Published Online
on February 25, 2002

A more recent version of this article appeared on March 19, 2002

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Submitted on October 10, 2001
Revised on January 10, 2002
Accepted on January 14, 2002

Long-Term Effects of Carotid Sinus Denervation on Arterial Blood Pressure in Humans

Arthur A.J. Smit MD, PhD, Henri J.L.M. Timmers MD^*, Wouter Wieling MD, PhD, Mariette Wagenaar MD, Henri A.M. Marres MD, PhD, Jacques W.M. Lenders MD, PhD, Gert A. van Montfrans MD, PhD, and John M. Karemaker PhD

From the Departments of Internal Medicine (A.A.A.J.S., W.W., G.A.v.M.) and Physiology (J.M.K.), Academic Medical Center, Amsterdam; and Departments of Internal Medicine (H.J.L.M., J.W.M.L.) and Otorhinolaryngology (M.W., H.A.M.M.), University Medical Center, St Radboud, Nijmegen, the Netherlands.

^* To whom correspondence should be addressed. E-mail: H.Timmers{at}aig.azn.nl.

Background—After experimental carotid sinus denervation in animals, blood pressure (BP) level and variability increase markedly but normalize to preoperative levels within 10 to 14 days. We investigated the course of arterial BP level and variability after bilateral denervation of the carotid sinus baroreceptors in humans.

Methods and Results—We studied 4 women (age 41 to 63 years) who were referred for evaluation of arterial baroreflex function because of clinical suspicion of carotid sinus denervation attributable to bilateral carotid body tumor resection. The course of BP level and variability was assessed from repeated office and 24-hour ambulatory measurements (Spacelabs/Portapres) during 1 to 10 years of (retrospective) follow-up. Rapid cardiovascular reflex adjustments to active standing and Valsalva's maneuver were assessed. Office BP level increased from 132/86 mm Hg (range, 118 to 148/80 to 92 mm Hg) before bilateral surgery to 160/105 mm Hg (range, 143 to 194/90 to 116 mm Hg) 1 to 10 years after surgery. During continuous 24-hour noninvasive BP recording (Portapres), a marked BP variability was apparent in all 4 patients. Initial symptomatic hypotension on change to the upright posture and abnormal responses to Valsalva's maneuver were observed.

Conclusions—Acute carotid sinus denervation, as a result of bilateral carotid body tumor resection, has a long-term effect on the level, variability, and rapid reflex control of arterial BP. Therefore, in contrast to earlier experimental observations, the compensatory ability of the baroreceptor areas outside the carotid sinus seems to be of limited importance in the regulation of BP in humans.

Key words: baroreceptors • carotid sinus • denervation • blood pressure • hypertension

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