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

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.

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Neck and other muscle pains in autonomic failure: their association with orthostatic hypotension

Journal of the Royal Society of Medicine ◽

10.1177/014107689809100704 ◽

1998 ◽

Vol 91 (7) ◽

pp. 355-359 ◽

Cited By ~ 50

Author(s):

K M Bleasdale-Barr ◽

C J Mathias

Keyword(s):

Blood Pressure ◽

Neck Pain ◽

Orthostatic Hypotension ◽

Autonomic Failure ◽

Lower Blood Pressure ◽

Buttock Pain ◽

Blood Pressure Fall ◽

Lower Blood ◽

Calf Pain ◽

Pressure Fall

Neck pain in the suboccipital and paracervical region (‘coathanger' configuration) is often reported by patients with autonomic failure and orthostatic hypotension. The frequency of this pain, along with pains in the buttock and calf regions, was determined by questionnaire in two major groups with primary chronic autonomic failure—pure autonomic failure (PAF) and multiple system atrophy (MSA). Comparisons were made with Parkinson's disease, cerebellar degeneration and other disorders in which neurological symptoms overlap but in which there was neither autonomic failure nor orthostatic hypotension. Neck pain was present in 93% of patients with PAF, 51% of patients with MSA and 38–47% of the non-autonomic groups. Buttock pain was present in smaller but similar proportions (8–19%) of each group, like calf pain (23–37%). Neck pain in PAF and MSA differed from that in the other groups in being relieved by sitting or lying flat and in being associated with factors that lower blood pressure in these patients. Buttock pain was posturally related in PAF and MSA; for calf pain there was no difference between groups. Neck pain was related to the degree of orthostatic hypotension; in PAF patients, whose postural blood-pressure fall was greater than that in MSA, there was a greater frequency of neck pain.

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Effects of midodrine on exercise-induced hypotension and blood pressure recovery in autonomic failure

Journal of Applied Physiology ◽

10.1152/japplphysiol.00547.2004 ◽

2004 ◽

Vol 97 (5) ◽

pp. 1978-1984 ◽

Cited By ~ 19

Author(s):

William G. Schrage ◽

John H. Eisenach ◽

Frank A. Dinenno ◽

Shelly K. Roberts ◽

Christopher P. Johnson ◽

...

Keyword(s):

Blood Pressure ◽

Blood Flow ◽

Autonomic Failure ◽

Peripheral Resistance ◽

Venous Occlusion ◽

Open Circuit ◽

Induced Hypotension ◽

Calf Exercise ◽

Exercise Induced ◽

Similar Peak

We tested the hypothesis that the oral α1-adrenergic agonist, midodrine, would limit the fall in arterial pressure observed during exercise in patients with pure autonomic failure (PAF). Fourteen subjects with PAF underwent a stand test, incremental supine cycling exercise (25, 50, and 75 W), and ischemic calf exercise, before (control) and 1 h after ingesting 10 mg midodrine. Heart rate (ECG), beat-to-beat blood pressure (MAP, arterial catheter), cardiac output (Q̇, open-circuit acetylene breathing), forearm blood flow (FBF, Doppler ultrasound), and calf blood flow (CBF, venous occlusion plethysmography) were measured. The fall in MAP after standing for 2 min was similar (∼60 mmHg; P = 0.62). Supine MAP immediately before cycling was greater after midodrine (124 ± 6 vs 117 ± 6 mmHg; P < 0.03), but cycling caused a workload-dependent hypotension ( P < 0.001), whereas increases in Q̇ were modest but similar. Midodrine increased MAP and total peripheral resistance (TPR) during exercise ( P < 0.04), but the exercise-induced fall in MAP and TPR were similar during control and midodrine ( P = 0.27 and 0.14). FBF during cycling was not significantly reduced by midodrine ( P > 0.2). By contrast, recovery of MAP after cycling was faster ( P < 0.04) after midodrine (∼25 mmHg higher after 5 min). Ischemic calf exercise evoked similar peak CBF in both trials, but midodrine reduced the hyperemic response over 5 min of recovery ( P < 0.02). We conclude midodrine improves blood pressure and TPR during exercise and dramatically improves the recovery of MAP after exercise.

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The effects of the somatostatin analogue, octreotide, on postural hypotension, before and after food ingestion, in primary autonomic failure

Clinical Autonomic Research ◽

10.1007/bf01826210 ◽

1991 ◽

Vol 1 (2) ◽

pp. 135-140 ◽

Cited By ~ 22

Author(s):

Elaine Armstrong ◽

Christopher J. Mathias

Keyword(s):

Postural Hypotension ◽

Autonomic Failure ◽

Somatostatin Analogue ◽

Food Ingestion ◽

Before And After ◽

Analogue Octreotide

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Clonidine and Sympathetic Activity during Sleep

Clinical Science ◽

10.1042/cs0570509 ◽

1979 ◽

Vol 57 (6) ◽

pp. 509-514 ◽

Cited By ~ 27

Author(s):

T. J. B. Maling ◽

C. T. Dollery ◽

C. A. Hamilton

Keyword(s):

Blood Pressure ◽

Sympathetic Activity ◽

Slow Release ◽

Paradoxical Sleep ◽

Plasma Noradrenaline ◽

Sleep Period ◽

Blood Pressure Fall ◽

Before And After ◽

Pressure Fall ◽

Healthy Males

1. Blood pressure, heart rate, plasma noradrenaline and electroencephalographic variables were measured simultaneously during sleep in five healthy males before and after slow-release clonidine (300 μg orally) or placebo. 2. The blood pressure fall during sleep correlated significantly with the depth of sleep. 3. Clonidine significantly reduced systolic blood pressure during sleep and profoundly reduced total paradoxical sleep duration. 4. Plasma noradrenaline declined progressively during the sleep period and concentrations were significantly lower after clonidine compared with placebo.

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