scholarly journals Local Passive Heat for the Treatment of Hypertension in Autonomic Failure

2021 ◽  
Author(s):  
Luis E. Okamoto ◽  
Jorge E. Celedonio ◽  
Emily C. Smith ◽  
Alfredo Gamboa ◽  
Cyndya A. Shibao ◽  
...  
Keyword(s):  
Orthostatic Hypotension ◽  
Autonomic Failure ◽  
Local Heat ◽  
Organ Damage ◽  
Crossover Fashion ◽  
Fluid Loss ◽  
Supine Hypertension ◽  
Novel Approach ◽  
Treatment Of Hypertension

BackgroundSupine hypertension affects a majority of patients with autonomic failure; it is associated with end‐organ damage and can worsen daytime orthostatic hypotension by inducing pressure diuresis and volume loss during the night. Because sympathetic activation prevents blood pressure (BP) from falling in healthy subjects exposed to heat, we hypothesized that passive heat had a BP‐lowering effect in patients with autonomic failure and could be used to treat their supine hypertension.Methods and ResultsIn Protocol 1 (n=22), the acute effects of local heat (40–42°C applied with a heating pad placed over the abdomen for 2 hours) versus sham control were assessed in a randomized crossover fashion. Heat acutely decreased systolic BP by −19±4 mm Hg (versus 3±4 with sham,P<0.001) owing to decreases in stroke volume (−18±5% versus −4±4%,P=0.013 ) and cardiac output (−15±5% versus −2±4%,P=0.013). In Protocol 2 (proof‐of‐concept overnight study; n=12), we compared the effects of local heat (38°C applied with a water‐perfused heating pad placed under the torso from 10 pmto 6 am) versus placebo pill. Heat decreased nighttime systolic BP (maximal change −28±6 versus −2±6 mm Hg,P<0.001). BP returned to baseline by 8 am. The nocturnal systolic BP decrease correlated with a decrease in urinary volume (r=0.57,P=0.072) and an improvement in the morning upright systolic BP (r=−0.76,P=0.007).ConclusionsLocal heat therapy effectively lowered overnight BP in patients with autonomic failure and supine hypertension and offers a novel approach to treat this condition. Future studies are needed to assess the long‐term safety and efficacy in improving nighttime fluid loss and daytime orthostatic hypotension.RegistrationURL:https://www.clinicaltrials.gov; Unique identifiers: NCT02417415 and NCT03042988.

603 CHALLENGES IN THE MANAGEMENT OF SEVERE ORTHOSTATIC HYPOTENSION ASSOCIATED WITH SUPINE HYPERTENSION IN A PATIENT WITH AUTONOMIC DYSFUNCTION ON BACKGROUND OF NASOPHARYNGEAL CARCINOMA AND TYPE II DIABETES MELLITUS

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii14-ii18
Author(s):  
Q M N Rachel ◽  
K Mamun ◽  
M H Nguyen
Keyword(s):  
Blood Pressure ◽  
Nasopharyngeal Carcinoma ◽  
Orthostatic Hypotension ◽  
Carotid Sinus ◽  
Blood Pressure Monitoring ◽  
Pharmacological Interventions ◽  
Supine Hypertension ◽  
Neck Irradiation ◽  
Baroreflex Failure

Abstract Introduction Combined chemotherapy and radiotherapy increases long term survival in patients with nasopharyngeal carcinoma. However, radiotherapy of the carotid sinus or brain stem can evolve labile hypertension and orthostatic intolerance from chronic baroreflex failure. Diabetes would also cause this neuropathy. Management of patients with Supine hypertension-Orthostatic hypotension can be very challenging. Methods A case report was done on a 71-year-old man with metastatic nasopharyngeal carcinoma status post radiation therapy who was admitted with severe supine hypertension-orthostatic hypotension. Patient was managed with both non-pharmacological and pharmacological methods, and monitored for postural symptoms, complications of severe supine hypertension—which has been linked to left ventricular hypertrophy and kidney dysfunction, and placed on 24 hour ambulatory blood pressure monitoring to aid in management so as to prevent hypertension induced organ damage. Results This review outlines the pathophysiology of Supine hypertension-Orthostatic hypotension, treatment complications and potential management strategies recommendations for this group of patients. It revealed the benefit of having a 24 hour ambulatory blood pressure monitoring, which provides insight on the timing and magnitude of an individual’s blood pressure fluctuations throughout the day so as to further guide management. Conclusion Chronic baroreflex failure is a late sequela of neck irradiation for naso-pharyngeal carcinoma due to accelerated atherosclerosis in the region of the carotid sinus baroreceptor. Treatment goal is achieved with adequate control of pre-syncopal symptoms and prevention of long term complications. Non-pharmacological interventions remain the first line of therapy, followed by pharmacological interventions as necessary. Nonetheless, management of blood pressure in these elderly patients with baroreflex dysfunction remains challenging and should be individualized. Moving forward, a prospective study on the incidence of late onset, iatrogenic baroreflex failure as a late complication of neck irradiation and its particular relationship to carotid arterial rigidity should be conducted to increase awareness, timely diagnosis and management of the condition among physicians.

scholarly journals The impact of supine hypertension on target organ damage and survival in patients with synucleinopathies and neurogenic orthostatic hypotension

2020 ◽  
Vol 75 ◽  
pp. 97-104 ◽  
Author(s):  
Jose-Alberto Palma ◽  
Gabriel Redel-Traub ◽  
Angelo Porciuncula ◽  
Daniela Samaniego-Toro ◽  
Patricio Millar Vernetti ◽  
...  
Keyword(s):  
Orthostatic Hypotension ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Target Organ ◽  
Neurogenic Orthostatic Hypotension ◽  
Supine Hypertension ◽  
The Impact

scholarly journals Orthostatic Hypotension and Supine Hypertension in Primary Autonomic Failure

Hypertension ◽  
2005 ◽  
Vol 45 (6) ◽  
Author(s):  
Michelangelo Sartori ◽  
Achille C. Pessina ◽  
Andrea Semplicini
Keyword(s):  
Orthostatic Hypotension ◽  
Autonomic Failure ◽  
Supine Hypertension

Abstract P379: Patient and Caregiver Experiences With the Diagnosis of Neurogenic Orthostatic Hypotension

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Lawrence A Hewitt ◽  
Charles H Adler ◽  
Daniel O Claassen ◽  
Christopher H Gibbons ◽  
Satish R Raj
Keyword(s):  
Orthostatic Hypotension ◽  
Autonomic Failure ◽  
Pure Autonomic Failure ◽  
Accurate Diagnosis ◽  
First Year ◽  
Neurogenic Orthostatic Hypotension ◽  
Postural Change ◽  
Sustained Reduction ◽  
Caregiver Experiences

Objective: To understand the challenges to diagnosis in patients with neurogenic orthostatic hypotension (nOH) Background: nOH is a sustained reduction in blood pressure (BP) with postural change associated with autonomic dysfunction. Despite symptoms of nOH, many patients struggle to find an accurate diagnosis. Methods: An online, US-based survey designed by the authors was conducted by Harris Poll. Eligible participants were ≥18 years of age with Parkinson disease, multiple system atrophy, or pure autonomic failure and ≥1 of the following: orthostatic hypotension (OH), nOH, low BP, OH/nOH symptoms, or were caregivers of eligible participants. Results: The survey included 363 patients and 128 caregivers. Groups were separate, where caregivers were not the caregivers to patient responders. Respondents indicated that patients experienced nOH symptoms long term (Table 1) . Most patients (69%) and caregivers (59%) reported discussing nOH symptoms with a healthcare provider (HCP) within the first year of symptom onset, but only 36% of patients and 16% of caregivers reported a formal diagnosis of OH or nOH. Of those with a formal diagnosis, the majority of patients (50%) were frustrated by the path to diagnosis and more than 40% of patients and caregivers reported that the patient saw ≥3 HCPs before diagnosis. After diagnosis, most patients (70%) and caregivers (60%) reported improved symptom management. Conclusions: This survey reveals that patients and caregivers may find the path to nOH diagnosis challenging and suggests increased awareness among HCPs is needed. Once a diagnosis is made nOH symptoms are better managed.

Case 77: Painful Small Fiber Neuropathy in Posttreatment Lyme Disease Syndrome

2019 ◽  
pp. 390-393
Author(s):  
Peter Novak
Keyword(s):  
Lyme Disease ◽  
Orthostatic Hypotension ◽  
Autonomic Failure ◽  
Small Fiber Neuropathy ◽  
Cerebral Hypoperfusion ◽  
Supine Hypertension ◽  
Autonomic Testing ◽  
Small Fiber ◽  
Immune Globulins ◽  
Sensory Fibers

This case illustrates autonomic failure in painful post-Lyme disease syndrome. Autonomic testing has shown supine hypertension, orthostatic hypotension, and hypocapnic cerebral hypoperfusion (HYCH). Small fiber neuropathy was painful, affecting sensory fibers. Patient noted improvement in the pain by about 40% after 12 month of intravenous immune globulins.

scholarly journals Management Strategies for Comorbid Supine Hypertension in Patients with Neurogenic Orthostatic Hypotension

2021 ◽  
Vol 21 (4) ◽  
Author(s):  
Stuart H. Isaacson ◽  
Khashayar Dashtipour ◽  
Ali A. Mehdirad ◽  
Amanda C. Peltier
Keyword(s):  
Orthostatic Hypotension ◽  
Treatment Approach ◽  
Management Strategies ◽  
Neurogenic Orthostatic Hypotension ◽  
Supine Hypertension ◽  
Individualized Approach ◽  
Short And Long Term ◽  
Cerebrovascular Risk ◽  
Pharmacologic Treatments

AbstractPurpose of ReviewIn autonomic failure, neurogenic orthostatic hypotension (nOH) and neurogenic supine hypertension (nSH) are interrelated conditions characterized by postural blood pressure (BP) dysregulation. nOH results in a sustained BP drop upon standing, which can lead to symptoms that include lightheadedness, orthostatic dizziness, presyncope, and syncope. nSH is characterized by elevated BP when supine and, although often asymptomatic, may increase long-term cardiovascular and cerebrovascular risk. This article reviews the pathophysiology and clinical characteristics of nOH and nSH, and describes the management of patients with both nOH and nSH.Recent FindingsPressor medications required to treat the symptoms of nOH also increase the risk of nSH. Because nOH and nSH are hemodynamically opposed, therapies to treat one condition may exacerbate the other. The management of patients with nOH who also have nSH can be challenging and requires an individualized approach to balance the short- and long-term risks associated with these conditions.SummaryApproaches to manage neurogenic BP dysregulation include nonpharmacologic approaches and pharmacologic treatments. A stepwise treatment approach is presented to help guide neurologists in managing patients with both nOH and nSH.

scholarly journals Management of Orthostatic Hypotension in Parkinson’s Disease

2020 ◽  
Vol 10 (s1) ◽  
pp. S57-S64
Author(s):  
Alessandra Fanciulli ◽  
Fabian Leys ◽  
Cristian Falup-Pecurariu ◽  
Roland Thijs ◽  
Gregor K. Wenning
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Orthostatic Hypotension ◽  
Organ Damage ◽  
Lifestyle Changes ◽  
Behavioral Measures ◽  
Blurred Vision ◽  
Supine Hypertension ◽  
Nocturnal Hypertension ◽  
Short And Long Term

Orthostatic hypotension (OH) is a common non-motor feature of Parkinson’s disease that may cause unexplained falls, syncope, lightheadedness, cognitive impairment, dyspnea, fatigue, blurred vision, shoulder, neck, or low-back pain upon standing. Blood pressure (BP) measurements supine and after 3 minutes upon standing screen for OH at bedside. The medical history and cardiovascular autonomic function tests ultimately distinguish neurogenic OH, which is due to impaired sympathetic nerve activity, from non-neurogenic causes of OH, such as hypovolemia and BP lowering drugs. The correction of non-neurogenic causes and exacerbating factors, lifestyle changes and non-pharmacological measures are the cornerstone of OH treatment. If these measures fail, pharmacological interventions (sympathomimetic agents and/or fludrocortisone) should be introduced stepwise depending on the severity of symptoms. About 50% of patients with neurogenic OH also suffer from supine and nocturnal hypertension, which should be monitored for with in-office, home and 24 h-ambulatory BP measurements. Behavioral measures help prevent supine hypertension, which is eventually treated with non-pharmacological measures and bedtime administration of short-acting anti-hypertensive drugs in severe cases. If left untreated, OH impacts on activity of daily living and increases the risk of syncope and falls. Supine hypertension is asymptomatic, but often limits an effective treatment of OH, increases the risk of hypertensive emergencies and, combined with OH, facilitates end-organ damage. A timely management of both OH and supine hypertension ameliorates quality of life and prevents short and long-term complications in patients with Parkinson’s disease.

scholarly journals Syndrome of Supine Hypertension with Orthostatic Hypotension: Pathophysiology and Clinical Approach

2020 ◽  
Vol 16 (1) ◽  
pp. 48-54
Author(s):  
Aamir Ahmed ◽  
Mohammed Ruzieh ◽  
Shaffi Kanjwal ◽  
Khalil Kanjwal
Keyword(s):  
Quality Of Life ◽  
Orthostatic Hypotension ◽  
Autonomic Failure ◽  
Treatment Options ◽  
Clinical Approach ◽  
Supine Hypertension ◽  
Physiologic Response ◽  
Clinical Considerations ◽  
Shed Light

This article is intended to provide guidance and clinical considerations for physicians managing patients suffering from supine hypertension with orthostatic hypotension, referred to as “SH-OH”. We review the normal physiologic response to orthostasis, focusing on the appropriate changes to autonomic output in this state. Autonomic failure is discussed with a generalized overview of the disease and examination of specific syndromes that help shed light on the pathophysiology of SH-OH. The goal of this review is to provide a better framework for clinical evaluation of these patients, review treatment options, and ultimately work toward achieving a better quality of life for patients afflicted with this disease.

Case 40: Parkinson’s Disease with Compensated Orthostatic Hypotension

2019 ◽  
pp. 233-236
Author(s):  
Peter Novak
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Orthostatic Hypotension ◽  
Autonomic Failure ◽  
Neurogenic Orthostatic Hypotension ◽  
Supine Hypertension ◽  
Reduced Flow

Autonomic failure manifesting as neurogenic orthostatic hypotension and supine hypertension are common manifestations of cardiovascular dysautonomia in Parkinson’s disease. Depending on the cerebral blood flow, neurogenic orthostatic hypotension can be either compensated (with stable orthostatic cerebral blood flow) and noncompensated (with reduced flow).

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