High on altitude: new attitudes

toward human cerebral blood

flow regulation and altitude
acclimatization
Glen E. Foster
School of Human Kinetics, University of
British Columbia, Vancouver, Canada

Email: glen.foster@ubc.ca

Travel to high altitude for the lowland

dweller unmasks a complicated array
of physiological mechanisms responsible
for acclimatization (Dempsey & Forster,
1982). First, the reduction in both the
barometric pressure and the arterial partial
pressure for oxygen (P aO2 ) stimulates an
increase in ventilation, the magnitude
of which depends upon the individual
ventilatory sensitivity to hypoxia. Then, the
arterial partial pressure for carbon dioxide
(P aCO2 ) is decreased due to hypoxic hyper-
ventilation resulting in respiratory alkalosis.
As time at altitude increases over the next
1–2 weeks, acid–base balance is normalized
by renal excretion of bicarbonate, and
P aO2 is improved by increases in the
ventilatory sensitivity to hypoxia and
polycythaemia. This simplified overview
of altitude acclimatization highlights two
major controlling factors for cerebral blood
flow (CBF): (1) changes in arterial blood
gases (i.e. P aO2 and P aCO2 ) and (2) changes
in pH.
The brain, notably a vital organ, relies
upon an adequate supply of blood and
delivery of oxygen for its normal operation.
Therefore, CBF is regulated not only
to maintain oxygen delivery but also to
maintain cerebral tissue pH (or cerebral
spinal fluid (CSF) pH). Interestingly, the
cerebral circulation is relatively insensitive
to hypoxia, only increasing CBF when P aO2
reaches levels <50 mmHg. Conversely, CBF
is highly sensitive to changes in P aCO2 (and
pH), decreasing CBF during hypocapnia
and increasing CBF with hypercapnia. This
property of the cerebral circulation may
dampen changes in CSF pH and provides
a unique point of respiratory integration.
It can be appreciated that oscillations
in CSF pH in the region responsible
for central chemoreception would directly
affect ventilation. Taking this one step
further, the individual magnitude of the

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