Role of the medulla oblongata in normal and high arterial blood pressure regulation: the contribution of Escola Paulista de Medicina - UNIFESP

Several forms of experimental evidence gathered in the last 37 years have unequivocally established that the medulla oblongata harbors the main neural circuits responsible for generating the vasomotor tone and regulating arterial blood pressure. Our current understanding of this circuitry derives mainly from the studies of Pedro Guertzenstein, a former student who became Professor of Physiology at UNIFESP later, and his colleagues. In this review, we have summarized the main findings as well as our collaboration to a further understanding of the ventrolateral medulla and the control of arterial blood pressure under normal and pathological conditions.

Numerosas formas de evidência experimental obtidas nos últimos 37 anos demonstraram inequivocamente que a medula oblongata contém os principais circuitos responsáveis pela geração e manutenção do tono vasomotor e a regulação da pressão arterial. A visão atual que possuímos destes circuitos deriva em grande parte dos estudos de Pedro Guertzenstein, um estudante e mais tarde Professor de Fisiologia da UNIFESP e seus colaboradores. Nesta revisão nós sumarizamos os seus principais resultados assim como a nossa colaboração para uma melhor compreensão da regulação da pressão arterial em condições normais e patológicas.

Role of the caudal pressor area in the regulation of sympathetic vasomotor tone

It is well known that the ventrolateral medulla contains neurons involved in the tonic and reflex control of the cardiovascular system. Two regions within the ventrolateral medulla were initially identified: the rostral ventrolateral medulla (RVLM) and the caudal ventrolateral medulla (CVLM). Activation of the RVLM raises arterial blood pressure and sympathetic nerve activity, and activation of the CVLM causes opposite effects. The RVLM premotor neurons project directly to sympathetic preganglionic neurons and are involved in the maintenance of resting sympathetic vasomotor tone. A significant proportion of tonic activity in the RVLM sympathetic premotor neurons is driven by neurons located in a third region of the ventrolateral medulla denominated caudal pressor area (CPA). The CPA is a pressor region located at the extreme caudal part of the ventrolateral medulla that appears to have an important role controlling the activity of RVLM neurons. In this brief review, we will address the importance of the ventrolateral medulla neurons for the generation of resting sympathetic tone related to arterial blood pressure control focusing on two regions, the RVLM and the CPA.

[Differential effectiveness of hormone replacement therapy and relaxation techniques on consequences of menopause vasomotor symptoms]

Vasomotor symptoms are usually accompanied with consequences such as headache, sleep disturbance and other events which can not be exactly attributed to endocrine changes already established in menopausal period. To compare the effect of hormone replacement therapy and relaxation techniques on consequences of menopause vasomotor symptoms. This was a quasi-experimental study carried out in 2003 in which ninety postmenopausal women with vasomotor symptoms referred to private doctors or midwives in Zanjan [Iran] were selected by convenience method. The subjects were randomly divided into 3 groups marked a HRT, RT and control groups. Data were collected through questionnaires and interviews before and after intervention. Data were further analyzed using T-test, T-Paired, X[2] and variance analysis. Our results demonstrated that RT and HRT both reduced the severity of vasomotor symptoms consequences [headache, sleep disturbance, depression, irritability and anxiety] in post-treatment period compared to pre-treatment stage. The findings were also indicative of a treatment period. Finally, although RT and HRT both reduced the severity of symptoms, RT found to have greater effect on depression than HRT. Based on results found in present study, RT and HRT both led to significant reduction in consequences of vasomotor symptoms however, RT showed greater effect on depression than HRT

The effects of cold stress test on vasomotor tonus in normal controls.

Plethsymographic recordings are used to evaluate changes in peripheral vascular tonus. Twenty-six volunteers (15 men, 11 women) with a mean age 31 years were included in this study. Plethsymographic recordings were done both at baseline and +40C temperatures bilaterally. Significant reductions in systemic blood flow were noted with different maneuvers. Reactive hyperemia occurring after ischemia was local, however local reduction in blood flow after cold test was systemic. As the local temperature increased, the blood flow parameters normalized, too. In normal controls these values normalized in 20 minutes. The changes in vasomotor tonus due to cold test demostrated a parallel pattern.

Tissue engineering a blood vessel substitute: the role of biomechanics

The engineering of a functional blood vessel substitute has for a quarter of a century been a "holy grail" within the cardiovascular research community. Such a substitute must exhibit long term patency, and the critical issues in this area in many ways are influenced by biomechanics. One of the requirements is that it must be non-thrombogenic, which requires an "endothelial-like" inner lining. It also must have mechanical strength, i.e. a burst pressure, sufficient to operate at arterial pressures. Ideally, however, it must be more than this. It also must have viscoelastic properties that match those of the native vessel being replaced. Finally, if it is to be able to adapt to changing blood flow conditions, it must exhibit vasoactivity, a function which in and of itself can be viewed as biomechanical in nature. To achieve this requires having, as part of the construct, vascular smooth muscle cells, which are contractile in nature and oriented in a circumferential direction. Only if an engineered blood vessel substitute possesses all of these functional characteristics, can one say that the functionality exhibited by a native vessel is being mimicked.

Aspectos reciente en la fisiopatología de la hipertensión arterial / New aspects in the physiopathology of arterial hypertension

En este trabajo analizamos los conocimientos recientes sobre los diversos mecanismos que se han relacionado con la fisiopatología de la hipertensión arterial esencial, su relación con el daño orgánico, principalmente aterosclerótico, las bases para tratamientos más específicos en el futuro, y la posibilidad de correcciones de tales alteraciones con los fármacos disponibles en la actualidad

Computerized analysis of isometric tension studies provides important additional information about vasomotor activity

Concentration-response curves of isometric tension studies on isolated blood vessels are obtained traditionally. Although parameters such as Imax, EC50 and pA2 may be readily calculated, this method does not provide information on the temporal profile of the responses or the actual nature of the reaction curves. Computerized data acquisition systems can be used to obtain average data that represent a new source of otherwise inaccessible information, since early and late responses may be observed separately in detail.

Central nervous control of venous tone. III. Responses of capacitance and resistance vessels of skin to bulbar and hypothalamic stimulation.

Electrical stimulation of 350 points in the bulbar formation of 35 dogs under chloralose anaesthesia demonstrated the presence of sites producing increase or decrease of systemic arterial pressure (SAP) in the same general morphological limits of bulbar pressor and depressor regions as described by earlier authors. Simultaneous recording of pressure changes in the cutaneous vessels however demonstrated that pressure changes in these vessels did not correspond to the pressor or depressor effects of the SAP. Instead, responses were obtained in which pressures in cutaneous capacitance and resistance vessels followed a trend which was opposite in direction and magnitude to that of SAP. Thus there were 30 depressor sites which produce increase in cutaneous vessel pressure and 23 pressor sites which produced a fall in cutaneous vessel pressure. For a marked rise in the SAP, only 62 sites elicited equally marked increase in both capacitance and resistance vessel pressure, while another 52 elicited only a small increase of equivalent magnitude in the capacitance and resistance vessels. Stimulation of 84 points produced dissimilar effects on capacitance and resistance vessels out of which 38 elicited moderate increase in resistance vessel tone with minimal changes in the capacitance vessel tone, while 46 points elicited moderate increase in capacitance vessel tone with only a small increase in the resistance vessel tone. These points were diffusely admixed in the bulbar reticular formation. Effects which were exclusive to the capacitance and resistance vessels of skin, singly or in combination, without affecting the SAP were elicited from 12 points while another 28 points produced marked rise or fall of systemic arterial pressure without affecting the cutaneous vessels. These observations suggest that the neuronal organisation regulating cardiovascular activities at the bulbar level is quite complex having the capacity to generate varying activities in different components of the vascular circuits by differentially altering the discharge of the efferent sympathetic fibres on the one hand, and marked selectivity of action on any particular vascular bed or circulatory component on the other hand. Stimulation of 93 points in the hypothalamus produced similar patterns of response as obtained from medulla oblongata. In addition, stimulation of 6 points in the anterior hypothalamus produced a distinctive response accompanied by dilatation of cutaneous resistance and capacitance vessels with marked increase in respiratory rate and minimal changes in the SAP. This type of response which resembled the physiological response employed for heat loss was not obtained from any stimulation site in the medulla oblongata.