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The effects of head‐up and head‐down tilt on cerebrovascular CO2 reactivity in anterior and posterior cerebral circulations

Cerebral autoregulation is a protective feature of the cerebrovasculature that maintains relatively constant cerebral perfusion in the face of static and dynamic fluctuations in mean arterial pressure (MAP). However, gravity‐dependent shifts in blood volume distribution during head‐up and head‐down tilt (HUT, HDT) have profound effects on venous return, cardiac output and MAP. Further, cerebral blood flow (CBF) is highly sensitive to the influence of changes in arterial CO2 (PaCO2) on arteriolar diameter. We tested the effects of steady‐state tilt on cerebral blood velocity (CBV) and CO2 reactivity in the middle and posterior cerebral arteries (MCA, PCA) using hyperoxic rebreathing and transcranial Doppler ultrasound in various positions on a tilt table. Following initial testing in supine position, subjects were positioned randomly and tested in each of four positions: 90° HDT, 45° HDT, 45° HUT and 90° HUT. There were no differences in steady‐state MCA or PCA CBV across positions. Absolute and relative CO2 reactivity slopes were calculated for the MCA and PCA using linear regression. Absolute reactivity was greater in the MCA than the PCA in all 5 positions, but there was no interaction between reactivity and tilt. Our data demonstrate that CBF is maintained through cerebral autoregulation in the face of superimposed steady‐state orthostatic stress and dynamic changes in PaCO2.