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1 Departments of Physiology and
Medicine, Medical College of Virginia at Virginia Commonwealth
University, and Hunter Holmes McGuire Department of Veteran Affairs
Medical Center, Richmond, Virginia 23249;
2 Department of Cardiology and
Cardiovascular Sciences, Fundación Cardiovascular del Oriente
Columbiano, AA 1143 Bucaramanga, Santander, Columbia;
3 Department of Anesthesia, Mayo
Clinic and Foundation, Rochester, Minnesota 55905;
4 Department of Clinical
Physiology,
We evaluated a method of baroreflex testing
involving sequential intravenous bolus injections of nitroprusside
followed by phenylephrine and phenylephrine followed by nitroprusside
in 18 healthy men and women, and we drew inferences regarding human sympathetic and vagal baroreflex mechanisms. We recorded
the electrocardiogram, photoplethysmographic finger arterial pressure,
and peroneal nerve muscle sympathetic activity. We then contrasted
least squares linear regression slopes derived from the depressor
(nitroprusside) and pressor (phenylephrine) phases with
1) slopes derived from spontaneous
fluctuations of systolic arterial pressures and R-R intervals, and
2) baroreflex gain derived from
cross-spectral analyses of systolic pressures and R-R
intervals. We calculated sympathetic baroreflex gain from
integrated muscle sympathetic nerve activity and diastolic pressures.
We found that vagal baroreflex slopes are less when arterial pressures
are falling than when they are rising and that this hysteresis exists
over pressure ranges both below and above baseline levels. Although
pharmacological and spontaneous vagal baroreflex responses correlate
closely, pharmacological baroreflex slopes tend to be lower than those derived from spontaneous fluctuations. Sympathetic baroreflex slopes
are similar when arterial pressure is falling and rising; however,
small pressure elevations above baseline silence sympathetic motoneurons. Vagal, but not sympathetic baroreflex gains vary inversely
with subjects' ages and their baseline arterial pressures. There is no
correlation between sympathetic and vagal baroreflex gains. We
recommend repeated sequential nitroprusside followed by phenylephrine
doses as a simple, efficientmeans to provoke and characterize human
vagal and sympathetic baroreflex responses.
baroreflex gain; hysteresis; muscle sympathetic nerve activity; aging
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