Effect of meal size on postprandial blood pressure and on postural hypotension in primary autonomic failure

1996 ◽  
Vol 6 (2) ◽  
pp. 111-114 ◽  
Author(s):  
S. Puvi-Rajasingham ◽  
C. J. Mathias
Keyword(s):  
Blood Pressure ◽  
Postural Hypotension ◽  
Autonomic Failure ◽  
Meal Size

Effect of the Somatostatin Analogue, Octreotide, on Exercise-Induced Hypotension in Human Subjects with Chronic Sympathetic Failure

1995 ◽  
Vol 89 (4) ◽  
pp. 367-373 ◽  
Author(s):  
G. D. P. Smith ◽  
M. Alam ◽  
L. P. Watson ◽  
C. J. Mathias
Keyword(s):  
Blood Pressure ◽  
Postural Hypotension ◽  
Autonomic Failure ◽  
Somatostatin Analogue ◽  
Induced Hypotension ◽  
Post Exercise ◽  
Blood Pressure Fall ◽  
Before And After ◽  
Exercise Induced ◽  
Pressure Fall

1. In autonomic failure, supine exercise lowers blood pressure and worsens postural hypotension. The somatostatin analogue, octreotide, reduces postprandial and postural hypotension, but its effects on exercise-induced hypotension and on postural hypotension post-exercise are unknown. 2. Eighteen subjects with chronic sympathetic denervation were studied; 12 had pure autonomic failure and six had additional neurological features of the Shy—Drager syndrome. Haemodynamic, hormonal and biochemical changes were measured before, during and after incremental supine leg exercise on two occasions: on no treatment and after subcutaneous octreotide. Exercise was performed 120 min after octreotide in eight subjects and 60 min after octreotide in ten subjects. 3. Octreotide did not improve exercise-induced hypotension; the blood pressure fall was greater during exercise, but the blood pressure level was no different than without treatment. Heart rate, stroke distance, cardiac index and systemic vascular resistance were similar at rest and changed to the same degree with exercise on and off octreotide. After octreotide, resting levels of serum growth hormone, plasma noradrenaline, adrenaline and renin were unchanged, but glucose was higher and insulin was lower. There was no change in biochemical and hormone levels during exercise either off or on octreotide. 4. After octreotide, although the rate of blood pressure recovery was similar post-exercise, the levels of blood pressure were higher than in the non-treatment phase and postural hypotension was improved before and after exercise. 5. In conclusion, in primary autonomic failure, octreotide did not improve exercise-induced hypotension in the supine position, suggesting that octreotide-sensitive vasodilatory peptides do not contribute to the blood pressure fall. With octreotide, supine blood pressure levels were higher post-exercise and postural hypotension was improved both before and after exercise.

Alcohol ingestion lowers supine blood pressure, causes splanchnic vasodilatation and worsens postural hypotension in primary autonomic failure

1993 ◽  
Vol 241 (3) ◽  
pp. 145-152 ◽  
Author(s):  
K. Ray Chaudhuri ◽  
S. Maule ◽  
T. Thomaides ◽  
D. Pavitt ◽  
C. J. Mathias
Keyword(s):  
Blood Pressure ◽  
Postural Hypotension ◽  
Autonomic Failure ◽  
Alcohol Ingestion ◽  
Supine Blood Pressure

VASOPRESSIN AND THE REGULATION OF FIBRINOLYSIS: HAEMOSTATIC RESPONSES TO HYPOTENSION IN THE ABSENCE OF ADRENALINE RELEASE

1987 ◽  
Author(s):  
K K Hampton ◽  
P J Grant ◽  
M Boothby ◽  
J A Davies ◽  
C R M Prentice
Keyword(s):  
Blood Pressure ◽  
Plasminogen Activator ◽  
Postural Hypotension ◽  
Autonomic Failure ◽  
Plasma Concentrations ◽  
Mean Blood Pressure ◽  
Plasma Adrenaline ◽  
Plasminogen Activator Activity ◽  
Adrenaline Release ◽  
Lying Down

Vasopressin (aVP) infusions resulting in plasma concentrations that simulate those during stress cause increases in factor VIII (EVTII) and plasminogen activator activity (PAA). During apcmorphine induced nausea and abdominal surgery similar increases in aVP are associated with elevated FVIII and PAA suggesting aVP is a mediator of haemostatic function. However during stress there is release of adrenaline which has similar effects on haemostasis. The aim of this study was to investigate the effects of endogenous aVP release on haemostasis in patients with postural hypotension (a potent stimulus to aVP release) due to autonomic neuropathy who have absent circulating adrenaline. The study was performed in i) three patients with progressive autonomic failure (PAF) who release aVP but not adrenaline ii) three patients with PAF with multi-system atrophy (MSA, the Shy-Drager syndrome) who have deficient release of both aVP and adrenaline. After lying down overnight patients stood for 2 minutes on 3 occasions at 1 hour intervals. Samples were taken for aVP, adrenaline, ECLT and FVIII. In PAF mean blood; pressure fell from 108 lying to 47 irmHg standing. Pulse did not change. aVP rose from 1.2 lying to 56 pg/ml standing. Plasma adrenaline was sub-normal throughout. Median PAA (106 /ECLT2 ) lying was 92 and rose on standing to 376 units and correlated with plasma aVP (r = 0.87, p < 0.0001). In PAF with MSA mean blood pressure fell from 107 lying to 61 irmHg standing. aVP levels did not change and adrenaline remained below normal. PAA rose from a median 30 lying to 87 units standing. No change in FVIII was observed in either group. The results suggest that aVP regulates plasminogen activator activity in the absence of adrenaline. The lack of a rise in FVIII suggests that circulating adrenaline may be necessary for aVP to exert an effect on FVIII concentrations.

Blood Pressure Variability in Health, Hypertension and Autonomic Failure

1985 ◽  
Vol 7 (2-3) ◽  
pp. 187-194 ◽  
Author(s):  
Stewart Mann ◽  
Michael W. Millar Craig ◽  
Douglas G. Altman ◽  
E. B. Raftery ◽  
S. N. Hunyor
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Variability ◽  
Autonomic Failure

Hypotensive and Regional Haemodynamic Effects of Exercise, Fasted and after Food, in Human Sympathetic Denervation

1998 ◽  
Vol 94 (1) ◽  
pp. 49-55 ◽  
Author(s):  
Sharmini Puvi-Rajasingham ◽  
Gareth D. P. Smith ◽  
Adeola Akinola ◽  
Christopher J. Mathias
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Superior Mesenteric Artery ◽  
Vascular Resistance ◽  
Mesenteric Artery ◽  
Autonomic Failure ◽  
Sympathetic Denervation ◽  
Stroke Distance

1. In human sympathetic denervation due to primary autonomic failure, food and exercise in combination may produce a cumulative blood pressure lowering effect due to simultaneous splanchnic and skeletal muscle dilatation unopposed by corrective cardiovascular reflexes. We studied 12 patients with autonomic failure during and after 9 min of supine exercise, when fasted and after a liquid meal. Standing blood pressure was also measured before and after exercise. 2. When fasted, blood pressure fell during exercise from 162 ± 7/92 ± 4 to 129 ± 9/70 ± 5 mmHg (mean arterial pressure by 22 ± 5%), P < 0.0005. After the meal, blood pressure fell from 159 ± 8/88 ± 6 to 129 ± 6/70 ± 4 mmHg (mean arterial pressure by 22 ± 3%), P < 0.0001, and further during exercise to 123 ± 6/61 ± 3 mmHg (mean arterial pressure by 9 ± 3%), P < 0.01. The stroke distance—heart rate product, an index of cardiac output, did not change after the meal. During exercise, changes in the stroke distance—heart rate product were greater when fasted. 3. Resting forearm and calf vascular resistance were higher when fasted. Calf vascular resistance fell further after exercise when fasted. Resting superior mesenteric artery vascular resistance was lower when fed; 0.19 ± 0.02 compared with 032 ± 0.06, P < 0.05. After exercise, superior mesenteric artery vascular resistance had risen by 82%, to 0.53 ± 0.12, P < 0.05 (fasted) and by 47%, to 0.29 ± 0.05, P < 0.05 (fed). 4. On standing, absolute levels of blood pressure were higher when fasted [83 ± 7/52 ± 7 compared with 71 ± 2/41 ± 3 (fed), each P < 0.05]. Subjects were more symptomatic on standing post-exercise when fed. 5. In human sympathetic denervation, exercise in the fed state lowered blood pressure further than when fasted and worsened symptoms of postural hypotension.

Severe Postural Hypotension Due to Imipramine Therapy

PEDIATRICS ◽  
1971 ◽  
Vol 47 (1) ◽  
pp. 132-134
Author(s):  
George W. Koehl ◽  
James E. Wenzel
Keyword(s):  
Blood Pressure ◽  
Physical Examination ◽  
Postural Hypotension ◽  
Toilet Training ◽  
Toxic Effects ◽  
Wide Acceptance ◽  
Complete History ◽  
Caucasian Female

The use of imipramine in the treatment of childhood enuresis has recently gained wide acceptance. The drug is known to be quite toxic to children who accidentally ingest it.1-4 Instances of incapacitating toxic effects caused by therapeutic dosages of the drug have not, to the best of our knowledge, been reported in children. It is our purpose to report a case of severe postural hypotension associated with therapeutic dosages of this drug. Report of a Case A 9-year-old Caucasian female was evaluated because of enuresis which had been present since toilet training was begun at age 2 years. A complete history and physical examination were nonrevealing; her pulse was 82 beats per minute and blood pressure was 110/75 mm Hg.

Abstract 022: Blood Pressure-Lowering Effect of Local Passive Heat in Autonomic Failure Patients with Supine Hypertension

Hypertension ◽  
2016 ◽  
Vol 68 (suppl_1) ◽  
Author(s):  
Luis E Okamoto ◽  
Jorge E Celedonio ◽  
Alfredo Gamboa ◽  
Cyndya A Shibao ◽  
Satish R Raj ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Autonomic Failure ◽  
Core Body Temperature ◽  
Sham Control ◽  
Blood Pressure Lowering Effect ◽  
Supine Hypertension ◽  
Lowering Effect ◽  
Pressure Lowering ◽  
Core Body ◽  
To Receive

Primary autonomic failure (AF) is characterized by disabling orthostatic hypotension that is acutely worsened by environmental heat. Given that about half of AF patients have paradoxical supine hypertension, we hypothesized that controlled local passive heat would lower supine blood pressure (BP) in these patients. Fourteen AF patients with supine hypertension (age 71±2 years, 9 men, systolic BP 172±6 mmHg) were randomized to receive passive heat (40-42°C, commercial heating pad over abdomen and pelvis) and sham control for up to 2 hours in a 2-day crossover study. Hemodynamic parameters and core body and skin temperatures were measured in the supine position. The heating pad increased abdominal skin temperature to 40.8±0.4°C and 40.1±0.3°C after 1 and 2 hours of passive heat (vs 35.2±0.2°C and 35.1±0.4°C in sham controls). Core body temperature increased after 1 hour (by 0.2±0.1°C [to 36.9±0.8°C] vs 0.0°C [36.7±0.1°C] in sham controls; P=0.04) and 2 hours (by 0.4±0.1°C [to 37.2±0.1°C] vs 0.1±0.03°C [to 36.8±0.1°C] in sham controls; P=0.04). Systolic BP decreased during heat stress compared to sham control (P<0.01 by mixed-effects model) with a maximal reduction at 1.7 hours of -26±5 mmHg (Figure). This BP drop was due to a decrease in cardiac output (-30±5% vs sham -5±3%; P=0.02) and stroke volume (-29±5% vs sham -6±3%; P<0.01). Systemic vascular resistance and heart rate were similar in both groups. In conclusion, low levels of local passive heat had a BP-lowering effect in AF patients with supine hypertension presumably due to an uncompensated decrease in central blood volume. The therapeutic application of this approach needs to be addressed in future studies.

Rotigotine Improves Abnormal Circadian Rhythm of Blood Pressure in Parkinson’s Disease

2018 ◽  
Vol 79 (5-6) ◽  
pp. 281-286 ◽  
Author(s):  
Hisayoshi Oka ◽  
Atuso Nakahara ◽  
Tadashi Umehara
Keyword(s):  
Blood Pressure ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Circadian Rhythm ◽  
Time Course ◽  
Autonomic Failure ◽  
Not Given ◽  
Daily Lives ◽  
Dopaminergic Drugs ◽  
Autonomic Responses

Introduction: Cardiovascular autonomic failure is commonly associated with Parkinson’s disease (PD), affecting the daily lives of patients. Rotigotine was recently reported not to influence cardiovascular autonomic responses in contrast to other dopaminergic drugs. The effect of rotigotine on daily blood pressure (BP) fluctuations might reflect autonomic failure in patients with PD. Methods: Twenty-five PD patients who were receiving rotigotine and 12 patients not receiving rotigotine were recruited. Systolic BP during the daytime and nighttime was measured by 24-h BP monitoring at an interval of 2 years. The patients were divided into 3 groups according to the BP fluctuation type: dippers (nocturnal fall in BP ≥10%), non-dippers (0–10%), and risers (< 0%). The time course of BP was compared between the patients given rotigotine and those not given rotigotine. Results: Among the 25 patients who received rotigotine, the BP type worsened in 2 patients, was unchanged in 16 patients, and improved in 7 patients. Among the 12 patients who were not receiving rotigotine, the BP type worsened in 5 patients, was unchanged in 4 patients, and improved only in 3 patients (p = 0.042). Conclusion: Rotigotine improves the abnormal circadian rhythm of BP in patients with PD. Rotigotine was suggested to have favorable effects on cardiovascular autonomic responses and circadian rhythm in patients with PD.

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