Skip to main content
NCBI home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1999 Oct;67(4):428–432. doi: 10.1136/jnnp.67.4.428

Cardiovascular, autonomic, and plasma catecholamine responses in unilateral and bilateral carotid artery stenosis

A Akinola 1, C Mathias 1, A Mansfield 1, D Thomas 1, J Wolfe 1, A Nicolaides 1, T Tegos 1
PMCID: PMC1736562  PMID: 10486386

Abstract

OBJECTIVE—To determine impairment of baroreceptor afferent activity, which may affect cardiovascular autonomic function in patients with unilateral and bilateral carotid artery stenosis. Comparison was made with normal subjects and hypertensive patients.
METHODS—A series of cardiovascular autonomic function tests along with plasma noradrenaline (norepinephrine) measurements were performed in 46 patients with carotid artery stenosis (CAS); 23 had unilateral and 23 had bilateral stenosis. Comparison was made with 21 hypertensive patients (with a similar degree of raised blood pressure), and 27 normal subjects.
RESULTS—Over a third of patients with unilateral and bilateral CAS had postural hypotension. Heart rate did not rise appropriately in CAS despite the postural fall in blood pressure. Pressor responses in CAS were preserved. Heart rate responses to respiratory stimuli were attenuated. Plasma noradrenaline concentrations rose normally during head up tilt.
CONCLUSION—A substantial proportion with CAS had postural hypotension and attenuated heart rate responses. This was not due to sympathetic vasoconstrictor or cardiac parasympathetic failure, thus suggesting impaired afferent baroreceptor activity, probably secondary to involvement of the carotid sinus. Cardiovascular autonomic testing and assessment of postural hypotension and factors enhancing it may be of clinical relevance in such patients, especially as the symptoms of postural hypotension overlap with those due to thromboembolism.



Full Text

The Full Text of this article is available as a PDF (84.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bristow J. D., Honour A. J., Pickering G. W., Sleight P., Smyth H. S. Diminished baroreflex sensitivity in high blood pressure. Circulation. 1969 Jan;39(1):48–54. doi: 10.1161/01.cir.39.1.48. [DOI] [PubMed] [Google Scholar]
  2. Dehn T. C., Angell-James J. E. Long-term effect of carotid endarterectomy on carotid sinus baroreceptor function and blood pressure control. Br J Surg. 1987 Nov;74(11):997–1000. doi: 10.1002/bjs.1800741113. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Dobkin B. H. Orthostatic hypotension as a risk factor for symptomatic occlusive cerebrovascular disease. Neurology. 1989 Jan;39(1):30–34. doi: 10.1212/wnl.39.1.30. [DOI] [PubMed] [Google Scholar]
  4. Hirschl M., Kundi M., Blazek G. Five-year follow-up of patients after thromboendarterectomy of the internal carotid artery: Relevance of baroreceptor sensitivity. Stroke. 1996 Jul;27(7):1167–1172. doi: 10.1161/01.str.27.7.1167. [DOI] [PubMed] [Google Scholar]
  5. Hirschl M., Kundi M., Hirschl M. M., Liebisch B., Magometschnigg D. Blood pressure responses after carotid surgery: relationship to postoperative baroreceptor sensitivity. Am J Med. 1993 May;94(5):463–468. doi: 10.1016/0002-9343(93)90079-5. [DOI] [PubMed] [Google Scholar]
  6. Ille O., Woimant F., Pruna A., Corabianu O., Idatte J. M., Haguenau M. Hypertensive encephalopathy after bilateral carotid endarterectomy. Stroke. 1995 Mar;26(3):488–491. doi: 10.1161/01.str.26.3.488. [DOI] [PubMed] [Google Scholar]
  7. Kamata T., Yokota T., Furukawa T., Tsukagoshi H. Cerebral ischemic attack caused by postprandial hypotension. Stroke. 1994 Feb;25(2):511–513. doi: 10.1161/01.str.25.2.511. [DOI] [PubMed] [Google Scholar]
  8. Mathias C. J., Bannister R. B., Cortelli P., Heslop K., Polak J. M., Raimbach S., Springall D. R., Watson L. Clinical, autonomic and therapeutic observations in two siblings with postural hypotension and sympathetic failure due to an inability to synthesize noradrenaline from dopamine because of a deficiency of dopamine beta hydroxylase. Q J Med. 1990 Jun;75(278):617–633. [PubMed] [Google Scholar]
  9. Mathias C. J., Holly E., Armstrong E., Shareef M., Bannister R. The influence of food on postural hypotension in three groups with chronic autonomic failure--clinical and therapeutic implications. J Neurol Neurosurg Psychiatry. 1991 Aug;54(8):726–730. doi: 10.1136/jnnp.54.8.726. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Mathias C. J. Orthostatic hypotension: causes, mechanisms, and influencing factors. Neurology. 1995 Apr;45(4 Suppl 5):S6–11. [PubMed] [Google Scholar]
  11. Ruff R. L., Talman W. T., Petito F. Transient ischemic attacks associated with hypotension in hypertensive patients with carotid artery stenosis. Stroke. 1981 May-Jun;12(3):353–355. doi: 10.1161/01.str.12.3.353. [DOI] [PubMed] [Google Scholar]
  12. Shimada K., Kitazumi T., Ogura H., Sadakane N., Ozawa T. Differences in age-independent effects of blood pressure on baroreflex sensitivity between normal and hypertensive subjects. Clin Sci (Lond) 1986 May;70(5):489–494. doi: 10.1042/cs0700489. [DOI] [PubMed] [Google Scholar]
  13. Skydell J. L., Machleder H. I., Baker J. D., Busuttil R. W., Moore W. S. Incidence and mechanism of post-carotid endarterectomy hypertension. Arch Surg. 1987 Oct;122(10):1153–1155. doi: 10.1001/archsurg.1987.01400220063013. [DOI] [PubMed] [Google Scholar]
  14. Sleight P. Neurophysiology of the carotid sinus receptors in normal and hypertensive animals and man. Cardiology. 1976;61 Suppl 1:31–45. doi: 10.1159/000169790. [DOI] [PubMed] [Google Scholar]
  15. Smith G. D., Mathias C. J. Postural hypotension enhanced by exercise in patients with chronic autonomic failure. QJM. 1995 Apr;88(4):251–256. [PubMed] [Google Scholar]
  16. Vlachakis N. D., Mendlowitz M., DGuia D., DGusman D. Diminished baroreceptor sensitivity in elderly hypertensives. Possible role of atherosclerosis. Atherosclerosis. 1976 Jul-Aug;24(1-2):243–249. doi: 10.1016/0021-9150(76)90079-4. [DOI] [PubMed] [Google Scholar]
  17. Winson M., Heath D., Smith P. Extensibility of the human carotid sinus. Cardiovasc Res. 1974 Jan;8(1):58–64. doi: 10.1093/cvr/8.1.58. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES