Autoregulation of cerebral blood flow in orthostatic hypotension

Vera Novak, Peter Novak, Judith M. Spies, Phillip A. Low

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Abstract

Background and Purpose - We sought to evaluate cerebral autoregulation in patients with orthostatic hypotension (OH). Methods - We studied 21 patients (aged 52 to 78 years) with neurogenic OH during 80°head-up tilt. Blood flow velocities (BFV) from the middle cerebral artery were continuously monitored with transcranial Doppler sonography, as were heart rate, blood pressure (BP), cardiac output, stroke volume, CO2, total peripheral resistance, and cerebrovascular resistance. Results - All OH patients had lower BP (P<.0001), BFV diastolic (P<.05), CVR (P<.007), and TPR (P<.02) during head-up tilt than control subjects. In control subjects, no correlations between BFV and BP were found during head-up tilt, suggesting normal autoregulation. OH patients could be separated into those with normal or expanded autoregulation (OH NA; n=16) and those with autoregulatory failure (OH AF; n=5). The OH NA group showed either no correlation between BFV and BP (n=8) or had a positive BFV/BP correlation (R2>.75) but with a fiat slope. An expansion of the 'autoregulated' range was seen in some patients. The OH AF group was characterized by a profound fall in BFV in response to a small reduction in BP (mean ABP <40 mm Hg; R2>.75). Conclusions - The most common patterns of cerebral response to OH are autoregulatory failure with a fiat flow-pressure relationship or intact autoregulation with an expanded autoregulated range. The least common pattern is autoregulatory failure with a steep flow-pressure relationship. Patients with patterns 1 and 2 have an enhanced capacity to cope with OH, while those with pattern 3 have reduced capacity.

Original languageEnglish (US)
Pages (from-to)104-111
Number of pages8
JournalStroke
Volume29
Issue number1
DOIs
StatePublished - Jan 1998

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Keywords

  • Autoregulation
  • Cerebral blood flow
  • Hypotension
  • Orthostatic
  • Ultrasonics

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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