Published Online
on March 4, 2002

A more recent version of this article appeared on March 26, 2002

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Submitted on December 17, 2001
Revised on January 15, 2002
Accepted on January 17, 2002

Baroreflex Buffering and Susceptibility to Vasoactive Drugs

Jens Jordan MD^*, Jens Tank MD, John R. Shannon MD, Andre Diedrich MD, Axel Lipp MD, Christoph Schröder MD, Guy Arnold MD, Arya M. Sharma MD, Italo Biaggioni MD, David Robertson MD, and Friedrich C. Luft MD

From Franz-Volhard Clinical Research Center and Helios Klinikum (J.J., J.T., C.S., A.M.S., F.C.L.) and the Department of Neurology (A.L., G.A.), Medical Faculty of the Charité, Humboldt-University, Berlin, Germany; and Autonomic Dysfunction Center, Vanderbilt University, Nashville, Tenn (J.R.S., A.D., I.B., D.R.).

^* To whom correspondence should be addressed. E-mail: jordan{at}fvk-berlin.de.

Background—The overall effect of vasoactive drugs on blood pressure is determined by a combination of the direct effect on vascular tone and an indirect baroreflex-mediated effect, a baroreflex buffering of blood pressure. Differences in baroreflex function affect the responsiveness to vasoactive medications, particularly baroreflex buffering of blood pressure; however, the magnitude is not known.

Methods and Results—We characterized baroreflex function and responses to vasoactive drugs in patients with idiopathic orthostatic intolerance, patients with essential hypertension, patients with monogenic hypertension and brachydactyly, patients with multiple system atrophy, and control subjects. We used phenylephrine sensitivity during ganglionic blockade as a measure of baroreflex buffering. Phenylephrine (25 µg) increased systolic blood pressure 6±1.6 mm Hg in control subjects, 6±1.1 mm Hg in orthostatic intolerance patients, 18±3.9 mm Hg in patients with essential hypertension, 31±3.4 mm Hg in patients with monogenic hypertension, and 25±3.4 mm Hg in patients with multiple system atrophy. Similar differences in sensitivities between groups were observed with nitroprusside. The sensitivity to vasoactive drugs was highly correlated with baroreflex buffering function and to a lesser degree with baroreflex control of heart rate. In control subjects, sensitivities to nitroprusside and phenylephrine infusions were correlated with baroreflex heart rate control and sympathetic nerve traffic.

Conclusions—Our findings are consistent with an important effect of baroreflex blood pressure buffering on the sensitivity to vasoactive drugs. They suggest that even moderate changes in baroreflex function may have a substantial effect on the sensitivity to vasoactive medications.

Key words: baroreceptors • nervous system, autonomic • drugs • blood pressure

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