therapy towards them to prevent development of hypertension. Probably integration of various risk factors rather than reliance on a single risk factor will be an efficient approach to implement when screening large populations as a basis for preventive interventions. The author of this manuscript has certified that she complies with the principles of ethical publishing in the International Journal of Cardiology (Shewan and Coats 2010;144:1-2).

Correlation of ulcer size and serum cortisol in subjects with Aphthous Ulcers

Background: Aphthous Ulcers are a painful oral ulcerative condition. Stress is one of the major causes for ulcer formation and cortisol level is increased in stress. This study aims at looking into the relationship between ulcer size and serum cortisol. Methods: 40 subjects in the age group of 18-35 years with aphthous ulcers were included in the study. Ulcer size was determined and morning serum cortisol was measured in all subjects. Correlation tests were applied and significance was set at p<0.05. Results: Ulcer size was 6.5 ±5.4 sq mm and serum cortisol was 123.3±72.6 ng/dl. There was a significant positive correlation between the serum cortisol and ulcer size when the serum cortisol was more than 100 ng/dl. Conclusion: Serum cortisol could be a significant contributor in ulcer formation and progression. Size of the ulcer could suggest the severity of distress/Stress in the individuals. Correlation of ulcer size and serum cortisol in subjects with Aphthous Ulcers