The reciprocal relationship between cardiac baroreceptor sensitivity and cerebral autoregulation during simulated hemorrhage in humans

Abstract

A reciprocal relationship between the baroreflex and cerebral autoregulation (CA) has been demonstrated at rest and in response to acute hypotension. We hypothesized that the reciprocal relationship between cardiac baroreflex sensitivity (BRS) and CA would be maintained during sustained central hypovolemia induced by lower body negative pressure (LBNP), and that the strength of this relationship would be greater in subjects with higher tolerance to this stress. Healthy young adults (n = 51; 23F/28M) completed a LBNP protocol to presyncope. Subjects were classified as high tolerant (HT; completion of -60 mmHg LBNP stage, ≥20-min) or low tolerant (LT; did not complete -60 mmHg LBNP stage, <20-min). R-R intervals (RRI), systolic arterial pressure (SAP), mean arterial pressure (MAP), and middle cerebral artery velocity (MCAv) were measured continuously. Cardiac BRS was calculated in the time domain (ΔHR/ΔSAP) and frequency domain (RRI-SAP low frequency (LF) transfer function gain), and CA was calculated in the time domain (ΔMCAv/ΔMAP) and frequency domain (MAP-mean MCAv LF transfer function gain). There was a moderate relationship between cardiac BRS and CA for the group of 51 subjects in both the time (R = -0.54, P < 0.0001) and frequency (R = 0.61, P < 0.001) domains; there was a stronger relationship in the HT group (R = 0.73) compared to the LT group (R = 0.31) in the frequency domain (P = 0.08), but no difference between groups in the time domain (HT: R = -0.73 vs. LT: R = -0.63; P = 0.27). These findings suggest that an interaction between BRS and CA may be an important compensatory mechanism that contributes to tolerance to simulated hemorrhage in young healthy adults.

Keywords: Cardiac baroreceptor sensitivity; Cerebral autoregulation; Cerebral blood velocity; Lower body negative pressure.

Fig. 1.

By design, tolerance to LBNP was higher in the high tolerant (HT) vs. low tolerant (LT) group (Panel A). HT subjects demonstrated a greater ΔSV (Panel B) and a greater ΔHR (Panel C) in response to maximal LBNP compared with LT subjects. There were no differences in ΔSAP (Panel D), ΔMAP (Panel E), or ΔMCAv (Panel F) between groups. Comparsions between HT and LT groups were made using unpaired t-tests. Exact P values are reported for all comparisons.

Fig. 2.

There is a moderate reciprocal relationship between baroreflex sensitivity (BRS) and cerebral autoregulation (CA) in the group of 51 subjects in both the time and frequency domain (Panels A and D). This relationship was stronger in the high tolerant (HT) group (Panels B and C) compared to low tolerant (LT) group (Panels E and F) in both the time and frequency domain. The relationships between BRS and CA were assessed with Pearson’s correlation coefficients for the entire group of 51 subjects, and within the HT and LT sub-groups. Exact P values are reported.