Blood pressure variability responses to tilt are buffered by cardiac autonomic control

Variability in blood pressure (BPV) is influenced by vascular sympathetic drive as well as autonomic control of the heart. Evidence suggests that elimination of cardiac autonomic control, as measured by heart period variability (HPV), produces a reduction in BPV at rest but an increase in BPV during challenge. We recently showed that the BPV response to psychological challenge, which principally produces cardiac parasympathetic withdrawal, was inversely related to the subject's level of cardiac control. In the current study we examined the BPV response to orthostatic tilt, a sympathetic stressor. Subjects were 22 healthy men and women who differed in cardiac control due in part to differences in aerobic capacity. HPV and BPV were measured noninvasively on a beat-to-beat basis. Tilt produced significant increases in heart rate and diastolic blood pressure and a significant decrease in high frequency HPV. As predicted, changes in BPV in response to tilt were inversely related to resting HPV. Results are interpreted in terms of a model of cardiovascular control which holds that BPV originates from feedforward effects of central control of the heart, feedback effects mediated through the baroreflexes, and direct sympathetic vascular effects.