Does sympathetic activation blunt nitric oxide-mediated hyperemia in the human forearm?

To determine if the vasodilating substance nitric oxide (NO) interferes with the ability of sympathetic nerves to regulate blood flow in humans, forearm blood flow (FBF) was measured during brachial artery infusions of acetylcholine (ACh) to evoke endothelial NO release, and during infusions of the NO donor nitroprusside (NTP) in five healthy volunteers. Sympathetic activity was increased by application of lower body suction and antagonized by brachial artery infusions of phentolamine. In the control condition, FBF was 2.4 ± 0.4 ml/100 ml per min and rose by 16.9 ± 3.6 ml/100 ml per min during ACh at 16 μg/min and by 17.0 ± 4.3 ml/100 ml per min at 64 μg/min. With suction, FBF was 1.7 ± 0.6 ml/100 ml per min (p < 0.05 versus control) and rose by 11.4 ± 3.2 ml/100 ml per min during ACh at 16 μg/min (p < 0.05 versus control). After phentolamine, FBF was 3.8 ± 0.5 ml/100 ml per min at baseline (p < 0.05 versus control) and the increases in flow with ACh at either 16 or 64 μg/min were identical to control. During the control NTP trial, FBF rose by 6.3 ± 1.1 ml/100 ml per min with NTP at 2.5 μg/min and by 12.1 ± 1.4 ml/100 ml per min at 10 μg/min. Suction blunted and phentolamine augmented the increases in flow with NTP by ~50% (p < 0.05). Due to the unexpected results with ACh, the effects of suction and pharmacological sympathectomy with both phentolamine and bretylium on ACh-mediated dilation were evaluated with lower doses of ACh (8 and 32 μg/min) in six additional studies. Again, altered sympathetic activity had inconsistent effects on the rise in FBF with ACh administration. The effects of altered sympathetic activity on the blood flow responses to NTP indicate that sympathetic activity can modulate NO-mediated vasodilation, suggesting that NO does not have a major sympatholytic effect in the human forearm. That sympathetic activity did not consistently alter ACh-mediated vasodilation suggests that vasodilating mechanisms, in addition to NO release, can be activated by arterial administration of ACh in the human forearm.