Paradoxical vasodilation during lower body negative pressure in patients with vasodepressor carotid sinus syndrome.
OBJECTIVE
To elucidate the pathophysiological mechanism of the vasodepressor form (VD) of carotid sinus syndrome (CSS) by maneuvers designed to induce generalized sympathetic activation after baroreceptor unloading (lower body negative pressure, LBNP) or direct peripheral adrenoreceptor stimulation via local administration of norepinephrine (NA).


METHODS
Subjects were identified with VD of CSS through diagnostic testing.


METHODS
Research laboratory.


METHODS
Eleven young controls (YC) (mean age +/- standard error of mean = 22.8 +/- 0.7), eight elderly controls (EC) (72.6 +/- 0.6), and eight elderly patients with VD (78.7 +/- 1.7).


METHODS
Forearm arterial blood flow (FABF) was measured in the left and right arms by venous occlusion plethysmography. Measurements were performed during baseline conditions, LBNP (-20 mmHg), and intra-arterial NA infusion in the left brachial artery at three progressively increasing rates (60, 120, and 240 pmol/min).


RESULTS
During LBNP, FABF significantly decreased in YC (baseline 3.61 +/- 0.30 vs -20 mmHg 2.96 +/- 0.24 mL/100 g/min, P =.030) and EC (4.05 +/- 0.74 vs 3.69 +/- 0.65 mL/100 g/min, P =.033) but increased in elderly patients with VD (3.65 +/- 0.60 vs 4.54 +/- 0.80 mL/100 g/min, P =.020). During NA infusion, a significant forearm vasoconstriction occurred in YC (FABF left:right ratio 1.00 +/- 0.05 at baseline; 0.81 +/- 0.08 at 60 pmol/min, P =.034; 0.81 +/- 0.05 at 120 pmol/min, P <.001; 0.72 +/- 0.04 at 240 pmol/min, P <.001), whereas no significant FABF changes were observed in EC (1.04 +/- 0.06; 0.96 +/- 0.07, P =.655; 0.89 +/- 0.10, P =.401; 0.94 +/- 0.10, P =.590) or elderly patients with VD (1.04 +/- 0.06; 1.16 +/-0.10, P =.117; 1.04 +/- 0.08, P =.602; 1.11 +/- 0.10, P =.305).


CONCLUSIONS
VD of CSS is associated with a paradoxical vasodilatation during LBNP and an impairment of peripheral alpha-adrenergic responsiveness, which may be age-related.
Mangoni
Arduino A
AA
Department of Health Care of the Elderly, Guy's, King's, and St Thomas' School of Medicine, King's College, London, United Kingdom. arduino.mangoni@kcl.ac.uk
Ouldred
Emma
E
Rgn
Allain
Theresa J
TJ
Close
Jacqueline C T
JC
Hilton
Diarmuid
D
Swift
Cameron G
CG
Lyons
Declan
D
Jackson
Stephen H D
SH
D000316:Adrenergic alpha-Agonists / Q000494:pharmacology*; D000328:Adult; D000368:Aged; D017704:Baroreflex / Q000502:physiology; D006439:Hemodynamics; D006801:Humans; D008150:Lower Body Negative Pressure / Q000379:methods*; D035002:Lower Extremity / Q000503:physiopathology*; D009638:Norepinephrine / Q000494:pharmacology*; D011941:Receptors, Adrenergic / Q000187:drug effects; D013564:Sympathetic Nervous System / Q000187:drug effects / Q000503:physiopathology*; D019462:Syncope, Vasovagal / Q000503:physiopathology*; D014664:Vasodilation / Q000502:physiology*
D000316:Adrenergic alpha-Agonists; D011941:Receptors, Adrenergic; D009638:Norepinephrine