Mechanisms of cutaneous vasoconstriction during upright posture

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Abstract
The cutaneous circulation is thought to participate in the neurocirculatory adjustments during orthostatic stress, but the underlying mechanisms mediating such reflex cutaneous vasoconstriction are poorly understood. The aim of this study was to assess the relative importance of baroreceptor (cardiopulmonary and arterial) and positional (vestibular, exercise, veno-arteriolar and myogenic) reflexes in triggering cutaneous vasoconstriction during upright posture. First, hypotensive lower body negative pressure (LBNP) was compared with actual postural changes to assess the relative contributions of baroreceptor reflexes and positional reflexes. Then changes in body position were compared with changes in limb position in the absence or presence of proximal (axillary) or distal (local cutaneous) nerve blocks, to assess the relative contributions of vestibular, exercise, veno-arteriolar and myogenic reflexes. Skin sympathetic nerve activity was determined by microneurography, and skin blood flow was determined by laser Doppler velocimetry. LBNP of -50 mm Hg cardiopulmonary + arterial baroreceptors) had no effect on skin sympathetic nerve activity or skin vascular resistance. In contrast, an upright posture with the arms dependent (baroreceptor + vestibular + exercise + veno-arteriolar reflexes) caused a two- to threefold increase in skin vascular resistance. In the supine position passive movement of the arm into a dependent position to activate veno-arteriolar reflexes alone evoked an increase in skin vascular resistance which approximated the response to normal upright posture. Blocking central sympathetic nerve impulses by application of an axillary blockade did not influence the cutaneous vasoconstrictor response to an upright posture or changes in limb position. In contrast, application of a distal nerve block by local cutaneous surface anaesthesia completely blocked vasoconstrictor responses evoked by these manoeuvres. In conclusion, these experiments in human subjects identify a primary role for veno-arteriolar reflexes in triggering vasoconstriction in the cutaneous circulation during upright posture.