Arterial Blood Pressure Range Research Articles

Static autoregulation in humans.

The process by which cerebral blood flow (CBF) remains approximately constant in response to short-term variations in arterial blood pressure (ABP) is known as cerebral autoregulation. This classic view, that it remains constant over a wide range of ABP, has however been challenged by a growing number of studies. To provide an updated understanding of the static cerebral pressure-flow relationship and to characterise the autoregulation curve more rigorously, we conducted a comprehensive literature research. Results were based on 143 studies in healthy individuals aged 18 to 65 years. The mean sensitivities of CBF to changes in ABP were found to be 1.47 ± 0.71%/% for decreased ABP and 0.37 ± 0.38%/% for increased ABP. The significant difference in CBF directional sensitivity suggests that cerebral autoregulation appears to be more effective in buffering increases in ABP than decreases in ABP. Regression analysis of absolute CBF and ABP identified an autoregulatory plateau of approximately 20 mmHg (ABP between 80 and 100 mmHg), which is much smaller than the widely accepted classical view. Age and sex were found to have no effect on autoregulation strength. This data-driven approach provides a quantitative method of analysing static autoregulation that can be easily updated as more experimental data become available.

High spatial and temporal resolution cerebrovascular reactivity for humans and large mammals: A technological description of integrated fNIRS and niABP mapping system.

Introduction: The process of cerebral vessels maintaining cerebral blood flow (CBF) fairly constant over a wide range of arterial blood pressure is referred to as cerebral autoregulation (CA). Cerebrovascular reactivity is the mechanism behind this process, which maintains CBF through constriction and dilation of cerebral vessels. Traditionally CA has been assessed statistically, limited by large, immobile, and costly neuroimaging platforms. However, with recent technology advancement, dynamic autoregulation assessment is able to provide more detailed information on the evolution of CA over long periods of time with continuous assessment. Yet, to date, such continuous assessments have been hampered by low temporal and spatial resolution systems, that are typically reliant on invasive point estimations of pulsatile CBF or cerebral blood volume using commercially available technology. Methods: Using a combination of multi-channel functional near-infrared spectroscopy and non-invasive arterial blood pressure devices, we were able to create a system that visualizes CA metrics by converting them to heat maps drawn on a template of human brain. Results: The custom Python heat map module works in "offline" mode to visually portray the CA index per channel with the use of colourmap. The module was tested on two different mapping grids, 8 channel and 24 channel, using data from two separate recordings and the Python heat map module was able read the CA indices file and represent the data visually at a preselected rate of 10 s. Conclusion: The generation of the heat maps are entirely non-invasive, with high temporal and spatial resolution by leveraging the recent advances in NIRS technology along with niABP. The CA mapping system is in its initial stage and development plans are ready to transform it from "offline" to real-time heat map generation.

Modeling of a Novel AlN Nanogenerator-Based Self-Powered MEMS Arterial-Pulse Sensor

A self-powered continuous arterial-pulse monitoring system can improve the treatment quality, and hence, lengthen patient&#x2019;s life. Conventional pulse monitoring sensors have significant power consumption drawbacks that limit their continuous operation. To overcome this limitation, a lead-free, biocompatible, and high-performance aluminum-nitride (AlN) piezoelectric nanogenerator-based self-powered (energy-harvesting) MEMS sensor is proposed which is capable of continuously monitoring arterial-pulse. This article presents a comprehensive physics-based mathematical modelling and numerical simulation results that deliver optimized design parameters for a novel piezoelectric thin-film MEMS diaphragm energy-converter (transducer) for improved sensitivity and fatigue stress life-span. The sensor yields a nano-generation sensitivity of 0.13V/kPa, which is much better than recently reported nanogenerator-based arterial-pulse sensors. Most materials encounter premature failure due to fatigue when subjected to cyclic loading. Damage-accumulation and cycles to fatigue-failure were also estimated using FEM simulations. The sensor&#x2019;s viability is around <inline-formula> <tex-math notation="LaTeX">$10^{8.03}$ </tex-math></inline-formula> cycles before structural-failure for pressure amplitude-range from 10.6kPa to 16kPa (Range of arterial blood pressure).

Cerebral Blood Flow Monitoring in High-Risk Fetal and Neonatal Populations.

Cerebrovascular pressure autoregulation promotes stable cerebral blood flow (CBF) across a range of arterial blood pressures. Cerebral autoregulation (CA) is a developmental process that reaches maturity around term gestation and can be monitored prenatally with both Doppler ultrasound and magnetic resonance imaging (MRI) techniques. Postnatally, there are key advantages and limitations to assessing CA with Doppler ultrasound, MRI, and near-infrared spectroscopy. Here we review these CBF monitoring techniques as well as their application to both fetal and neonatal populations at risk of perturbations in CBF. Specifically, we discuss CBF monitoring in fetuses with intrauterine growth restriction, anemia, congenital heart disease, neonates born preterm and those with hypoxic-ischemic encephalopathy. We conclude the review with insights into the future directions in this field with an emphasis on collaborative science and precision medicine approaches.

Tracking blood pressure changes by means of non-invasive intermittent blood pressure measurements in clinical application

Abstract Considering accuracy/precision cut-offs of 5 ± 8 mmHg and cut-off values for inter-class correlation coefficients (ICC=0.37...1, from DIN EN ISO 81060-2), absolute and relative errors in time independent measurement of blood pressure changes with non-invasive intermittent devices (NiBP) are derived mathematically for mean arterial blood pressure range of 40-180 mmHg. As a clinically relevant value for change of arterial blood pressure 20% of the baseline blood pressure is considered. The mean ratio between the change of BP measured by the NiBP and measured by the invasive reference device (TE%) were proposed as quality measure for the evaluation of NiBP device tracking capability. The proposed measure TE%is theoretically independent of absolute accuracy but depends on precision and ICC of a device. NiBP devices show considerable maximum TE% of 41% in tracking mean blood pressure changes respectively. In 10% of the measurements in the low blood pressure range TE% exceeding 100%. The mean 50th/90th TE% percentile over the whole blood pressure range were 25/61%, respectively. Furthermore, TE% was relatively insensitive to assumed blood pressure range but sensitive to ICC. NiBP devices have high relative error in tracking blood pressure changes that make those devices not well-suited for tracking blood pressure changes. The proposed tracking error allows the definition of reasonable accuracy/precision requirements of NBP devices.

Influence of Impeller Speed Patterns on Hemodynamic Characteristics and Hemolysis of the Blood Pump

A continuous-flow output mode of a rotary blood pump reduces the fluctuation range of arterial blood pressure and easily causes complications. For a centrifugal rotary blood pump, sinusoidal and pulsatile speed patterns are designed using the impeller speed modulation. This study aimed to analyze the hemodynamic characteristics and hemolysis of different speed patterns of a blood pump in patients with heart failure using computational fluid dynamics (CFD) and the lumped parameter model (LPM). The results showed that the impeller with three speed patterns (including the constant speed pattern) met the normal blood demand of the human body. The pulsating flow generated by the impeller speed modulation effectively increased the maximum pulse pressure (PP) to 12.7 mm Hg, but the hemolysis index (HI) in the sinusoidal and pulsatile speed patterns was higher than that in the constant speed pattern, which was about 2.1 × 10−5. The flow path of the pulsating flow field in the spiral groove of the hydrodynamic suspension bearing was uniform, but the alternating high shear stress (0~157 Pa) was caused by the impeller speed modulation, causing blood damage. Therefore, the rational modulation of the impeller speed and the structural optimization of a blood pump are important for improving hydrodynamic characteristics and hemolysis.

Defective Choroidal Blood Flow Baroregulation and Retinal Dysfunction and Pathology Following Sympathetic Denervation of Choroid.

PurposeWe sought to determine if sympathetic denervation of choroid impairs choroidal blood flow (ChBF) regulation and harms retina.MethodsRats received bilateral superior cervical ganglionectomy (SCGx), which depleted choroid of sympathetic but not parasympathetic innervation. The flash-evoked scotopic ERG and visual acuity were measured 2 to 3 months after SCGx, and vasoconstrictive ChBF baroregulation during high systemic arterial blood pressure (ABP) induced by LNAME was assessed by laser Doppler flowmetry (LDF). Eyes were harvested for histologic evaluation.ResultsChBF increased in parallel with ABP in SCGx rats over an ABP range of 90% to 140% of baseline ABP, while in sham rats ChBF remained stable and uncorrelated with ABP. ERG a- and b-wave latencies and amplitudes, and visual acuity were significantly reduced after SCGx. In SCGx retina, Müller cell GFAP immunolabeling was upregulated 2.5-fold, and Iba1+ microglia were increased 3-fold. Dopaminergic amacrine cell fibers in inner plexiform layer were reduced in SCGx rats, and photoreceptors were slightly depleted. Functional deficits and pathology were correlated with impairments in sympathetic regulation of ChBF.ConclusionsThese studies indicate that sympathetic denervation of choroid impairs ChBF baroregulation during elevated ABP, leading to choroidal overperfusion. This defect in ChBF regulation is associated with impaired retinal function and retinal pathology. As sympathetic ChBF baroregulatory defects have been observed in young individuals with complement factor H (CFH) polymorphisms associated with risk for AMD, our results suggest these defects may harm retina, perhaps contributing to AMD pathogenesis.

Influence of body temperature in autoregulation measured by cerebral oximetry index need more research

Cerebral autoregulation (CA) is the mechanism responsible for maintaining a relatively constant cerebral blood flow (CBF) over a wide range of arterial blood pressure. CA depends on several mechanisms to maintain a suitable CBF based on cerebral metabolic demands. These mechanisms protect the brain from oligemia or hyperemia. Under specific conditions, the range of CA is severely compromised, increasing the risk of cerebral swelling (1).

Clinical Studies of Cerebral Autoregulation in Neurological Diseases

Cerebral autoregulation (CA) refers to the capability of the brain to maintain relatively constant blood flow within a certain range of arterial blood pressure or cerebral perfusion pressure. In recent years, the application of transcranial Doppler ultrasonography made it possible to detect rapid characteristics of cerebral autoregulation in response to the dynamic changes in blood pressure, which is known as dynamic cerebral autoregulation. Cerebral autoregulation assessment is an interesting tool in understanding cerebrovascular hemodynamics and now has been widely applied in neurological disorders. For cerebrovascular disease, CA is of clinical significance for it may helpful in predicting prognosis and stroke recurrence, improving blood pressure management and delineating optimal therapeutic strategy. For some other diseases that associated with stroke, such as patent foramen ovale (PFO), obstructive sleep apnea-hypopnea syndrome (OSAHS) and insomnia, which have been confirmed sharing an impaired CA, this may suggest an underlying pathogenic mechanism behind stroke. In this lecture, I will briefly introduce our clinical studies of cerebral autoregulation in various neurological diseases.

Abstract 17967: Systemic Hypertension in Children After Superior Cavo-pulmonary Shunt is Associated With Cerebrovascular Dysautoregulation

Introduction: Hypertension is frequently seen after superior cavo-pulmonary shunt. It is unknown if hypertension is necessary to maintain cerebral blood flow due to increased cerebral venous pressure. We sought to determine the range of arterial blood pressures (ABP) associated with intact and impaired autoregulation after superior cavo-pulmonary shunt. Hypothesis: Hypertension (mean ABP&gt;60 mmHg) is associated with cerebrovascular dysautoregulation after superior cavo-pulmonary shunt. Methods: All patients &lt; 12 months undergoing superior cavo-pulmonary shunt from 10/2014 were eligible. Subjects underwent continuous 100 Hz monitoring of ABP, pulmonary arterial pressure (PAP), and near-infrared spectroscopy measurements of cerebral oximetry (rSO 2 ) and cerebral blood volume (CBV). Cerebrovascular autoregulation was measured by the hemoglobin volume index (HVx). ABP and CBV were low-pass filtered as 10 sec average values. Pearson’s correlation coefficient was performed over 300 sec windows. The associations between HVx changes relative to ABP and PAP were tested using linear regression with generalized estimation of equations. Optimal ABP and PAP defined by lowest HVx was determined using a curve-fit algorithm. The relationship between PAP and ABP was tested by piecewise regression. Results: Ten patients were enrolled. Median age and weight were 6.5 months and 6.2 kg. Optimal ABP and PAP were obtained in 7/10. HVx became impaired with increased ABP (top panel) and increased PAP (middle panel), indicating worse cerebrovascular dysautoregulation. PAP increased with increasing ABP (r = 0.55, p&lt;0.0001) with an intercept of 72 mmHg above which ΔPAP/ΔABP doubled from 0.23 [0.22- 0.24] to 0.46 [0.43 - 0.49] (bottom panel). Elevations of ABP above optimal for HVx did not improve rSO2 (p&gt;0.05). Conclusion: Hypertension after superior cavo-pulmonary shunt is associated with elevated PAP, no improvement in rSO 2 , and cerebrovascular dysautoregulation.

What is the definition of intraoperative hypotension in dogs? Results from a survey of diplomates of the ACVAA and ECVAA

ObjectiveDetermine arterial blood pressure range that diplomates of the American College of Veterinary Anesthesia and Analgesia (ACVAA) and European College of Veterinary Anaesthesia and Analgesia (ECVAA) use to define intraoperative hypotension in dogs and identify the threshold values used for intervention. Study designSurvey of veterinary anesthesia specialists. PopulationDiplomates of the ACVAA and ECVAA. MethodsACVAA and ECVAA diplomates (n=313) were invited to participate in an Internet-based survey regarding anesthetized healthy dogs undergoing two types of procedures (diagnostic or surgical). ResultsThere were 151 respondents to the survey; 70.2% were ACVAA diplomates and 29.8% were ECVAA diplomates. The majority of the respondents (70.9%) worked in academia while the others were in private practice (19.2%), or research, diagnostic or pharmaceutical fields (9.9%). Hypotension was defined (mean ± SD) by the respondents as systolic arterial blood pressure (SAP) <87 ± 8 mmHg for surgical cases and <87 ± 6 mmHg for diagnostic cases, or mean arterial pressure (MAP) <62 ± 4 mmHg for both types of cases. Arterial pressures reported to prompt treatment were SAP 85 ± 13 mmHg or MAP 61 ± 4 mmHg in surgical cases, and SAP 84 ± 11 mmHg or MAP 63 ± 8 mmHg in diagnostic cases. Conclusions and clinical relevanceThere was agreement between ACVAA and ECVAA diplomates on the definition of intraoperative hypotension in dogs during anesthesia. The blood pressures used to define hypotension were similar to the pressures that would prompt diplomates to start treatment. Readers could infer that diplomates define hypotension as a clinical condition that requires treatment at the time of diagnosis.

Increases in Electroencephalogram and Electromyogram Variability Are Associated with an Increased Incidence of Intraoperative Somatic Response

sBIS, the variability of the Bispectral Index (BIS), sEMG, the variability of facial electromyogram power (EMG), and the Composite Variability Index (CVI) are 3 new measures of electroencephalogram and EMG variability. CVI is a single measure of the combined variability in BIS and EMG. We investigated whether increases in these variables are associated with intraoperative somatic responses. This multicenter study included 120 patients undergoing elective, noncardiac surgery from 4 different sites. General anesthesia was maintained using propofol and remifentanil at 2 of the sites and sevoflurane and remifentanil at the 2 other sites. Propofol or sevoflurane was adjusted to maintain BIS between 45 and 60. Clinicians were blinded to CVI (v2.0) at all times, and remifentanil infusions were adjusted at the discretion of the clinician. The times of all intraoperative somatic events, defined as movement, grimacing, or eye opening, were recorded. Offline, the maintenance phase of each case was divided into consecutive, nonoverlapping, 10-minute segments. Segments were identified as containing a somatic event or containing no events. For each segment, mean sBIS, sEMG, and CVI and the heart rate (HR) range and mean arterial blood pressure range were calculated. To quantify how effectively each variable discriminated between somatic event segments and nonevent segments, we computed the area under the receiver operating characteristic (ROC) curve for each variable. Finally, we observed the time course of sBIS, sEMG, CVI, and the HR range before each somatic event and characterized the earliest time before the somatic event at which each variable was able to discriminate between the somatic events and a specified set of nonevents. The analysis included 33 somatic event segments and 829 nonevent segments from 105 surgical cases. The areas under the ROC curve (±SE) for sBIS, sEMG, and CVI were 0.83 ± 0.04, 0.92 ± 0.02, and 0.89 ± 0.03, respectively. The areas under the ROC curve for HR range and mean arterial blood pressure range were 0.77 ± 0.03 and 0.68 ± 0.05, respectively. CVI, sBIS, and sEMG all demonstrated higher average values before upcoming somatic events when compared with nonevents. HR range only showed a difference within a few seconds before the somatic event. sBIS, sEMG, and CVI, measures of electroencephalogram and EMG variability, increased when intraoperative somatic events occurred. sBIS, sEMG, and CVI discriminated between 10-minute segments that contained a somatic event and those segments that did not contain an event better than changes in HR and mean arterial blood pressure. Furthermore, CVI increases before somatic events began earlier than HR changes and may provide caregivers with an early warning of potentially inadequate antinociception.

Comparison of an implantable telemetry device and an oscillometric monitor for measurement of blood pressure in anaesthetized and unrestrained green iguanas (Iguana iguana)

ObjectiveThe objective of this study was to compare an implanted direct blood pressure monitor and a non‐invasive oscillometric unit for use in anesthetized and awake green iguanas. Study designProspective experimental trial. AnimalsFour male and four female adult green iguanas (Iguana iguana) weighing 1833 ± 534 g. MethodsFor each animal, the carotid artery was surgically exposed and the catheter tip of the pressure transducer was placed in the aortic arch. Non‐invasive blood pressure was measured using a cuff over the left femoral region. Pulse rate, respiratory rate and arterial blood pressure (ABP) measurements were taken every 5 minutes. Direct ABP measurements consisted of recording numerical values and graphic output. Simultaneous direct and indirect measurements were repeated in awake animals. ResultsThe oscillometric device failed to provide a reading in over 80% of attempts, and failed to provide readings that correlated with direct measurements. The implanted direct transducer was capable of detecting blood pressures throughout all ABP ranges examined. ConclusionsThe implantable transducer was a reliable means of determining blood pressure in this study, while the oscillometric device was unreliable and often failed to provide any reading. Clinical relevanceWe do not recommend using the oscillometric device as described in a research or clinical setting for green iguanas. The advantages of an implantable device include the ability to monitor awake and anesthetized subjects remotely and continuously. These monitors are small, biocompatible and function across a wide range of ABP.

Choroidal blood flow compensation in rats for arterial blood pressure decreases is neuronal nitric oxide-dependent but compensation for arterial blood pressure increases is not

Choroidal blood flow (ChBF) compensates for changes in arterial blood pressure (ABP) and thereby remains relatively stable within a ±40 mmHg range of basal ABP in rabbits, humans and pigeons. In the present study, we investigated if ChBF can compensate for increases and decreases in ABP in rats. ChBF was continuously monitored using laser Doppler flowmetry in anesthetized rats, and ABP measured via the femoral artery. At multiple intervals over a 2–4 h period during which ABP varied freely, ChBF and ABP were sampled and the results compiled across rats. We found that ChBF remained near baseline over an ABP range from 40 mmHg above basal ABP (90–100 mmHg) to 40 mmHg below basal ABP, but largely followed ABP linearly below 60 mmHg. Choroidal vascular resistance increased linearly as BP increased above 100 mmHg, and decreased linearly as BP declined from basal to 60 mmHg, but resistance declined no further below 60 mmHg. Inhibition of nitric oxide (NO) formation by either a selective inhibitor of neuronal nitric oxide synthase (NOS) (N ω-propyl- l-arginine) or a nonselective inhibitor of both neuronal NOS and endothelial NOS (N ω-nitro- l-arginine methyl ester) did not affect compensation above 100 mmHg ABP, but did cause ChBF to linearly follow declines in BP below 90 mmHg. In NOS-inhibited rats, vascular resistance increased linearly with BP above 100 mmHg, but remained at baseline below 90 mmHg. These findings reveal that ChBF in rats, as in rabbits, humans and pigeons, compensates for rises and/or declines in arterial blood pressure so as to remain relatively stable within a physiological range of ABPs. The ChBF compensation for low ABP in rats is dependent on choroidal vasodilation caused by neuronal NO formation but not the compensation for elevated BP, implicating parasympathetic nervous system vasodilation in the ChBF compensation to low ABP.

Rapid and local autoregulation of cerebrovascular blood flow: a deep‐brain imaging study in the mouse

The brain obtains energy by keeping the cerebral blood flow constant against unexpected changes in systemic blood pressure. Although this homeostatic mechanism is widely known as cerebrovascular autoregulation, it is not understood how widely and how robustly it works in the brain. Using a needle-like objective lens designed for deep-tissue imaging, we quantified the degree of autoregulation in the mouse hippocampus with single-capillary resolution. On average, hippocampal blood flow exhibited autoregulation over a comparatively broad range of arterial blood pressure and did not significantly respond to pressure changes induced by the pharmacological activation of autonomic nervous system receptors, whereas peripheral tissues showed linear blood flow changes. At the level of individual capillaries, however, about 40% of hippocampal capillaries did not undergo rapid autoregulation. This heterogeneity suggests the presence of a local baroreflex system to implement cerebral autoregulation.

Sevoflurane Impairs Cerebral Blood Flow Autoregulation in Rats: Reversal by Nonselective Nitric Oxide Synthase Inhibition

In this study, we investigated the effects of 1.0 and 2.0 minimum alveolar anesthetic concentration (MAC) sevoflurane on cerebral blood flow (CBF) autoregulation before and after nonselective inhibition of nitric oxide (NO) synthase in rats. Rats were randomly assigned as follows: Group 1 (n = 8): 1.0 MAC sevoflurane; Groups 2 and 3 (n = 8 per group): 2.0 MAC sevoflurane. Assessment of autoregulation within a mean arterial blood pressure range of 140-60 mm Hg was performed by graded hemorrhage before and after administration of l-arginine methyl ester (l-NAME, 30 mg/kg IV, Groups 1 and 2) or during hypocapnia (Group 3). In 10 additional animals, brain tissue NO(2)(-) concentrations were measured at 1.0 and 2.0 MAC sevoflurane. CBF autoregulation was maintained with 1.0 MAC sevoflurane (Group 1) regardless of NO synthase status indicating that CBF autoregulation might not be related to NO availability. Sevoflurane dose-dependently increased brain tissue NO(2)(-) and impaired CBF autoregulation. Administration of l-NAME (Group 2) but not hypocapnia (Group 3) restored CBF autoregulation. This suggests that sevoflurane impairs the autoregulatory capacity secondary to an increase of the perivascular NO availability and questions the importance of basal cerebrovascular tone in terms of vasodilatory capacity during hypotensive challenges. The present study suggests that the volatile anesthetic sevoflurane dose-dependently impairs cerebrovascular autoregulation by mechanisms secondary to increase of perivascular nitric oxide availability.

Choroidal blood flow in pigeons compensates for decreases in arterial blood pressure

While it had once been thought that choroidal blood flow (ChBF) does not compensate for changes in perfusion pressure, recent studies have shown that ChBF in rabbits and humans does compensate for changes in arterial blood pressure (ABP) and thereby remains relatively stable within a physiological range of ABPs. In this study, we sought to determine if ChBF in birds can compensate for decreases in ABP, either spontaneously occuring or caused by blood withdrawal. ChBF was continuously monitored using laser Doppler flowmetry in anesthetized pigeons, and at the same time ABP was measured via the brachial artery. In studies of spontaneous fluctuation in ABP, ChBF and ABP were analyzed at regular intervals over a 2–3 hr period, while for blood withdrawal studies, blood was transiently withdrawn via the brachial artery. In both paradigms, ChBF remained near baseline over an ABP range from basal (about 90 mmHg) to about 55 mmHg, followed ABP nearly linearly below 50 mmHg, and showed no compensation below 40 mmHg. The blood withdrawal studies further showed that the compensation was more rapid with small acute declines in ABP than with larger declines. These findings reveal that ChBF in pigeons, as in rabbits and humans, compensates for declines in ABP so as to remain relatively stable within a physiological range of ABPs. Given the phylogenetic distance between humans and rabbits on one hand and birds on the other, these results suggest that choroidal compensation for ABP declines may be a common ocular mechanism among warm-blooded vertebrates.

Cerebral blood flow velocity response to induced and spontaneous sudden changes in arterial blood pressure

The influence of different types of maneuvers that can induce sudden changes of arterial blood pressure (ABP) on the cerebral blood flow velocity (CBFV) response was studied in 56 normal subjects (mean age 62 yr, range 23-80). ABP was recorded in the finger with a Finapres device, and bilateral recordings of CBFV were performed with Doppler ultrasound of the middle cerebral arteries. Recordings were performed at rest (baseline) and during the thigh cuff test, lower body negative pressure, cold pressor test, hand grip, and Valsalva maneuver. From baseline recordings, positive and negative spontaneous transients were also selected. Stability of PCO2 was monitored with transcutaneous measurements. Dynamic autoregulatory index (ARI), impulse, and step responses were obtained for 1-min segments of data for the eight conditions by fitting a mathematical model to the ABP-CBFV baseline and transient data (Aaslid's model) and by the Wiener-Laguerre moving-average method. Impulse responses were similar for the right- and left-side recordings, and their temporal pattern was not influenced by type of maneuver. Step responses showed a sudden rise at time 0 and then started to fall back to their original level, indicating an active autoregulation. ARI was also independent of the type of maneuver, giving an overall mean of 4.7 +/- 2.9 (n = 602 recordings). Amplitudes of the impulse and step responses, however, were significantly influenced by type of maneuver and were highly correlated with the resistance-area product before the sudden change in ABP (r = -0.93, P < 0.0004). These results suggest that amplitude of the CBFV step response is sensitive to the point of operation of the instantaneous ABP-CBFV relationship, which can be shifted by different maneuvers. Various degrees of sympathetic nervous system activation resulting from different ABP-stimulating maneuvers were not reflected by CBFV dynamic autoregulatory responses within the physiological range of ABP.

Single-unit sympathetic discharge : quantitative assessment in human hypertensive disease.

Background-Reports demonstrating sympathetic hyperactivity in hypertension with the use of microneurography have been inconsistent. One possible reason is that previous studies have assessed muscle sympathetic nerve activity (MSNA) from integrated voltage waves ("bursts") recorded from multiunit discharges. We studied single units with defined vasoconstrictor properties (s-MSNA) to further characterize sympathetic output in hypertensive disease. Methods and Results-We examined 74 subjects with a wide range of arterial blood pressure that were considered to be either normal (NT), high normal (HN), or stages 1 to 3 essential hypertension (EHT-1, EHT-2/3). All had their peripheral sympathetic activity measured from both multiunit bursts and single-unit vasoconstrictor impulses. There was a significant correlation between s-MSNA and MSNA, and results of variability studies were similar. The EHT-1 and EHT-2/3 groups had greater s-MSNA and MSNA than did the matched NT group (always P<0. 01). The HN group also had greater s-MSNA and MSNA than did the NT group (mean+/-SEM; 43+/-5 vs 29+/-2 impulses/100 beats, P<0.05; 36+/-4 vs 24+/-2 bursts/100 beats, P<0.05). In addition, the EHT-1 group had significantly greater s-MSNA than did the EHT-2/3 group (63+/-6 vs 51+/-3 impulses/100 beats, P<0.05), which could not be demonstrated with MSNA bursts. Conclusions-Quantification from single vasoconstrictor units has provided additional evidence in established essential hypertension of increased central sympathetic output. Furthermore, in the mild or early stages of hypertension, this technique has provided new evidence of augmented sympathetic output compared with more severe hypertension.

Role of KATP channels on modulating diaphragmatic microvascular flow during hemorrhagic hypotension.

The effects of glibenclamide (GLB), a specific blocker of ATP-sensitive potassium (KATP) channels, and tetraethylammonium (TEA) on modulating the regulation of diaphragmatic microcirculation were assessed in anesthetized mechanically ventilated rats. With bicarbonate-buffered Ringer solution continuously suffusing the left hemidiaphragm, microcirculatory blood flow was recorded by laser-Doppler flowmetry (QLDF). Hemorrhagic hypotension (HH) was induced via bleeding into a pressure reservoir. Five sets of experiments were performed. In set 1 (n = 6), the vasodilator effect of diazoxide (3 x 10(-4) M) was abolished after a 30-min suffusion with GLB, whereas the vasodilator effect of sodium nitroprusside (3 x 10(-6) M) remained the same. In set 2 (vehicle + HH; n = 23), a stepwise reduction in systemic arterial blood pressure (ABP) induced two distinct patterns of microvascular responses. Regulation of QLDF could be observed in pattern A animals in a range of ABP from 113 to 52 mmHg, whereas QLDF in pattern B animals rose progressively with declining ABP. In set 3 (GLB + HH; n = 17), baseline values of QLDF were not significantly affected after a 30-min suffusion of GLB (10(-5) M). During HH, two microvascular patterns similar to those in set 2 were observed. GLB significantly potentiated the reduction in QLDF in pattern A animals. In contrast, GLB had no effect on QLDF in pattern B animals. In set 4 (TEA + HH; n = 17), similar microvascular responses, compared with the vehicle group, were observed during HH after a 30-min suffusion of TEA (2 x 10(-3) M). In set 5 (n = 5), baseline values of QLDF were not significantly altered during sham hypotension. We conclude that 1) KATP channels are functional but not active in the resting diaphragmatic microcirculation and 2) KATP channels can modulate regulation of the microcirculation in the resting diaphragm during HH.