Relative Contributions of Sympathetic, Cholinergic, and Myogenic Mechanisms to Cerebral Autoregulation

• Published in: Stroke (1970) 2014-06, Vol.45 (6), p.1771-1777
• Main Authors: Hamner, J.W, Tan, Can Ozan
• Format: Article
• Language: English
• Subjects: Adrenergic alpha-Antagonists - administration & dosage; Adult; Biological and medical sciences; Blood Flow Velocity - physiology; Blood Flow Velocity - radiation effects; Blood Pressure - drug effects; Blood Pressure - physiology; Calcium Channel Blockers - administration & dosage; Cerebral circulation. Blood-brain barrier. Choroid plexus. Cerebrospinal fluid. Circumventricular organ. Meninges; Cerebrovascular Circulation - drug effects; Cerebrovascular Circulation - physiology; Cholinergic Antagonists - administration & dosage; Female; Fundamental and applied biological sciences. Psychology; Homeostasis - drug effects; Homeostasis - physiology; Humans; Male; Medical sciences; Models, Cardiovascular; Muscarinic Antagonists - administration & dosage; Neurology; Sympathetic Nervous System - physiology; Vascular diseases and vascular malformations of the nervous system; Vertebrates: nervous system and sense organs
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.114.005293

BACKGROUND AND PURPOSE—Prior work aimed at improving our understanding of human cerebral autoregulation has explored individual physiological mechanisms of autoregulation in isolation, but none has attempted to consolidate the individual roles of these mechanisms into a comprehensive model of the overall cerebral pressure–flow relationship. METHODS—We retrospectively analyzed this relationship before and after pharmacological blockade of α-adrenergic–, muscarinic-, and calcium channel–mediated mechanisms in 43 healthy volunteers to determine the relative contributions of the sympathetic, cholinergic, and myogenic controllers to cerebral autoregulation. Projection pursuit regression was used to assess the effect of pharmacological blockade on the cerebral pressure–flow relationship. Subsequently, ANCOVA decomposition was used to determine the cumulative effect of these 3 mechanisms on cerebral autoregulation and whether they can fully explain it. RESULTS—Sympathetic, cholinergic, and myogenic mechanisms together accounted for 62% of the cerebral pressure–flow relationship (P