Abstract
Young women exhibit higher prevalence of orthostatic hypotension with presyncopal symptoms compared to men. These symptoms could be influenced by an attenuated ability of the cerebrovasculature to respond to rapid blood pressure (BP) changes [dynamic cerebral autoregulation (dCA)]. The influence of sex on dCA remains unclear. dCA in 11 fit women (25 ± 2 years) and 11 age‐matched men (24 ± 1 years) was compared using a multimodal approach including a sit‐to‐stand (STS) and forced BP oscillations (repeated squat‐stand performed at 0.05 and 0.10 Hz). Prevalence of initial orthostatic hypotension (IOH; decrease in systolic ≥ 40 mmHg and/or diastolic BP ≥ 20 mmHg) during the first 15 sec of STS was determined as a functional outcome. In women, the decrease in mean middle cerebral artery blood velocity (MCAvmean) following the STS was greater (−20 ± 8 vs. −11 ± 7 cm sec−1; P = 0.018) and the onset of the regulatory change (time lapse between the beginning of the STS and the increase in the conductance index (MCAvmean/mean arterial pressure) was delayed (P = 0.007). Transfer function analysis gain during 0.05 Hz squat‐stand was ~48% higher in women (6.4 ± 1.3 vs. 3.8 ± 2.3 cm sec−1 mmHg−1; P = 0.017). Prevalence of IOH was comparable between groups (women: 4/9 vs. men: 5/9, P = 0.637). These results indicate the cerebrovasculature of fit women has an attenuated ability to react to rapid changes in BP in the face of preserved orthostasis, which could be related to higher resting cerebral blood flow allowing women to better face transient hypotension.
Highlights
The prevalence of orthostatic hypotension is higher in women compared to men [13]
) These results indicate the cerebrovasculature of healthy women has an attenuated ability to react to large and rapid changes in blood pressure (BP) in the face of preserved orthostasis, which could be related to a higher cerebrovascular reserve to face a rapid transient hypotension
Accumulating evidence supports the notion that cerebral blood flow (CBF) is regulated differently in women compared to men
Summary
The prevalence of orthostatic hypotension is higher in women compared to men [13]. In addition, women suffer more often from symptoms of cerebral hypoperfusion such as light-headedness, nausea and blurred vision [3]. Using transfer function analysis (TFA) of spontaneous or forced oscillations in mean arterial pressure (MAP) and middle cerebral artery blood velocity (MCAv), investigators reported older women have either similar [25] or enhanced dCA [9, 11, 37] compared to age-matched men. These findings are difficult to translate to a younger population since studies have shown older women regulate CBF in a different manner when compared with younger women [11]
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