Hypoxia increases exercise heart rate despite combined inhibition of β-adrenergic and muscarinic receptors

Am J Physiol Heart Circ Physiol. 2015 Jun 15;308(12):H1540-6. doi: 10.1152/ajpheart.00861.2014. Epub 2015 Apr 17.

Abstract

Hypoxia increases the heart rate response to exercise, but the mechanism(s) remains unclear. We tested the hypothesis that the tachycardic effect of hypoxia persists during separate, but not combined, inhibition of β-adrenergic and muscarinic receptors. Nine subjects performed incremental exercise to exhaustion in normoxia and hypoxia (fraction of inspired O2 = 12%) after intravenous administration of 1) no drugs (Cont), 2) propranolol (Prop), 3) glycopyrrolate (Glyc), or 4) Prop + Glyc. HR increased with exercise in all drug conditions (P < 0.001) but was always higher at a given workload in hypoxia than normoxia (P < 0.001). Averaged over all workloads, the difference between hypoxia and normoxia was 19.8 ± 13.8 beats/min during Cont and similar (17.2 ± 7.7 beats/min, P = 0.95) during Prop but smaller (P < 0.001) during Glyc and Prop + Glyc (9.8 ± 9.6 and 8.1 ± 7.6 beats/min, respectively). Cardiac output was enhanced by hypoxia (P < 0.002) to an extent that was similar between Cont, Glyc, and Prop + Glyc (2.3 ± 1.9, 1.7 ± 1.8, and 2.3 ± 1.2 l/min, respectively, P > 0.4) but larger during Prop (3.4 ± 1.6 l/min, P = 0.004). Our results demonstrate that the tachycardic effect of hypoxia during exercise partially relies on vagal withdrawal. Conversely, sympathoexcitation either does not contribute or increases heart rate through mechanisms other than β-adrenergic transmission. A potential candidate is α-adrenergic transmission, which could also explain why a tachycardic effect of hypoxia persists during combined β-adrenergic and muscarinic receptor inhibition.

Keywords: altitude; antagonist; autonomic nervous system; parasympathetic; sympathetic.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic beta-Antagonists / pharmacology*
  • Adult
  • Bicycling
  • Cardiac Output
  • Denmark
  • Exercise Tolerance
  • Exercise*
  • Heart Rate / drug effects*
  • Humans
  • Hypoxia / complications*
  • Hypoxia / metabolism
  • Hypoxia / physiopathology
  • Male
  • Muscarinic Antagonists / pharmacology*
  • Receptors, Adrenergic, beta / drug effects*
  • Receptors, Adrenergic, beta / metabolism
  • Receptors, Muscarinic / drug effects*
  • Receptors, Muscarinic / metabolism
  • Respiration
  • Tachycardia / etiology*
  • Tachycardia / metabolism
  • Tachycardia / physiopathology
  • Tachycardia / prevention & control
  • Time Factors
  • Young Adult

Substances

  • Adrenergic beta-Antagonists
  • Muscarinic Antagonists
  • Receptors, Adrenergic, beta
  • Receptors, Muscarinic