| Clonidine for the treatment of supine hypertension and pressure natriuresis in autonomic failure. | |
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MedLine Citation:
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PMID: 16391172 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Patients with autonomic failure are disabled by orthostatic hypotension, which can be worsened by the nighttime pressure natriuresis induced by associated supine hypertension. Several pharmacological agents are available that effectively reduce nighttime hypertension, but none of them prevent pressure natriuresis. Because hypertension of autonomic failure can be driven by residual sympathetic tone, we hypothesized that clonidine would be effective in reducing blood pressure (BP) and nocturnal natriuresis. Therefore, we determined the effect of placebo, 0.1 mg clonidine, and 0.1-mg/h nitroglycerin transdermal patch on supine BP, orthostatic hypotension, and pressure natriuresis in 23 patients with primary autonomic failure and supine hypertension. Medications were given at 8:00 PM, and BP was recorded every 2 hours for 12 hours. The maximal decrease in BP was seen 6 to 8 hours after drug administration and was similar to clonidine and nitroglycerin (-29+/-9 and -30+/-10 mm Hg, respectively), as was the average fall in BP throughout the night. However, only clonidine effectively reduced nocturnal natriuresis (-0.09 mmol/mg Cr; 95% CI, -0.13 to -0.04; P=0.004), but this was not associated with improvement in morning orthostatic hypotension because of a residual hypotensive effect. The decrease in BP induced by clonidine was modestly but significantly correlated with the magnitude of residual sympathetic tone determined in 10 subjects by the fall in BP induced by ganglionic blockade (r=0.66; P=0.043). These results are consistent with residual sympathetic tone contributing to supine hypertension in autonomic failure, which can be targeted with clonidine to decrease BP and nocturnal natriuresis. |
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Authors:
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Cyndya Shibao; Alfredo Gamboa; Robert Abraham; Satish R Raj; Andre Diedrich; Bonnie Black; David Robertson; Italo Biaggioni |
Publication Detail:
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Type: Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't Date: 2006-01-03 |
Journal Detail:
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Title: Hypertension Volume: 47 ISSN: 1524-4563 ISO Abbreviation: Hypertension Publication Date: 2006 Mar |
Date Detail:
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Created Date: 2006-02-17 Completed Date: 2006-03-17 Revised Date: 2010-06-25 |
Medline Journal Info:
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Nlm Unique ID: 7906255 Medline TA: Hypertension Country: United States |
Other Details:
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Languages: eng Pagination: 522-6 Citation Subset: IM |
Affiliation:
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Division of Clinical Pharmacology, Department of Medicine and Pharmacology, The Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, TN, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Antihypertensive Agents / therapeutic use* Autonomic Nervous System / physiopathology Autonomic Nervous System Diseases / complications*, physiopathology Blood Pressure / drug effects* Clonidine / therapeutic use* Female Humans Hypertension / drug therapy*, etiology, physiopathology Hypotension, Orthostatic / etiology, physiopathology Male Middle Aged Natriuresis / drug effects* Nitroglycerin / therapeutic use Supine Position Sympathetic Nervous System / drug effects, physiopathology Sympatholytics / therapeutic use* Vasodilator Agents / therapeutic use |
| Grant Support | |
ID/Acronym/Agency:
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K23 RR020783/RR/NCRR NIH HHS; K23 RR020783-02/RR/NCRR NIH HHS; M01 RR00095/RR/NCRR NIH HHS; R01 HL56693/HL/NHLBI NIH HHS; R01 HL67232/HL/NHLBI NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Antihypertensive Agents; 0/Sympatholytics; 0/Vasodilator Agents; 4205-90-7/Clonidine; 55-63-0/Nitroglycerin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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