• Victor A Convertino, Caroline A Rickards, and Kathy L Ryan.
• US Army Institute of Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX 78234-6315, USA. victor.convertino@amedd.army.mil
• Clin. Auton. Res. 2012 Jun 1;22(3):123-30.

IntroductionHemorrhage is accompanied by baroreflex-mediated tachycardia and vasoconstriction. The difference between baseline and maximum responses is defined as the heart rate (HR) and vasoconstrictor 'reserve'.ObjectiveTo test the hypothesis that higher HR and vasoconstrictor reserves in subjects with high tolerance (HT) to central hypovolemia is associated with greater reserve for sympathoexcitation and vagal withdrawal compared with low tolerant (LT) subjects.MethodsR-R intervals (RRI), systolic arterial pressure (SAP), estimated stroke volume, and muscle sympathetic nerve activity (MSNA) were measured during lower body negative pressure (LBNP) designed to induce pre-syncope. Subjects with tolerance ≤ 60 mmHg LBNP were classified as LT (n = 22) while subjects who tolerated LBNP levels >60 mmHg were classified as HT (n = 56). Spontaneous cardiac baroreflex sensitivity (BRS) was assessed via RRI-SAP down-down sequences.ResultsHR reserve in HT subjects (+52 ± 2 bpm) was twofold greater (P < 0.001) than that in LT subjects (+27 ± 3 bpm). Vasoconstrictor reserve in the HT group (+3.4 ± 0.5 pru) was greater (P = 0.04) than that of the LT group (+1.9 ± 0.3 pru). HT subjects demonstrated greater (P ≤ 0.03) BRS reserve (-14.2 ± 1.8 ms/mmHg) and MSNA reserve (+41 ± 2 bursts/min) compared with LT subjects (-7.4 ± 1.7 ms/mmHg and +26 ± 7 bursts/min).InterpretationOur data support the hypothesis that greater physiological reserve capacity for tachycardia and vasoconstriction related to high tolerance to central hypovolemia is associated with greater reserves for sympathoexcitation and cardiac vagal withdrawal.

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