Document Detail

Orthostatic hypotension in patients, bed rest subjects, and astronauts.
MedLine Citation:
PMID:  7522239     Owner:  NLM     Status:  MEDLINE    
Orthostatic hypotension after even short space flights has affected a significant number of astronauts. Given the need for astronauts to function at a high level of efficiency during and after their return from space, the application of pharmacologic and other treatments is strongly indicated. This report addresses the clinical problem of orthostatic hypotension and its treatments to ascertain whether pharmacologic or physiologic treatment may be useful in the prevention of orthostatic hypotension associated with space flight. Treatment of orthostatic hypotension in patients now includes increasing intravascular volume with high sodium intake and mineralocorticoids, or increasing vascular resistance through the use of drugs to stimulate alpha or block beta vascular receptors. Earlier treatment used oral sympathomimetic ephedrine hydrochloride alone or with "head-up" bed rest. Then long-acting adrenocortical steroid desoxycorticosterone preparations with high-salt diets were used to expand volume. Fludrocortisone was shown to prevent the orthostatic drop in blood pressure. The combination of the sympathomimetic amine hydroxyamphetamine and a monoamine oxidase inhibitor tranylcypromine has been used, as has indomethacin alone. Davies et al. used mineralocorticoids at low doses concomitantly with alpha-agonists to increase vasoconstrictor action. Schirger et al used tranylcypromine and methylphenidate with or without a Jobst elastic leotard garment or the alpha-adrenergic agonist midodrine (which stimulates both arterial and venous systems without direct central nervous system or cardiac effects). Vernikos et al established that the combination of fludrocortisone, dextroamphetamine, and atropine exhibited a beneficial effect on orthostatic hypotension induced by 7-day 6 degrees head-down bed rest (a model used to simulate the weightlessness of space flight). Thus, there are numerous drugs that, in combination with mechanical techniques, including lower body negative pressure to elevate transmural pressure, could be studied to treat orthostatic hypotension after space flight.
C M Lathers; J B Charles
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Publication Detail:
Type:  Case Reports; Comparative Study; Journal Article; Review    
Journal Detail:
Title:  Journal of clinical pharmacology     Volume:  34     ISSN:  0091-2700     ISO Abbreviation:  J Clin Pharmacol     Publication Date:  1994 May 
Date Detail:
Created Date:  1994-10-19     Completed Date:  1994-10-19     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0366372     Medline TA:  J Clin Pharmacol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  403-17     Citation Subset:  IM; S    
NASA/Johnson Space Center, Space Biomedical Research Institute, Houston, Texas.
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MeSH Terms
Atropine / therapeutic use
Bed Rest / adverse effects*
Fludrocortisone / therapeutic use
Hypotension, Orthostatic* / physiopathology,  prevention & control,  therapy
Indomethacin / therapeutic use
Lower Body Negative Pressure
Middle Aged
Midodrine / therapeutic use
Monoamine Oxidase Inhibitors / therapeutic use
Space Flight*
Sympathomimetics / therapeutic use
Reg. No./Substance:
0/Monoamine Oxidase Inhibitors; 0/Sympathomimetics; 127-31-1/Fludrocortisone; 42794-76-3/Midodrine; 51-55-8/Atropine; 53-86-1/Indomethacin

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