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Partial pharmacologic blockade shows sympathetic connection between blood pressure and cerebral blood flow velocity fluctuations

Published:April 17, 2016DOI:https://doi.org/10.1016/j.jns.2016.04.022

      Highlights

      • Cerebral autoregulation (CA) dampens blood pressure (BP)-fluctuations.
      • Thus, cerebral blood flow velocity (CBFV)-oscillations precede BP-oscillations.
      • Phase angle (PA) between sympathetic CBFV- and BP-oscillations measures CA quality.
      • Sympathetic stimulation shortens PA; sympathetic blockade abolishes PA-shortening.
      • PA measurements provide a subtle marker of sympathetic CA effects.

      Abstract

      Cerebral autoregulation (CA) dampens transfer of blood pressure (BP)-fluctuations onto cerebral blood flow velocity (CBFV). Thus, CBFV-oscillations precede BP-oscillations. The phase angle (PA) between sympathetically mediated low-frequency (LF: 0.03–0.15 Hz) BP- and CBFV-oscillations is a measure of CA quality. To evaluate whether PA depends on sympathetic modulation, we assessed PA-changes upon sympathetic stimulation with and without pharmacologic sympathetic blockade.
      In 10 healthy, young men, we monitored mean BP and CBFV before and during 120-second cold pressor stimulation (CPS) of one foot (0 °C ice-water). We calculated mean values, standard deviations and sympathetic LF-powers of all signals, and PAs between LF-BP- and LF–CBFV-oscillations. We repeated measurements after ingestion of the adrenoceptor-blocker carvedilol (25 mg). We compared parameters before and during CPS, without and after carvedilol (analysis of variance, post-hoc t-tests, significance: p < 0.05).
      Without carvedilol, CPS increased BP, CBFV, BP-LF- and CBFV-LF-powers, and shortened PA. Carvedilol decreased resting BP, CBFV, BP-LF- and CBFV-LF-powers, while PAs remained unchanged. During CPS, BPs, CBFVs, BP-LF- and CBFV-LF-powers were lower, while PAs were longer with than without carvedilol. With carvedilol, CPS no longer shortened resting PA.
      Sympathetic activation shortens PA. Partial adrenoceptor blockade abolishes this PA-shortening. Thus, PA-measurements provide a subtle marker of sympathetic influences on CA and might refine CA evaluation.

      Abbreviations:

      CA (cerebral autoregulation), BP (blood pressure), CBFV (cerebral blood flow velocity), CPS (cold pressor stimulation), ETCO2 (end-tidal carbon dioxide levels), HF (high-frequency), LF (low-frequency), PA (phase angle), RRI (RR-interval), SD (standard deviation), TCD (transcranial Doppler sonography)

      Keywords

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