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We hypothesised that CVR<jats:sub>CO2<\/jats:sub> would be lower in patients with both AF and HTN (AF\u2009+\u2009HTN) compared to normotensive AF patients, due to an additive effect of AF and HTN on CVR<jats:sub>CO2<\/jats:sub>. Forty AF (68\u2009\u00b1\u20099 years) and fifty-seven AF\u2009+\u2009HTN (68\u2009\u00b1\u20098 years) patients underwent transcranial Doppler ultrasound measurement of middle cerebral artery blood velocity (MCA V<jats:sub>m<\/jats:sub>) during stepped increases and decreases in end-tidal carbon dioxide (P<jats:sub>ET<\/jats:sub>CO<jats:sub>2<\/jats:sub>). A cerebrovascular conductance index (CVCi) was calculated as the ratio of MCA V<jats:sub>m<\/jats:sub> and mean arterial pressure (MAP). CVR<jats:sub>CO2<\/jats:sub> was determined from the linear slope for MCA V<jats:sub>m<\/jats:sub> and MCA CVCi vs P<jats:sub>ET<\/jats:sub>CO<jats:sub>2<\/jats:sub>. Baseline MAP was higher in AF\u2009+\u2009HTN than AF (107\u2009\u00b1\u20099 vs. 98\u2009\u00b1\u20099\u2009mmHg, respectively; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), while MCA V<jats:sub>m<\/jats:sub> was not different (AF\u2009+\u2009HTN:49.6 [44.1\u201369.0]; AF:51.7 [45.2\u201363.3] cm.s<jats:sup>\u22121<\/jats:sup>; <jats:italic>p<\/jats:italic>\u2009=\u20090.075), and CVCi was lower in AF\u2009+\u2009HTN (0.46 [0.42\u20130.57] vs. 0.54 [0.44\u20130.63] cm.s<jats:sup>\u22121<\/jats:sup>.mmHg<jats:sup>\u22121<\/jats:sup>; p\u2009&lt;\u20090.001). MCA V<jats:sub>m<\/jats:sub> CVR<jats:sub>CO2<\/jats:sub> was not different (AF\u2009+\u2009HTN: 1.70 [1.47\u20132.19]; AF 1.74 [1.54\u20132.52] cm\/s\/mmHg<jats:sup>\u22122<\/jats:sup>; <jats:italic>p<\/jats:italic>\u2009=\u20090.221), while CVCi CVR<jats:sub>CO2<\/jats:sub> was 13% lower in AF\u2009+\u2009HTN (0.013\u2009\u00b1\u20090.004 vs 0.015\u2009\u00b1\u20090.005\u2009cm.s<jats:sup>\u22121<\/jats:sup>.mmHg<jats:sup>\u22121<\/jats:sup>; p\u2009=\u20090.047). Our results demonstrate blunted cerebral vasodilatory reserve (determined as MCA CVCi CVR<jats:sub>CO2<\/jats:sub>) in AF\u2009+\u2009HTN compared to AF alone. This may implicate HTN as a driver of further cerebrovascular dysfunction in AF that may be important for the development of AF-related cerebrovascular events and downstream cognitive decline.<\/jats:p>","DOI":"10.1038\/s41440-024-01662-2","type":"journal-article","created":{"date-parts":[[2024,4,10]],"date-time":"2024-04-10T07:02:11Z","timestamp":1712732531000},"page":"1678-1687","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The effect of hypertension on cerebrovascular carbon dioxide reactivity in atrial fibrillation patients"],"prefix":"10.1038","volume":"47","author":[{"given":"Harvey J.","family":"Walsh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rehan T.","family":"Junejo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory Y. 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Speaker for Bayer, BMS\/Pfizer, Medtronic, Boehringer Ingelheim, and DaiichiSankyo. No fees are directly received personally. JPF has received funding from BMS\/Pfizer for an investigator-led and competitively reviewed research project. RTJ was previously employed by University of Birmingham as a research fellow on BMS\/Pfizer funded, investigator-led and competitively reviewed research project which he managed. This required regular contact with funders for continued project grant support. No fees\/funds were directly received personally.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Ethical approval was received from the National Research Ethics Service Committee West Midlands (15\/WM\/0447) and North West (17\/NW\/0714).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}