Circulation, Vol 89, 169-179, Copyright © 1994 by American Heart Association
JK Triedman and JP Saul
BACKGROUND: Despite constant fluctuations in cardiac preload caused by the
effects of respiration and changes in posture on venous return to the
heart, arterial blood pressure remains remarkably constant. The effects of
instantaneous lung volume (ILV) and variations of central venous pressure
(CVP) on blood pressure (BP) were studied by use of frequency domain
techniques to quantify the contribution of heart rate (HR) reflexes to
attenuation of the effects of changes in right ventricular preload on
arterial pressure. METHODS AND RESULTS: Random independent variation of
ILV, then CVP (obtained using lower-body negative pressure), was performed
in eight humans in the supine position. HR, ILV, CVP, and systolic (SBP)
and diastolic (DBP) BPs were recorded during control periods and after
complete blockade obtained by use of 0.04 mg/kg atropine and 0.2 mg/kg
propranolol. A frequency- domain analysis was performed on pairwise
relations by the cross- spectral technique. During autonomic blockade,
fluctuations in CVP were induced up to 0.14 Hz but caused corresponding
changes in arterial pressure only up to 0.08 Hz (P < .02), indicating a
mechanical damping effect of the heart and pulmonary vasculature.
Fluctuations of BP were also delayed from CVP by 1.55 to 2.10 seconds. At
frequencies < 0.1 Hz, relations of CVP to all indices of BP increased
with blockade (CVP-SBP, 0.9 +/- 0.5 versus 2.7 +/- 0.8 mm Hg/mm Hg, P <
.01; CVP-DBP, 1.3 +/- 0.4 versus 4.3 +/- 1.4 mm Hg/mm Hg, P < .01;
CVP-pulse pressure [PP], 1.0 +/- 0.3 versus 1.9 +/- 0.8 mm Hg/mm Hg, P <
.05). Higher-frequency fluctuations of arterial BP were a relatively pure
manifestation of respiratory activity. At frequencies from 0.15 to 0.35 Hz,
the relation of ILV to SBP was unchanged with blockade, whereas relations
of ILV to DBP and PP decreased (ILV-DBP, 6.1 +/- 3.5 versus 3.3 +/- 2.2 mm
Hg/L, P < .02; ILV-PP, 7.0 +/- 4.3 versus 2.7 +/- 2.2 mm Hg/L, P <
.01). An associated change in phase of these relations suggested that
neurally mediated changes in HR may offset mechanical effects caused by
respiration. CONCLUSIONS: Both slow changes of BP (< 0.08 Hz) induced by
variations of CVP and more rapid changes induced by ILV are actively
buffered by heart rate reflexes. During blockade, the mechanical properties
of interposed cardiopulmonary structures limit CVP-induced fluctuations of
BP. These findings have implications for BP regulation in pathological
conditions associated with impairment of HR control.
ARTICLES
Blood pressure modulation by central venous pressure and respiration. Buffering effects of the heart rate reflexes
Department of Cardiology, Children's Hospital, Boston, Mass. 02115.
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