From the Autonomic Disorders Center, Department of Neurology, Mayo Clinic
and Foundation, Rochester, Minn.
Correspondence to Phillip A. Low, MD, Autonomic Disorders Center, Department of Neurology, Mayo Clinic and Foundation, 200 First St SW, Rochester, MN 55905. E-mail low.phillip{at}mayo.edu
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 flat 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
Conclusions—The most common patterns of cerebral response to OH
are autoregulatory failure with a flat 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.
© 1998 American Heart Association, Inc.
Original Contributions
Autoregulation of Cerebral Blood Flow in Orthostatic Hypotension
BP <40 mm Hg;
R2>.75).
Key Words: autoregulation • cerebral blood flow • hypotension, orthostatic • ultrasonics
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