Sex Differences in Vascular Reactivity with Acute and Chronic Hypoxia

Abstract

Objective Males and females may respond differently to hypoxic exposure at high altitude. Females have reduced vascular resistance in response to hypoxia, possibly due to differences in adrenergic control. We investigated the role of sex in vascular control during hypoxia. We hypothesized females have reduced vasoreactivity to sympathetic stressors compared to males during acute and prolonged hypoxia exposure. Methods We studied a convenient sample of 7 males and 6 females at three time points: 1) low altitude (Calgary AB, 1100m) breathing room air (normoxia; LOW) and acute isocapnic hypoxia (PETO2~50mmHg; PETCO2~32mmHg; ACUTE); 2) during early (day 2-3; EARLY) and 3) late (day 8-10; LATE) acclimatization at high altitude (White Mountain, CA; 3800m) breathing room air (PETO2~50mmHg) and hyperoxia (100% O2). Heart rate (HR), mean arterial pressure (MAP), and blood oxygen saturation (SpO2) were collected beat-by-beat. Participants performed a cold pressor test (CPT) to assess integrated cardiovascular reactivity to a sympathetic stressor. To isolate α1-adrenergic receptor sensitivity, we delivered a graded series of phenylephrine hydrochloride (PE) injections. Statistical analysis included a mixed model ANOVA, and Holm-Sidak post hoc tests when we identified main effects (α<0.05). Results In response to CPT, peak change in MAP decreased with hypoxia duration (p<0.001). There was also a significant interaction between condition and sex (p=0.038). While LOW (+17.0±5.9mmHg) and ACUTE (+15.3±4.7mmHg) responses were not different (p=0.565), males showed a marked decrease in peak MAP response to CPT at EARLY (+10.2±4.9mmHg) and LATE (+9.8±5.4mmHg) compared to LOW (both p<0.001). Similarly, LOW (+11.8±8.4mmHg) and ACUTE (+8.2±3.8mmHg) peak MAP responses to CPT were not different in females (p=0.137). Though female responses decreased between LOW and EARLY (+6.3±3.3mmHg; p=0.042), they returned to similar values by LATE (+9.7±7.5mmHg; p=0.479). Adrenergic sensitivity slope was decreased at altitude (p=0.025) independent of sex (p=0.977). LOW (0.33±0.21) and ACUTE (0.22±0.10) sensitivity were not different (p=0.309). Notably, sensitivity was reduced at altitude at LATE (0.14±0.16; p=0.043), but not significantly at EARLY (0.16±0.18; p=0.051) compared to LOW. Hyperoxia did not correct CPT responses or PE adrenergic sensitivity to low altitude values at EARLY (p<0.001; p=0.01, respectively) nor LATE (p=0.013; p=0.042, respectively). Conclusions Our data indicate decreased α1-adrenergic responsiveness with acclimatization underlies blunted vascular reactivity in both sexes. However, female responses to CPT returned to low altitude values following 8 days at altitude, indicating differential adaptation. Additional mechanisms influencing the vascular response to stress (e.g. less neuropeptide mediated constriction, higher β-adrenergic dilation) may account for lower responsiveness in females compared to males. Our results have implications for understanding vascular function at high altitude and in clinical conditions characterized by hypoxemia.