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J Appl Physiol (July 10, 2008). doi:10.1152/japplphysiol.00003.2008
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Submitted on January 2, 2008
Accepted on July 8, 2008

Contrasting effects of isocapnic and hypocapnic hyperventilation on orthostatic circulatory control

Roland D Thijs1*, Joost G. van den Aardweg2, Robert HAM Reijntjes1, J Gert van Dijk1, and Johannes J. van Lieshout3

1 Neurology, Leiden University Medical Centre, Leiden, Netherlands
2 Dept. Pulmonary Medicine 117, Medical Center Alkmaar, Alkmaar, Netherlands
3 Medium Care Internal Medicine, Academic Medical Center, Amsterdam, Netherlands; Human Cardiovascular Physiology Unit, AMC Center for Heart Failure Research, Meibergdreef 9, Amsterdam, Netherlands

* To whom correspondence should be addressed. E-mail: r.d.thijs{at}lumc.nl.

The effects of hyperventilation (HV) on mean arterial pressure (MAP) are variable. To identify factors affecting the MAP response to HV, we dissected the effects of hypocapnic HV (HHV) and isocapnic HV (IHV) and evaluated the effects of acute vs. prolonged HHV. In 11 healthy subjects the cardio- and cerebrovascular effects of HHV and IHV vs. normal ventilation were examined for 15 min in the supine position and also for 15 min during 60° head-up tilt. The end-tidal CO2 of the HHV condition was set at 15-20 mmHg. With HHV in the supine position, mCBFV declined (95%CI -43 to -34%), heart rate (HR) increased (95% CI 7 to 16 bpm), but MAP did not change (95% CI -1 to 6 mmHg). However, an augmentation of the supine MAP was observed in the last 10 min of HHV compared to the first 5 min of HHV (95% CI 2 to 12 mmHg). During HHV in the tilted position mCBFV declined (95% CI -28 to -12%) and MAP increased (95% CI 3 to 11 mmHg) without changes in HR. With supine IHV, mCBFV decreased (95% CI -14 to -4%) and MAP increased (95% CI 1 to 13 mmHg) without changes in HR. During IHV in the tilted position MAP was further augmented (95% CI 11 to 20 mmHg) without changes in CBFV or HR. Preventing hypocapnia during HV resulted in a higher MAP, suggesting two contrasting effects of HV on MAP: hypocapnia causing vasodepression and hyperpnea without hypocapnia acting as a vasopressor.




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