Dissociation between blood pressure and heart rate response to hypoxia after bilateral carotid body removal in men with systolic heart failure.
While the ventilatory response to hypoxia is known to be mediated by the carotid bodies, the origin of the haemodynamic alterations evoked by hypoxia is less certain. Bilateral carotid body removal (CBR) performed to treat congestive heart failure may serve as a model to improve our understanding of haemodynamic responses to hypoxia in humans. We studied six congestive heart failure patients before and 1 month after CBR [median (interquartile range): age, 58.5 (56-61) years old; and ejection fraction, 32 (25-34)%]. Peripheral chemosensitivity (hypoxic ventilatory response) was equated to the slope relating lowest oxygen saturation to highest minute ventilation following exposures to hypoxia. Likewise, systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) slopes were calculated as slopes relating the lowest oxygen saturations to the highest SBP, DBP and HR responses. We found that CBR reduces the hypoxic ventilatory response (91%, P < 0.05), SBP (71%, P < 0.05) and DBP slopes (59%, P = 0.07). In contrast, the HR slope remained unchanged. The dissociation between the blood pressure and HR responses after CBR shows involvement of a different chemoreceptive site(s) maintaining the response to acute hypoxia. We conclude that carotid bodies are responsible for ventilatory and blood pressure responses, while the HR response might be mediated by the aortic bodies. The significant reduction of the blood pressure response to hypoxia after CBR suggests a decrease in sympathetic tone, which is of particular clinical relevance in congestive heart failure.
* Department of Cardiology, Centre for Heart Disease, 4th Military Hospital, 4 Wojskowy Szpital Kliniczny, Ul. Weigla 5, Wroclaw 50-981, Poland.    pnsky@wp.pl.
Piotr
P
Niewinski
Dariusz
D
Janczak
Artur
A
Rucinski
Stanislaw
S
Tubek
Zoar J
ZJ
Engelman
Przemyslaw
P
Jazwiec
Waldemar
W
Banasiak
Paul A
PA
Sobotka
Emma C J
EC
Hart
Julian F R
JF
Paton
Piotr
P
Ponikowski
D001794:Blood Pressure / Q000502:physiology*; D002344:Carotid Body / Q000502:physiology*; D002628:Chemoreceptor Cells / Q000502:physiology; D003627:Data Interpretation, Statistical; D003714:Denervation; D006333:Heart Failure / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D000860:Hypoxia / Q000503:physiopathology*; D008297:Male; D015656:Respiratory Mechanics / Q000502:physiology