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Reduced defense of central blood volume during acute hypovolemic circulatory stress in aging women
Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.ORCID iD: 0000-0002-9095-403X
2012 (English)In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 37, no 6, 579-585 p.Article in journal (Refereed) Published
Abstract [en]

Elderly men respond with decreased defense of central blood volume during hypovolemic stress, but this response has not been evaluated with age in women. The aim was to examine the compensatory mechanisms to defend central blood volume during experimental hypovolemia in elderly compared to young women. Cardiovascular responses in 34 women, 12 elderly (66.4±1.4 yr) and 22 young (23.1±0.4 yr) were studied during experimental hypovolemic circulatory stress induced by lower body negative pressure (LBNP) of 11-44 mmHg. Volumetric technique was used to assess the capacitance response (redistribution of peripheral venous blood to the central circulation) as well as to assess net capillary fluid transfer from tissue to blood in the arm. LBNP created comparable hypovolemia in elderly and young women. Heart rate increased less in elderly women (LBNP of 44 mmHg: 20±2 vs. 37±4 %, P < 0.01), but with similar decrease in forearm vascular conductance (FVC). Mobilization of capacitance blood from the peripheral circulation was both slower and decreased by ~60 % in elderly, and net capillary fluid absorption from surrounding tissues was reduced by ~40 % (LBNP of 44 mmHg). In conclusion, during acute hypovolemic circulatory stress elderly women responded with less increase in heart rate but with an equal change in FVC, implying decreased cardiovagal baroreceptor sensitivity. Furthermore, both capacitance response and net capillary fluid absorption were reduced, indicating less efficiency to defend central blood volume in elderly than in young women.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2012. Vol. 37, no 6, 579-585 p.
Keyword [en]
Female, trauma, baroreceptor sensitivity, orthostatic tolerance, adrenergic receptor response
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-15419DOI: 10.1097/SHK.0b013e31824fbb3eISI: 000304202200004OAI: oai:DiVA.org:liu-15419DiVA: diva2:114146
Note

funding agencies|Medical Faculty, Linkoping University||Futurum-The Academy of Health Care, Jonkoping County Council||Medical Research Council| 12661 |Heart and Lung Foundation||

Available from: 2008-11-06 Created: 2008-11-06 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Cardiovascular responses to hypovolemic circulatory stress in women: With special reference to venous compliance and capacitance
Open this publication in new window or tab >>Cardiovascular responses to hypovolemic circulatory stress in women: With special reference to venous compliance and capacitance
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Acute haemorrhage is a leading cause of death in trauma. Young women (YW) seem more susceptible to hypovolemic circulatory stress than young men (YM), but the underlying mechanisms are not clear. Elderly subjects are more vulnerable to haemorrhage, with a decreased defence of central blood volume in elderly men, but the defence has not been evaluated in elderly women  (EW). The aims were to assess differences in cardiovascular responses to hypovolemic circulatory stress, emphasizing compensatory mechanisms to maintain central blood volume in YW, EW and in women prone to vaso‐vagal reaction (VW).

Lower body negative pressure (LBNP) was used as a model for haemorrhage and to create acute hypovolemic stress. Volumetric techniques were used to assess venous compliance, capacitance and capillary fluid exchange both caused by LBNP in the calf and the response to maintain central blood volume.

LBNP induced a comparable hypovolemic stimulus in YW and YM, with lower calf venous compliance and capacitance but higher net capillary fluid filtration in YW. YW responded with smaller vasoconstriction without association between P‐NE and peripheral vascular resistance in contrast to YM. Venous capacitance response was decreased with time in YW. Further, net capillary fluid absorption from peripheral tissues to central circulation was decreased in YW in response to hypovolemic stress. All in all, this indicates less efficiency to defend central blood volume in young women.

Calf venous compliance and capacitance was maintained in EW compared to YW but capillary filtration was decreased, implying reduced capillary function with age. With increasing transmural pressures however, filtration and capillary filtration coefficient (CFC) increased indicating increased capillary susceptibility to transmural pressure load in dependent regions with age. Heart rate increase was attenuated in EW while peripheral vascular conductance was maintained suggesting reduced cardiovagal baroreceptor function in response to hypovolemia with age. Venous capacitance response and fluid absorption from peripheral tissues to central circulation were decreased with age, indicating less efficiency to defend central blood volume.

LBNP induced a slower hypovolemic stimulus in VW compared with nonvagal women. Further, the cardiopulmonary baroreflex was less efficient, and the venous capacitance response from peripheral tissues to central circulation was decreased, which may explain their susceptibility to orthostatic challenge.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2008. 70 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1087
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-15420 (URN)978-91-7393-756-6 (ISBN)
Public defence
2008-11-21, Elsa Brändström salen, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 09:15 (English)
Opponent
Supervisors
Available from: 2008-11-06 Created: 2008-11-06 Last updated: 2017-04-15Bibliographically approved

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Lindenberger, MarcusLänne, Toste

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