P238: A survey of technique for measuring lying and standing blood pressure

Abstract. Current drugs used for hyperprolactinemia may have severe side effects. Effects and side effects of a new propylergoline derivate (CQP 201-403 SANDOZ®) have been evaluated. Twenty-four otherwise healthy women (21–44 years) with hyperprolactinemia (35–318 μg/l) without extrasellar extension of pituitary adenomas took part in a randomized, doubleblind study. Fasting prolactin levels measured on day 7 was significantly decreased when compared with day 1 (P < 0.05) in all CQP groups, to 78% with 0.005 mg daily, to 40% with 0.015 mg daily, and to 27% with 0.025 mg CQP per day for one week. The levels in the control group did not change (96%). The area under the curve of the prolactin day curve (1–8 h after drug administration) decreased significantly (P < 0.05) at all doses when day 7 was compared with day 1, to 77% with 0.005 mg, to 51% with 0.015 mg, and to 37% with 0.025 mg CQP. No change was seen in the control group (96%). Four patients (one on 0.005 mg, one on 0.015 mg, and two on 0.025 mg) experienced orthostatic hypotension while standing blood pressure was to be measured on the first day of treatment, and they had to lie down. CQP 201-403 lowers prolactin levels in hyperprolactinemic women at all doses employed. The effect was seen after the first dose of treatment, and lasted for at least 24 h. The adverse reactions are few and tolerable, and might be less than with current bromocriptine therapy.

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The Transient Anti-Hypertensive Effect of Phentolamine in Patients Receiving Beta-Blocker Treatment

Journal of International Medical Research ◽

10.1177/030006057300100214 ◽

1973 ◽

Vol 1 (2) ◽

pp. 462-464

Author(s):

Ann Dawson ◽

Ian Smith ◽

Brian F Johnson

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Essential Hypertension ◽

Beta Blocker ◽

Peak Plasma ◽

Beta Blockers ◽

Peak Plasma Concentration ◽

Hypotensive Effect ◽

Additional Reduction ◽

Standing Blood Pressure

In seven hypertensives receiving beta-blocker drugs, an additional reduction in standing blood pressure occurred between 60 and 90 minutes after 40 mg phentolamine by mouth. The occurrence of the postural hypotensive effect was delayed in relation to the reported time of peak plasma concentration of unchanged phentolamine. Supine blood pressure and heart rate were unaffected. Phentolamine has no clinically useful anti-hypertensive effect in conjunction with beta-blockers in patients with essential hypertension.

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Neurogenic Orthostatic Hypotension: State of the Art and Therapeutic Strategies

Clinical Medicine Insights Cardiology ◽

10.1177/1179546820953415 ◽

2020 ◽

Vol 14 ◽

pp. 117954682095341

Author(s):

Dinesh K Kalra ◽

Anvi Raina ◽

Sumit Sohal

Keyword(s):

Blood Pressure ◽

Orthostatic Hypotension ◽

Clinical Features ◽

Autonomic Dysfunction ◽

State Of The Art ◽

Therapeutic Strategies ◽

Review Article ◽

Neurogenic Orthostatic Hypotension ◽

Standing Blood Pressure ◽

Secondary Causes

Neurogenic orthostatic hypotension (nOH) is a subtype of orthostatic hypotension in which patients have impaired regulation of standing blood pressure due to autonomic dysfunction. Several primary and secondary causes of this disease exist. Patients may present with an array of symptoms making diagnosis difficult. This review article addresses the epidemiology, pathophysiology, causes, clinical features, and management of nOH. We highlight various pharmacological and non-pharmacological approaches to treatment, and review the recent guidelines and our approach to nOH.

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The Use of Frusemide and Propranolol in the Treatment of the Hypertension of Chronic Renal Disease

Scottish Medical Journal ◽

10.1177/00369330740190s106 ◽

1974 ◽

Vol 19 (1_suppl) ◽

pp. 25-32 ◽

Cited By ~ 2

Author(s):

R. Wilkinson ◽

Mary Pickering ◽

Valerie Robson ◽

R. W. Elliott ◽

D. N. S. Kerr

Keyword(s):

Blood Pressure ◽

Renal Function ◽

Renal Disease ◽

Serum Creatinine ◽

Marked Reduction ◽

Chronic Renal Disease ◽

Plasma Renin ◽

Sodium Retention ◽

Exchangeable Sodium ◽

Standing Blood Pressure

Nine patients with renal disease, hypertension and impairment of renal function of varying degree have been studied before and during treatment with frusemide. In three patients observations were repeated following the addition of propranolol. In most cases frusemide resulted in a reduction of both lying and standing blood pressure but for the group the fall was not significant (P>0.05). In all patients a reduction in exchangeable sodium was achieved and the fall was significant for the group (P<0.05); this was accompanied by a significant increase in serum creatinine (P < 0.05). Plasma renin activity was increased in all patients during treatment with frusemide and the change for the group was significant (P<0.05). The addition of propranolol resulted in a marked reduction in renin in the three patients treated but in two blood pressure actually rose; in these two sodium retention had occurred following the introduction of propranolol.

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Leg strengthening exercise to improve standing blood pressure response during muscle tensing in the treatment of orthostatic hypotension

http://isrctn.com/ ◽

10.1186/isrctn45337422 ◽

2020 ◽

Author(s):

James Frith

Keyword(s):

Blood Pressure ◽

Orthostatic Hypotension ◽

Blood Pressure Response ◽

Pressure Response ◽

Strengthening Exercise ◽

Standing Blood Pressure

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Angiotensin II Blockade in Normal Subjects and Essential Hypertensive Patients

Clinical Science ◽

10.1042/cs051193s ◽

1976 ◽

Vol 51 (s3) ◽

pp. 193s-196s

Author(s):

G. A. MacGregor ◽

P. M. Dawes

Keyword(s):

Blood Pressure ◽

Essential Hypertension ◽

Angiotensin Ii ◽

Sodium Intake ◽

Normal Subjects ◽

Competitive Inhibitor ◽

Hypertensive Patients ◽

Sodium Diet ◽

Incremental Rate ◽

Standing Blood Pressure

1. Saralasin (Sar1-Ala8-angiotensin II), a competitive inhibitor of angiotensin II (AII), has been infused into normal subjects and patients with essential hypertension when deprived of sodium by 5 days of a 10 mmol/day sodium diet. 2. When saralasin was given by an incremental rate of infusion starting at 0·25 μg min—1 kg—1, sodium-deprived normal subjects showed a fall in standing blood pressure with no change in lying blood pressure, sodium-deprived normal-renin hypertensive patients showed no change in lying or standing blood pressure and sodium-deprived low-renin patients showed a significant sustained rise in lying and standing blood pressure. 3. These findings suggest that: (a) standing blood pressure in sodium-deprived normal subjects is angiotensin II dependent; (b) normal-renin hypertensive patients when sodium deprived by diet alone do not appear to be angiotensin II dependent (angiotensin II is unlikely therefore to be directly maintaining their blood pressure on their normal sodium intake); (c) the rise in blood pressure seen in low-renin hypertensive patients with saralasin may be a further way of distinguishing this group of patients.

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Comparison of baroreflex sensitivity with a fall and rise in blood pressure induced by the Valsalva manoeuvre

Clinical Science ◽

10.1042/cs20130802 ◽

2014 ◽

Vol 127 (5) ◽

pp. 307-313 ◽

Cited By ~ 9

Author(s):

Naoki Wada ◽

Wolfgang Singer ◽

Tonette L. Gehrking ◽

David M. Sletten ◽

James D. Schmelzer ◽

...

Keyword(s):

Blood Pressure ◽

Baroreflex Sensitivity ◽

Clinical Laboratory ◽

Valsalva Manoeuvre ◽

Heart Period ◽

Simple Method ◽

Standing Blood Pressure

The baroreflexes are essential in maintaining standing blood pressure. In the present study, we describe and validate an accurate and relatively simple method of evaluating baroreflexes in the clinical laboratory using heart period responses to both a rise and fall in blood pressure.

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Sitting and standing blood pressure measurements are not accurate for the diagnosis of orthostatic hypotension

QJM ◽

10.1093/qjmed/hcp020 ◽

2009 ◽

Vol 102 (5) ◽

pp. 335-339 ◽

Cited By ~ 32

Author(s):

J. Cooke ◽

S. Carew ◽

M. O'Connor ◽

A. Costelloe ◽

T. Sheehy ◽

...

Keyword(s):

Blood Pressure ◽

Orthostatic Hypotension ◽

Pressure Measurements ◽

Standing Blood Pressure

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Safety and efficacy of ampreloxetine in symptomatic neurogenic orthostatic hypotension: a phase 2 trial

Clinical Autonomic Research ◽

10.1007/s10286-021-00827-0 ◽

2021 ◽

Author(s):

Horacio Kaufmann ◽

Ross Vickery ◽

Whedy Wang ◽

Jitendra Kanodia ◽

Cyndya A. Shibao ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Orthostatic Hypotension ◽

Controlled Study ◽

Neurogenic Orthostatic Hypotension ◽

Median Dose ◽

Double Blind ◽

Supine Blood Pressure ◽

Part C ◽

Standing Blood Pressure

Abstract Purpose In neurogenic orthostatic hypotension, blood pressure falls when upright owing to impaired release of norepinephrine, leading to dizziness. Ampreloxetine, a selective norepinephrine reuptake inhibitor, increases circulating norepinephrine levels. This study explored the safety of ampreloxetine and its effect on blood pressure and symptoms in patients with neurogenic orthostatic hypotension. Methods A multicenter ascending-dose trial (range 1–20 mg, Part A) was followed by a 1 day, double-blind, randomized, placebo-controlled study (median dose 15 mg, Part B). Eligible patients then enrolled in a 20-week, open-label, steady-state extension phase (median dose 10 mg, Part C) followed by a 4-week withdrawal. Assessments included the Orthostatic Hypotension Symptom Assessment Scale (item 1), supine/seated/standing blood pressure, and safety. Results Thirty-four patients (age 66 ± 8 years, 22 men) were enrolled. Part A: The proportion of participants with a positive response (i.e., increase from baseline in seated systolic blood pressure of ≥ 10 mmHg) was greater with the 5 and 10 mg ampreloxetine doses than with placebo or other active ampreloxetine doses. Part B: Seated blood pressure increased 15.7 mmHg 4 h after ampreloxetine and decreased 14.2 mmHg after placebo [least squares mean difference (95% CI) 29.9 mmHg (7.6–52.3); P = 0.0112]. Part C: Symptoms of dizziness/lightheadedness improved 3.1 ± 3.0 points from baseline and standing systolic blood pressure increased 11 ± 12 mmHg. After 4 weeks of withdrawal, symptoms returned to pretreatment levels. The effect of ampreloxetine on supine blood pressure was minimal throughout treatment duration. Conclusion Ampreloxetine was well tolerated and improved orthostatic symptoms and seated/standing blood pressure with little change in supine blood pressure. Trial registration NCT02705755 (first posted March 10, 2016).

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