Evidence for fludrocortisone in postural hypotension

Abstract Background Peripheral neuropathy is one of the most frequent adverse events associated to bortezomib therapy; among neuropathic syndromes, postural hypotension is described as well. However, information on disautonomic toxicity are limited and there are no studies addressed to this particular issue so far. Before starting this study we had observed a case of dramatic acute autonomic failure during bortezomib treatment in a patient with advanced multiple myeloma, who developed severe orthostatic hypotension, tachycardia and impairment to tolerate the sitting and orthostatic posture for several weeks. Methods We prospectively studied 12 consecutive patients, treated with bortezomib at our Institution between February 2005 and July 2006. Assessment included neurological examination, INCAT Disability scale, INCAT sensory sum score, MRC sum score, nerve conduction studies, and standard cardiovascular autonomic tests including Lying to standing, Deep breathing and Postural hypotension. These tests were conducted baseline and after each bortezomib 21-days cycle up to three consecutive cycles. Results Two pts showed a clinically evident autonomic involvement with orthostatic hypotension; a change to a pathological score in 2 out of 3 tests anticipated clinical disautonomic signs in 1 and 11 weeks respectively. Clinical impairment showed to be reversible in both cases. Four pts presented only 1 pathological test (without any clinical sign or symptom of postural hypotension) and 6 patient had normal results. There was no apparent correlation between autonomic impairment and disease response to therapy or patients baseline characteristics (disease stage, Ig class, previous anti-myeloma therapies, concomitant thalidomide or anti-hypertensive treatment); furthermore, none had evidence of amyloidosis. Conclusions Our prospective study confirms that autonomic dysfunction is a potential adverse effect of bortezomib. Autonomic, non invasive, cardiovascular testing may reveal subclinical involvement and precede clinical evidence of disautonomic neuropathy. Further studies in larger cohorts of patients are needed to clarify the interactions between proteasome inhibitor activity and autonomic nervous system, in order to assess the frequency, the ability of available test in early pre-clinical diagnosis and the potential of the reversibility of neuropathic signs after drug discontinuation.

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Drug-related Postural Hypotension: to Withdraw or Not to Withdraw (A Case Series)

International Journal of Human and Health Sciences (IJHHS) ◽

10.31344/ijhhs.v3i4.110 ◽

2019 ◽

Vol 3 (4) ◽

pp. 241

Author(s):

Fadzilah Mohamad ◽

Navin Kumar Devaraj ◽

Aneesa Abdul Rashid ◽

Abdul Hadi Abdul Manap

Keyword(s):

Primary Care ◽

Orthostatic Hypotension ◽

Postural Hypotension ◽

Care Setting ◽

Primary Care Setting ◽

Case Series ◽

The Elderly ◽

Health Sciences ◽

Significant Morbidity ◽

Common Presentation

Orthostatic hypotension is a common presentation in the primary care setting. Concise management is important as it can lead to falls, particularly in the elderly and can lead to significant morbidity and mortality. Its management presents as a challenge as there are differing guidelines on managing these patients. This case report illustrates two cases of drug-related orthostatic hypotension with similar presentation, however both were managed differently.International Journal of Human and Health Sciences Vol. 03 No. 04 October’19 Page : 241-244

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Arterial stiffness is a potential mechanism and promising indicator of orthostatic hypotension in the general population

VASA ◽

10.1024/0301-1526/a000389 ◽

2014 ◽

Vol 43 (6) ◽

pp. 423-432 ◽

Cited By ~ 11

Author(s):

Qingtao Meng ◽

Si Wang ◽

Yong Wang ◽

Shixi Wan ◽

Kai Liu ◽

...

Keyword(s):

General Population ◽

Arterial Stiffness ◽

Orthostatic Hypotension ◽

Operating Characteristic ◽

Pulse Wave ◽

Augmentation Index ◽

Multiple Logistic Regression Analysis ◽

The Elderly ◽

Baroreceptor Sensitivity ◽

Roc Curve Analysis

Background: Orthostatic hypotension (OH) is a disease prevalent among middle-aged men and the elderly. The association between arterial stiffness and OH is unclear. This study evaluates whether arterial stiffness is correlated with OH and tests the usefulness of brachial-ankle pulse wave velocity (baPWV), an arterial stiffness marker, with regard to identifying OH. Patients and methods: A sample of 1,010 participants was recruited from the general population (64.8 ± 7.7 years; 426 men) who attended health check-ups. BaPWV and the radial augmentation index (rAI) were both assessed as the arterial stiffness markers, and OH was determined using blood pressure (BP) measured in the supine position, as well as 30 seconds and 2 minutes after standing. Results: The prevalence of OH in this population was 4.9 %. Compared with the non-OH group, both baPWV (20.5 ± 4.5 vs 17.3 ± 3.7, p < 0.001) and rAI (88.1 ± 10.8 vs 84.2 ± 10.7, p < 0.05) were significantly higher in the OH group. In the multiple logistic regression analysis, baPWV (OR, 1.3; 95 % CI, 1.106–1.528; p < 0.05) remained associated with OH. Moreover, the degree of orthostatic BP reduction was related to arterial stiffness. In addition, increases in arterial stiffness predicted decreases in the degree of heart rate (HR) elevation. Finally, a receiver operating characteristic (ROC) curve analysis showed that baPWV was useful in discriminating OH (AUC, 0.721; p < 0.001), with the cut-off value of 18.58 m/s (sensitivity, 0.714; specificity, 0.686). Conclusions: Arterial stiffness determined via baPWV, rather than rAI, was significantly correlated with the attenuation of the orthostatic hemodynamic response and the resultant OH. The impaired baroreceptor sensitivity might be the mechanism. In addition, baPWV appears to be a relatively sensitive and reliable indicator of OH in routine clinical practice.

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Pharmakologische Akutbehandlung Methamphetamin-bezogener Störungen: systematische übersicht gemäß einer S3-Leitlinie mit ausgewählten Beispielen

SUCHT - Zeitschrift für Wissenschaft und Praxis / Journal of Addiction Research and Practice ◽

10.1024/0939-5911/a000615 ◽

2019 ◽

Vol 65 (4) ◽

pp. 273-285

Author(s):

Norbert Wodarz ◽

Michael Christ ◽

Heribert Fleischmann ◽

Winfried Looser ◽

Katharina Schoett ◽

...

Keyword(s):

Systematische Übersicht ◽

Medikamentöse Behandlung ◽

Systematische Übersichtsarbeiten ◽

Cochrane Database

Zusammenfassung. Zielsetzung: Die medikamentöse Behandlung akuter Methamphetamin-induzierter Störungen wie Intoxikationssyndrome, akute Entzugssyndrome oder Psychosen bekommt durch die Zunahme des „Crystal“ Konsums eine besondere Relevanz. Es wird über die Erarbeitung einer S 3-Leitlinie und ausgewählte Beispiele für die Behandlung der genannten Störungsbilder berichtet. Methode: Auf Basis einer systematische Literatur- und Leitlinienrecherche zu therapeutischen Interventionen bei Methamphetamin-bezogenen Störungen in den Datenbanken Cochrane-Database, Medline, PSYINDEX, OVID, „PsycINFO“, G-I-N-Library sowie der AWMF-Datenbank wurden für den Zeitraum 2000 bis Juni 2015 insgesamt 103 Publikationen und 9 systematische übersichtsarbeiten einbezogen. In einer Arbeitsgruppe von 21 Personen aus verschiedenen Fachgesellschaften wurden im nominalen Gruppenprozess (Zustimmung > 75 %) Empfehlungen in drei Konsensuskonferenzen und einer öffentlichen Anhörung bis Juni 2015 konsentiert. Ergebnisse: Mittel der Wahl bei Methamphetamin-induzierten Intoxikationssyndromen, insbesondere mit akuter Erregung, sind Benzodiazepine. Die Behandlung der Entzugssyndrome erfolgt symptomorientiert. Bei der Behandlung von Psychosen sollte zunächst gemäß aktueller Behandlungsleitlinien bei schizophrenen Psychosen vorgegangen werden. Schlussfolgerungen: Es liegt nur wenig spezifische und positive Evidenz zur medikamentösen Akutbehandlung Methamphetamin-induzierter Störungen vor. Die Empfehlungen basieren daher im Wesentlichen auf klinischem Expertenkonsens. Insgesamt besteht weiterer Forschungsbedarf.

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Pyridostigmine Raises Standing BP in Orthostatic Hypotension

Family Practice News ◽

10.1016/s0300-7073(06)73270-4 ◽

2006 ◽

Vol 36 (11) ◽

pp. 14

Author(s):

Mary Ann Moon

Keyword(s):

Orthostatic Hypotension

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Postural Changes in Essential Hypertension under Treatment and their Effect on the Renogram

Nuklearmedizin ◽

10.1055/s-0038-1624732 ◽

1971 ◽

Vol 10 (01) ◽

pp. 39-46

Author(s):

C. Alexandrou ◽

E. Papadakis ◽

E. Gyftaki ◽

J. Darsinos

Keyword(s):

Renal Function ◽

Essential Hypertension ◽

Early Diagnosis ◽

Postural Hypotension ◽

Antihypertensive Treatment ◽

Normal Subjects ◽

Upright Position ◽

Postural Changes ◽

Significant Impairment

SummaryRadioisotope renograms were obtained in the upright and prone position in 9 normal subjects, in 5 patients with untreated essential hypertension and in 21 hypertensives under treatment, showing moderate postural hypotension.No significant renographic change were seen in the two positions in normal subjects and untreated hypertensives. Treated hypertensives with postural hypotension showed significant impairment of renal function in the upright position in 15 cases and no change in 6. Renal creatinine clearance was lower in the group that showed renographic changes. Renography in the upright position is suggested as a convenient test for early diagnosis and follow-up of the adverse effects of antihypertensive treatment.

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