The effect of aging on phenylephrine response in normal subjects

With aging, cardiac responses to β-adrenergic stimulation decline but the responses to α1-stimulation are less clear. Moreover, whether aging, in the absence of disease, influences the left ventricular response to an increase in afterload is unclear. This study examined the effect of aging on heart rate (HR), blood pressure (BP), cardiac index (CI) and several left ventricular contractility measurements during α 1-stimulation with a phenylephrine infusion.

Subjects were rigorously screened to be normal by history, physical, blood tests, ECG, ETT and echocardiogram. Twelve young (mean 26 years, all male) and 15 aged (69 years, 11 males) subjects were studied during 10 minute infusions of phenylephrine at 0.5 and 1.0 mcg/ kg/min. HR, BP and radionuclide ventriculographic cardiac volumes were measured.

Systolic BP increased more in the aged than in the young (22 vs. 13%, p=0.003), while heart rate (16 vs. 21%, p=0.05) fell less. Contractile responses to phenylephrine, including EF, stroke volume index (SVI), stroke work index and left ventricular contractility index were not altered with aging. Systemic vascular resistance (SVR) was higher at baseline and at each infusion rate, but there was no age-associate change in the response to PE.

In a healthy normal aged population, a preserved SVI response in the setting of a higher baseline SVR results in an increased SBP response to α1-stimulation. Contractile responses to increased afterload are not altered with aging. Age-associated differences in the response to α1-stimulation are small and are explained by altered baroreflex sensitivity and a stiffer vasculature.