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Orthostatic Effects of Midodrine Versus L-NAME on Cerebral Blood Flow and the Renin-Angiotensin-Aldosterone System in Tetraplegia.
MedLine Citation:
PMID:  21762873     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Wecht JM, Radulovic M, Rosado-Rivera D, Zhang RL, LaFountaine MF, Bauman WA. Orthostatic effects of midodrine versus L-NAME on cerebral blood flow and the renin-angiotensin-aldosterone system in tetraplegia. OBJECTIVE: To compare responses to head-up tilt (HUT) in individuals with chronic tetraplegia after midodrine hydrochloride (10mg) versus nitro-L-arginine methyl ester (L-NAME, 1mg/kg) administration. DESIGN: Prospective comparative drug trial. SETTING: Veterans Affairs medical center. PARTICIPANTS: Participants (N=7) were studied during 3 laboratory visits: no drug, midodrine (administered orally 30min before HUT), and L-NAME (infused over a 60-min period). INTERVENTIONS: Anti-hypotensive agents, midodrine, and L-NAME. MAIN OUTCOME MEASURES: Mean arterial pressure (MAP), cerebral blood flow (CBF), and markers of the renin-angiotensin-aldosterone system (RAAS, plasma renin and serum aldosterone) were measured in the supine position at baseline (BL) and during a 45° HUT maneuver. Data were compared between BL and the average of 3 assessments collected during HUT. RESULTS: Orthostatic MAP and CBF were increased with the midodrine and L-NAME groups compared with the no drug trial and the relationship between the change in MAP and CBF was significant (r=0.770; P<0.001). Both L-NAME and midodrine appeared to suppress the post-HUT RAAS response compared with no drug. CONCLUSIONS: Increasing orthostatic blood pressure with L-NAME or midodrine appears to increase CBF and suppress the RAAS during HUT in persons with tetraplegia, although more data are needed to confirm these preliminary findings.
Authors:
Jill M Wecht; Miroslav Radulovic; Dwindally Rosado-Rivera; Run-Lin Zhang; Michael F Lafountaine; William A Bauman
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-7-13
Journal Detail:
Title:  Archives of physical medicine and rehabilitation     Volume:  -     ISSN:  1532-821X     ISO Abbreviation:  -     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-7-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  2985158R     Medline TA:  Arch Phys Med Rehabil     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 the American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
Affiliation:
Center of Excellence, James J. Peters Veterans Affairs Medical Center, Bronx, NY; Medical Service, James J. Peters Veterans Affairs Medical Center, Bronx, NY; Department of Medicine, Mount Sinai School of Medicine, New York, NY; Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY.
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