Cortisol rapidly increases baroreflex sensitivity of heart rate control, but does not affect cardiac modulation of startle

Physiol Behav. 2020 Mar 1:215:112792. doi: 10.1016/j.physbeh.2019.112792. Epub 2019 Dec 21.


Cortisol, the final product of human HPA axis activation, rapidly modulates the cortical processing of afferent signals originating from the cardiovascular system. While peripheral effects have been excluded, it remains unclear whether this effect is mediated by cortical or subcortical (e.g. brainstem) CNS mechanisms. Cardiac modulation of startle (CMS) has been proposed as a method to reflect cardio-afferent signals at subcortical (potentially brainstem-) level. Using a single blind, randomized controlled design, the cortisol group (n = 16 volunteers) received 1 mg cortisol intravenously, while the control group (n = 16) received a placebo substance. The CMS procedure involved the assessment of eye blink responses to acoustic startle stimuli elicited at six different latencies to ECG-recorded R-waves (R + 0, 100, 200, 300, 400 and 500 ms). CMS was assessed at four measurement points: baseline, -16 min, +0 min, and +16 min relative to substance application. Baroreflex sensitivity (BRS) of heart rate (HR) control was measured non-invasively based on spontaneous beat-to-beat HR and systolic blood pressure changes. In the cortisol group, salivary cortisol concentration increased after IV cortisol administration, indicating effective distribution of the substance throughout the body. Furthermore, BRS increased in the cortisol group after cortisol infusion. There was no effect of cortisol on the CMS effect, however. These results suggest that low doses of cortisol do not affect baro-afferent signals, but central or efferent components of the arterial baroreflex circuit presumably via rapid, non-genomic mechanisms.

Keywords: Baro-afferent signal transmission; Cortisol; Human startle response; Interoception; Stress; Symptom perception.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Baroreflex / drug effects*
  • Blinking / drug effects
  • Blood Pressure / drug effects
  • Electrocardiography / drug effects
  • Female
  • Heart Rate / drug effects*
  • Humans
  • Hydrocortisone / metabolism
  • Hydrocortisone / pharmacology*
  • Interoception / drug effects
  • Male
  • Reflex, Startle / physiology*
  • Saliva / chemistry
  • Single-Blind Method
  • Young Adult


  • Hydrocortisone