Reduced cerebral blood flow with orthostasis precedes hypocapnic hyperpnea, sympathetic activation, and postural tachycardia syndrome

Hypertension

Volumn 63, Issue 6, 2014, Pages 1302-1308

  Del Pozzi, Andrew T ^a   Schwartz, Christopher E ^a   Tewari, Deepali ^a   Medow, Marvin S ^a   Stewart, Julian M ^a,b  

^a NEW YORK MEDICAL COLLEGE   (United States)

^b Center for Hypotension   (United States)

Author keywords

Autonomic nervous system; Orthostatic intolerance

Indexed keywords

ADULT; ARTICLE; BLOOD VOLUME; BRAIN BLOOD FLOW; BRAIN ISCHEMIA; BREATHING RATE; CARDIOPULMONARY HEMODYNAMICS; CAROTID BODY; CHEMORECEPTOR REFLEX; CLINICAL ARTICLE; CONTROLLED STUDY; END TIDAL CARBON DIOXIDE TENSION; FEMALE; HEAD TILTING; HEART OUTPUT; HEART RATE; HUMAN; HYPERPNEA; HYPERVENTILATION; HYPOCAPNIA; HYPOVOLEMIA; LUNG MINUTE VOLUME; MALE; MEAN ARTERIAL PRESSURE; MUSCLE SYMPATHETIC NERVE ACTIVITY; ORTHOSTATIC HYPOTENSION; ORTHOSTATIC STRESS; POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME; PRIORITY JOURNAL; STANDING; SYMPATHETIC TONE; TIDAL VOLUME; VASCULAR RESISTANCE;

AUTONOMIC NERVOUS SYSTEM; ORTHOSTATIC INTOLERANCE;

ADOLESCENT; BLOOD PRESSURE; CEREBROVASCULAR CIRCULATION; DIZZINESS; FEMALE; HEART RATE; HUMANS; HYPOCAPNIA; HYPOTENSION, ORTHOSTATIC; MALE; POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME; PULMONARY VENTILATION; REGIONAL BLOOD FLOW; RESPIRATION; SUPINE POSITION; SYMPATHETIC NERVOUS SYSTEM; TIME FACTORS; YOUNG ADULT;

EID: 84902272583     PISSN: 0194911X     EISSN: 15244563     Source Type: Journal    
DOI: 10.1161/HYPERTENSIONAHA.113.02824     Document Type: Article

References (41)

1. Robertson D. The epidemic of orthostatic tachycardia and orthostatic intolerance. Am J Med. Sci. 1999;317:75-77.
2. Low PA, Opfer-Gehrking TL, McPhee BR, Fealey RD, Benarroch EE, Willner CL, Suarez GA, Proper CJ, Felten JA, Huck CA. Prospective evaluation of clinical characteristics of orthostatic hypotension. Mayo Clin Proc. 1995;70:617-622.
3. Stewart JM, Medow MS, Cherniack NS, Natelson BH. Postural hypocapnic hyperventilation is associated with enhanced peripheral vasoconstriction in postural tachycardia syndrome with normal supine blood flow. Am J Physiol Heart Circ Physiol. 2006;291:H904-H913.
4. Burnum JF, Hickam JB, Stead EA Jr. Hyperventilation in postural hypotension. Circulation. 1954;10:362-365.
5. Lagi A, Cencetti S, Corsoni V, Georgiadis D, Bacalli S. Cerebral vasoconstriction in vasovagal syncope: any link with symptoms? A transcranial Doppler study. Circulation. 2001;104:2694-2698.
6. Taneja I, Medow MS, Clarke DA, Ocon AJ, Stewart JM. Baroreceptor unloading in postural tachycardia syndrome augments peripheral chemoreceptor sensitivity and decreases central chemoreceptor sensitivity. Am J Physiol Heart Circ Physiol. 2011;301:H173-H179.
7. Convertino VA, Rickards CA, Lurie KG, Ryan KL. Hyperventilation in response to progressive reduction in central blood volume to near syncope. Aviat Space Environ Med. 2009;80:1012-1017.
8. LeLorier P, Klein GJ, Krahn A, Yee R, Skanes A, Shoemaker JK. Combined head-up tilt and lower body negative pressure as an experimental model of orthostatic syncope. J Cardiovasc Electrophysiol. 2003;14:920-924.
9. Stewart JM, Rivera E, Clarke DA, Baugham IL, Ocon AJ, Taneja I, Terilli C, Medow MS. Ventilatory baroreflex sensitivity in humans is not modulated by chemoreflex activation. Am J Physiol Heart Circ Physiol. 2011;300:H1492-H1500.
10. Novak V, Spies JM, Novak P, McPhee BR, Rummans TA, Low PA. Hypocapnia and cerebral hypoperfusion in orthostatic intolerance. Stroke. 1998;29:1876-1881.
11. Schondorf R, Low PA. Idiopathic postural orthostatic tachycardia syndrome: an attenuated form of acute pandysautonomia? Neurology. 1993;43:132-137.
12. Jacob G, Costa F, Shannon JR, Robertson RM, Wathen M, Stein M, Biaggioni I, Ertl A, Black B, Robertson D. The neuropathic postural tachycardia syndrome. N Engl J Med. 2000;343:1008-1014.
13. Jordan J, Shannon JR, Diedrich A, Black BK, Robertson D. Increased sympathetic activation in idiopathic orthostatic intolerance: role of systemic adrenoreceptor sensitivity. Hypertension. 2002;39:173-178.
14. Stewart JM, Medow MS, Glover JL, Montgomery LD. Persistent splanchnic hyperemia during upright tilt in postural tachycardia syndrome. Am J Physiol Heart Circ Physiol. 2006;290:H665-H673.
15. Ito H, Kanno I, Ibaraki M, Hatazawa J, Miura S. Changes in human cerebral blood flow and cerebral blood volume during hypercapnia and hypocapnia measured by positron emission tomography. J Cereb Blood Flow Metab. 2003;23:665-670.
16. Plash WB, Diedrich A, Biaggioni I, Garland EM, Paranjape SY, Black BK, Dupont WD, Raj SR. Diagnosing postural tachycardia syndrome: comparison of tilt testing compared with standing haemodynamics. Clin Sci (Lond). 2013;124:109-114.
17. Singer W, Sletten DM, Opfer-Gehrking TL, Brands CK, Fischer PR, Low PA. Postural tachycardia in children and adolescents: what is abnormal? J Pediatr. 2012;160:222-226.
18. Montgomery LD, Hanish HM, Marker RA. An impedance device for study of multisegment hemodynamic changes during orthostatic stress. Aviat Space Environ Med. 1989;60:1116-1122.
19. Schwartz CE, Lambert E, Medow MS, Stewart JM. Disruption of phase synchronization between blood pressure and muscle sympathetic nerve activity in postural vasovagal syncope. Am J Physiol Heart Circ Physiol. 2013;305:H1238-H1245.
20. Stewart JM, Clarke D. "He's dizzy when he stands up": an introduction to initial orthostatic hypotension. J Pediatr. 2011;158:499-504.
21. Wieling W, Krediet CT, van Dijk N, Linzer M, Tschakovsky ME. Initial orthostatic hypotension: review of a forgotten condition. Clin Sci (Lond). 2007;112:157-165.
22. Dyson KS, Shoemaker JK, Arbeille P, Hughson RL. Modelflow estimates of cardiac output compared with Doppler ultrasound during acute changes in vascular resistance in women. Exp Physiol. 2010;95:561-568.
23. Wang Y, Marshall RJ, Shepherd JT. The effect of changes in posture and of graded exercise on stroke volume in man. J Clin Invest. 1960;39:1051-1061.
24. Sheriff DD, Nådland IH, Toska K. Role of sympathetic responses on the hemodynamic consequences of rapid changes in posture in humans. J Appl Physiol (1985). 2010;108:523-532.
25. Thomas KN, Cotter JD, Galvin SD, Williams MJ, Willie CK, Ainslie PN. Initial orthostatic hypotension is unrelated to orthostatic tolerance in healthy young subjects. J Appl Physiol (1985). 2009;107:506-517.
26. Levine BD, Giller CA, Lane LD, Buckey JC, Blomqvist CG. Cerebral versus systemic hemodynamics during graded orthostatic stress in humans. Circulation. 1994;90:298-306.
27. Miller JD, Pegelow DF, Jacques AJ, Dempsey JA. Skeletal muscle pump versus respiratory muscle pump: modulation of venous return from the locomotor limb in humans. J Physiol. 2005;563(Pt 3):925-943.
28. Tani H, Singer W, McPhee BR, Opfer-Gehrking TL, Haruma K, Kajiyama G, Low PA. Splanchnic-mesenteric capacitance bed in the postural tachycardia syndrome (POTS). Auton Neurosci. 2000;86: 107-113.
29. Riggs AF. The Bohr effect. Annu Rev Physiol. 1988;50:181-204.
30. Laffey JG, Kavanagh BP. Hypocapnia. N Engl J Med. 2002;347:43-53.
31. Anthonisen NR, Bartlett D, Tenney SM. Postural effect on ventilatory control. J Appl Physiol. 1965;20:191-196.
32. Hughson RL, Edwards MR, O'Leary DD, Shoemaker JK. Critical analysis of cerebrovascular autoregulation during repeated head-up tilt. Stroke. 2001;32:2403-2408.
33. Schondorf R, Stein R, Roberts R, Benoit J, Cupples W. Dynamic cerebral autoregulation is preserved in neurally mediated syncope. J Appl Physiol (1985). 2001;91:2493-2502.
34. Shepherd JT. The lungs as receptor sites for cardiovascular regulation. Circulation. 1981;63:1-10.
35. Takata M, Wise RA, Robotham JL. Effects of abdominal pressure on venous return: abdominal vascular zone conditions. J Appl Physiol (1985). 1990;69:1961-1972.
36. Zhang R, Zuckerman JH, Giller CA, Levine BD. Transfer function analysis of dynamic cerebral autoregulation in humans. Am J Physiol. 1998;274(1 Pt 2):H233-H241.
37. Van Lieshout JJ, Wieling W, Karemaker JM, Secher NH. Syncope, cerebral perfusion, and oxygenation. J Appl Physiol (1985). 2003;94:833-848.
38. 2 delivery during the modified Oxford maneuver increases with sodium nitroprusside and decreases during phenylephrine. Am J Physiol Heart Circ Physiol. 2013;304:H1576-H1583.
39. Ding Y, Li YL, Schultz HD. Role of blood flow in carotid body chemoreflex function in heart failure. J Physiol. 2011;589(Pt 1):245-258.
40. Mitchell RA. Respiration. Annu Rev Physiol. 1970;32:415-438.
41. Serrador JM, Picot PA, Rutt BK, Shoemaker JK, Bondar RL. MRI measures of middle cerebral artery diameter in conscious humans during simulated orthostasis. Stroke. 2000;31:1672-1678.