Preservation of autoregulation of cerebral blood flow in autonomic failure

Cerebral blood flow (CBF) measurements have been made at systolic pressures between 40 and 170 mm Hg in 8 patients with chronic autonomic failure and widespread sympathetic efferent defects. Hypotension was produced by head up tilt. Cerebral autoregulation was preserved over a wide range and only failed at a systolic pressure close to 60 mm Hg, which is below the level at which it fails in normal subjects. Therefore, although autoregulation is probably mediated largely by local myogenic factors, its lower limit appears to be reduced by defective sympathetic function. These findings help to explain the remarkable tolerance of severe postural hypotension in autonomic failure.