Abstract
The relationship between sympathetic nervous system activity and cardiovascular responses to head-up tilt in patients with spinal cord injuries and in able-bodied subjects was studied. Twenty-seven adults, nine in each of the three groups (tetraplegia, paraplegia, and able-bodied subjects) were tilted 70°, head up, for 12 minutes after 20 minutes supine rest. Differences between steady-state measurements of mean arterial pressure, stroke volume, and sympathetic nervous system activity were estimated in both positions. Sympathetic nervous system activity was reflected by the low-frequency peak of the blood pressure variability spectrum. From supine rest to head-up tilt, low-frequency power increased in able-bodies subjects (median, 0.42 mm Hg2, p=0.003), which was different (p=0.015) from patients with tetraplegia and paraplegia (−0.15 and −0.10 mm Hg2, respectively). Stroke volume and mean arterial pressure decreased in patients with tetraplegia (−40% and −9 mm Hg, respectively; p=0.008, both variables) more than in ablebodied subjects (−33%, 11 mm Hg, respectively) or patients with paraplegia (−24%, 8 mm Hg, respectively). Results indicated increased sympathetic nervous system activity during head-up tilt in able-bodied subjects, but not in patients with paraplegia or tetraplegia, whereas patients with tetraplegia, but not paraplegia, showed poorer cardiovascular homeostasis than able-bodied subjects. This suggests that patients with paraplegia maintained cardiovascular homeostasis during head-up tilt without increased sympathetic nervous system activity.
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Corbett JL, Frankell HL, Harris PJ. Cardiovascular responses to tilting in tetraplegic man.J Physiol Lond 1971; 215:411–431.
Figoni SF. Cardiovascular and haemodynamic responses to tilting and to standing in tetraplegic patients: a review.Paraplegia 1984; 22:99–109.
Grimm DR, DeMeersman RE, Almenoff PL, Spungen AM, Bauman WA. Sympathovagal balance of the heart in subjects with spinal cord injury.Am J Physiol 1997; 272:H835-H842.
Shoenfeld Y, Shapiro Y, Ohry A, Levy Y, Udassin R, Drory Y, et al. Orthostatic hypotension in amputees and subjects with spinal cord injuries.Arch Phys Med Rehabil 1978; 59:138–141.
Corbett JL, Debarge, O, Frankel HL, Mathias C. Cardiovascular responses in tetraplegic man to muscle spasm, bladder percussion and head-up tilt.Clin Exp Pharmacol Physiol 1975; (suppl 2):189–193.
Pagani M, Lombardi F, Guzzetti S, Rimoldi O, Furlan R, Pizzinelli P, et al. Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympatho-vagal interaction in man and conscious dog.Circ Res 1986; 59:178–193.
de Boer RW, Karemaker JM, Strackee J. Hemodynamic fluctuations and baroreflex sensitivity in humans: a beat-to-beat model.Am J Physiol 1987; 253:H680-H689.
Malliani A, Pagani M, Lombardi F, Cerutti S. Cardiovascular neural regulation explored in the frequency domain.Circulation 1991; 84:482–492.
Bootsma M, Swenne CA, van Bolhuis HH, Chang PC, Cats VM, Bruschke AVG. Heart rate and heart rate variability as indexes of sympathovagal balance.Am J Physiol 1994; 266:H1565-H1571.
Yamamoto Y, Hughson RL. Coarse graining spectral analysis: new method for studying heart rate variability.J Appl Physiol 1991; 71:1143–1150.
Guzzetti S, Cogliati C, Broggi C, Carozzi C, Caldiroli D, Lombardi F, et al. Influences of neural mechanisms on heart period and arterial pressure variabilities in quadriplegic patients.Am J Physiol 1994; 266:1112–1120.
Inoue K, Miyake S, Kumashiro M, Ogata H, Ueta T, Akatsu T. Power spectral analysis of blood pressure variability in traumatic quadriplegic humans.Am J Physiol 1991; 260:H842-H847.
Inoue K, Ogata H, Hayano J, Miyake S, Kamada T, Kuno M, et al. Assessment of autonomic function in traumatic quadriplegic and paraplegic patients by spectral analysis of heart rate variability.J Auton Nerv Syst 1995; 54:225–234.
Bunten DC, Warner AL, Brunneman SR, Segal JL. Heart rate variability is altered following spinal cord injury.Clin Auton Res 1998; 8:329–334.
Imholz BPM, Langewouters GJ, van Montfrans GA, Parati G, van Goudoever J, Wesseling KH, et al. Feasibility of ambulatory, continuous 24-hour finger arterial pressure recording.Hypertension 1993; 21:65–73.
Imholz BPM, Settels JJ, van der Meiracker AH, Wesseling KH, Wieling W. Non-invasive continuous flow blood pressure measurement during orthostatic stress compared to intra-arterial pressure.Cardiovasc Res 1990: 24:214–221.
Rongen GA, Bos WJW, Lenders JWM, van Montfrans GA, van Lier HJJ, van Goudoever J, et al. Comparison of intrabrachial and finger blood pressure in healthy elderly volunteers.Am J Hypertens 1995; 8:237–248.
Hughson RL, Maillet A, Dureau G, Yamamoto Y, Gharib C. Spectral analysis of blood pressure variability in heart transplant patients.Hypertension 1995; 25(part 1):643–650.
Grimm DR, DeMeersman RE, Garofano RP, Spungen AM, Bauman WA. Effect of provocative maneuvers on heart rate variability in subjects with quadriplegia.Am J Physiol 1995; 268: H2239-H2245.
Pomeranz B, Macauly RJB, Caudil MA, Kutz I, Adam D, Gordon D, et al. Assessment of autonomic function in humans by heart rate spectral analysis.Am J Physiol 1985; 248:H151-H153.
Grasso R, Schena F, Gulli G, Cevese A. Does low-frequency variability of heart period reflect a specific parasympathetic mechanism?J Auton Nerv Syst 1997; 60:30–38.
Eckberg DL. Sympathovagal balance: a critical appraisal.Circulation 1997; 96:3224–3232.
Stok WJ, Baisch F, Hillebrecht A, Schilz H, Meyer M, Karemaker JM. Non-invasive cardiac output measurement by arterial pulse analysis compared with inert gas rebreathing.J Appl Physiol 1993; 74:2687–2693.
Wessling KH, Jansen JRC, Settels JJ, Schreuder JJ. Computation of aortic flow from pressure in humans using a nonlinear, threeelement model.J Appl Physiol 1993; 74:2566–2573.
Mathias CJ, Frankel HL. Cardiovascular control in spinal man.Annu Rev Physiol 1988; 50:577–592.
Wieling, W, Karemaker JM. Measurement of heart rate and blood pressure to evaluate disturbances in neurovascular control. In: Mathias CJ, Bannister R, eds.Autonomic failure: textbook of clinical disorders of the autonomic nervous system, 4th ed. Oxford: Oxford University Press; 1999. pp. 196–210.
Koh J, Brown TE, Beightol LA, Ha CH, Eckberg DL. Human autonomic rhythms: vagal cardiac mechanisms in tetraplegic subjects.J Physiol 1994; 474:483–495.
Hopman MTE, Nommensen E, van Asten WNJM, Oeseburg B, Binkhorst RA. Properties of the venous vascular system in the lower extremities of individuals with paraplegia.Paraplegia 1994; 32:810–816.
Andersen EB, Boesen F, Henriksen O, Sonne M. Blood flow in skeletal muscle of tetraplegic man during postural changes.Clin Sci 1986; 70:321–325.
Henriksen O. Sympathetic reflex control of blood flow in human peripheral tissues.Acta Physiol Scand 1991; 603(suppl):33–39.
Johnson RH, Park DM, Frankel HL. Orthostatic hypotension and the renin-angiotensin system in paraplegia.Paraplegia 1971; 9:146–152.
Mathias CJ, Christensen NJ, Corbett JL, Frankel HL Goodwin TJ, Peart WS. Plasma catecholamines, plasma renin activity and plasma aldosterone in tetraplegic man, horizontal and tilted.Clin Sci Mol Med 1975; 49:291–299.
Mathias CJ, Christensen NJ, Frankel HL, Peart WS. Renin release during head-up tilt occurs independently of sympathetic nervous activity in tetraplegic man.Clin Sci 1980; 59:251–256.
Koepchen HP. History of studies and concepts of blood pressure waves. In: Miyakawa K, Koepchen HP, Polosa C, eds.Mechanisms of blood pressure waves. Berlin: Springer-Verlag; 1984. pp. 3–23.
Guttman L, Munro AF, Robinson R, Walsh JJ. Effects of tilting on the cardiovascular responses and plasma catecholamine levels in spinal man.Paraplegia 1963; 1:4–18.
Schmid A, Huonker M, Stahl F, Barturen JM, Konig D, Heim M, et al. Free plasma catecholamines in spinal cord injured persons with different injury levels at rest and during exercise.J Auton Nerv Syst 1998; 68:96–100.
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Houtman, S., Oeseburg, B., Hughson, R.L. et al. Sympathetic nervous system activity and cardiovascular homeostasis during head-up tilt in patients with spinal cord injuries. Clinical Autonomic Research 10, 207–212 (2000). https://doi.org/10.1007/BF02291358
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DOI: https://doi.org/10.1007/BF02291358