Contrasting effects of vasodilators on blood pressure and sodium balance in the hypertension of autonomic failure.
نویسندگان
چکیده
Supine hypertension, which is very common in patients with autonomic failure, limits the use of pressor agents and induces nighttime natriuresis. In 13 patients with severe orthostatic hypotension due to autonomic failure (7 women, 6 men, 72 +/- 3 yr) and supine hypertension, the effect of 30 mg nifedipine (n = 10) and 0.025 to 0.2 mg/h nitroglycerin patch (n = 11) on supine BP, renal sodium handling, and orthostatic tolerance was determined. Medications were given at 8 p.m.; patients stood up at 8 a.m. Nitroglycerin was removed at 6 a.m. Compared with placebo, nifedipine and nitroglycerin decreased systolic BP during the night by a maximum of 37 +/- 9 and 36 +/- 10 mmHg, respectively (P < 0.01). At 8 a.m., supine systolic BP was 23 +/- 7 mmHg lower with nifedipine than with placebo (P < 0.05), but was similar with nitroglycerin and placebo. Sodium excretion during the night was not reduced with nitroglycerin (0.13 +/- 0.02 mmol/mg creatinine [Cr] versus 0.15 +/- 0.03 mmol/mg Cr with placebo), but it was increased with nifedipine (0.35 +/- 0.06 mmol/mg Cr versus 0.13 +/- 0.02 mmol/mg Cr with placebo, P < 0.05). Nifedipine but not nitroglycerin worsened orthostatic hypotension in the morning. It is concluded that nifedipine and transdermal nitroglycerin are effective in controlling supine hypertension in patients with autonomic failure. However, nifedipine has a prolonged depressor effect and worsens orthostatic hypotension in the morning. The decrease in pressure natriuresis that would be expected with the substantial decrease in BP obtained with nitroglycerin and nifedipine may be offset by a direct effect of both drugs on renal sodium handling.
منابع مشابه
Dietary Approaches to Stop Hypertension (DASH) Eating Plan: Beyond the Hypertension
Background and Objectives: Dietary Approaches to Stop Hypertension (DASH) eating pattern, a diet rich in fruits, vegetables, whole grains and low-fat dairy with a reduced content of sodium, saturated fat, and total fat is introduced as an appropriate diet for hypertension. This eating pattern was basically designed to normalize blood pressure in patients with hypertension, and a large body of d...
متن کاملReversible Pulmonary Hypertension in an Infant Treated with Diazoxide
Background: Diazoxide is the main therapeutic agent for congenital hyperinsulinism. The drug is generally well tolerated; however, in this report severe adverse effects including heart failure (HF) and pulmonary hypertension (PH) in an infant are reported.Case report: A sixteen-day male infant with persistent hypoglycemia and with diagnosis of congenital hyperinsulinism underwent near total pan...
متن کاملThe effect of progressive aerobic continuous training on angiotensin-1, angiotensin-2 and angiotensin-converting enzyme type 2 in patients with heart failure
Background: Chronic hypertension causes structural and functional changes in the heart, ultimately leading to heart failure (HF), which further increases mortality and morbidit. HF is a complex clinical syndrome caused by various structural or functional abnormalities of the heart that impair the filling capacity of the ventricles. The findings of various trials have shown the association betwe...
متن کاملعلل هورمونی پرفشاری خون در کودکان
This article outlines the various childhood endocrine disorders associated with hypertension . In many circumstances this is due to inadequate sodium excretion although other mechanisms are often involved. A close link with the kidney will be apparent since it is through this organ that the major effects of hormonal control of sodium are manifested although primary disturbances of kidney funct...
متن کاملPrevalence and pattern of hypertension and effect of body mass index on blood pressure in six communities of Biase LGA In Cross River, Nigeria
Objective: Hypertension is a major risk factor for stroke, renal failure, and heart failure globally. This trend of complications has been seen even among our rural and urban dwellers in the tropics. This study aims at determining the prevalence and pattern of hypertension and body mass index (BMI) in six rural communities in Southern Nigeria.Methods: Adult participants, aged 18-80 years ...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Journal of the American Society of Nephrology : JASN
دوره 10 1 شماره
صفحات -
تاریخ انتشار 1999