Adaptation of Baroreflexes and Orthostatic Hypotension

The footward shift of blood volume and compensatory autonomic reflex responses initiated during the assumption of the upright posture in terrestrial gravity is a common feature in humans. When regular exposure to upright posture is removed, the headward redistribution of blood induces numerous physiological adaptations which compromise this normal response and the development of low blood pressure upon standing (orthostatic hypotension) can ensue. Such microgravity conditions can be produced by prolonged exposure to spaceflight or prolonged bed rest. Since the reduction of blood and plasma volume during exposure to microgravity has been associated with orthostatic instability following spaceflight and bed rest, it has been a reasonable assumption that hypovolemia may be a primary contributing factor to the development of orthostatic hypotension. This view was supported by the observation that the attempt to restore vascular volume in astronauts by drinking saline solutions just prior to re-entry had proven effective in reducing orthostatic instability after spaceflights of short duration. However, as the duration of spaceflight lengthens, orthostatic instability persists despite fluid loading procedures, suggesting that mechanisms other than hypovolemia may contribute to orthostatic hypotension following prolonged exposure to microgravity conditions. Recent evidence has been generated from spaceflight and groundbase experiments that supports the notion that changes in autonomic baroreflexes that control cardiac and vascular responses during orthostatic challenges may be affected by longer periods of microgravity exposure and can contribute to postflight orthostatic instability.