Temporary elimination of orthostatic hypotension by norepinephrine infusion

Goldstein, David S.; Sewell, LaToya; Holmes, Courtney; Pechnik, Sandra; Diedrich, André; Robertson, David

doi:10.1007/s10286-012-0176-4

Cited by 7 publications

(3 citation statements)

References 10 publications

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“…This study showed drastic increases in Epi before syncopal episodes, suggesting that vasodilation in neurocardiogenic syncope is, at least in part, humorally mediated (10,18). Furthermore, intraveneous infusion of NE maintained BP in OH subjects during HUT, temporarily eliminating OH (19). Thus, the imbalance of NE and Epi, with higher circulating Epi, most likely contributes to vasodilation or impairments in peripheral vascular resistance by stimulating vasodilating ␤ 2 -adrenergic receptors in skeletal blood vessels, which results in low BP/cardiac output in OH and syncope subjects (15).…”

Section: Discussionmentioning

confidence: 55%

“…The neurohumoral profile included measurements of circulating catecholamines (Epi and NE), the renin-angiotensin-aldosterone system axis, and AVP to provide a comprehensive panel for subjects with OI to test the effects of orthostatic challenge. Our methodology was unique in that the neurohumoral profile was measured during HUT as opposed to previous studies in adults in which sample collection was taken in the supine position alone, after completion of a 30-min test, or after an evoked HUT response (11,19,20,34,37). Our approach aimed to more accurately reflect real-time neurohumoral changes as they related to cardiovascular symptoms including HR and BP changes, especially for neurohumoral factors that are less stable and metabolized quickly (1).…”

Section: Discussionmentioning

confidence: 99%

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Distinct neurohumoral biomarker profiles in children with hemodynamically defined orthostatic intolerance may predict treatment options

Wagoner

Shaltout

Fortunato

et al. 2016

American Journal of Physiology-Heart and Circulatory Physiology

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Studies of adults with orthostatic intolerance (OI) have revealed altered neurohumoral responses to orthostasis, which provide mechanistic insights into the dysregulation of blood pressure control. Similar studies in children with OI providing a thorough neurohumoral profile are lacking. The objective of the present study was to determine the cardiovascular and neurohumoral profile in adolescent subjects presenting with OI. Subjects at 10-18 yr of age were prospectively recruited if they exhibited two or more traditional OI symptoms and were referred for head-up tilt (HUT) testing. Circulating catecholamines, vasopressin, aldosterone, renin, and angiotensins were measured in the supine position and after 15 min of 70° tilt. Heart rate and blood pressure were continuously measured. Of the 48 patients, 30 patients had an abnormal tilt. Subjects with an abnormal tilt had lower systolic, diastolic, and mean arterial blood pressures during tilt, significantly higher levels of vasopressin during HUT, and relatively higher catecholamines and ANG II during HUT than subjects with a normal tilt. Distinct neurohumoral profiles were observed when OI subjects were placed into the following groups defined by the hemodynamic response: postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension (OH), syncope, and POTS/syncope. Key characteristics included higher HUT-induced norepinephrine in POTS subjects, higher vasopressin in OH and syncope subjects, and higher supine and HUT aldosterone in OH subjects. In conclusion, children with OI and an abnormal response to tilt exhibit distinct neurohumoral profiles associated with the type of the hemodynamic response during orthostatic challenge. Elevated arginine vasopressin levels in syncope and OH groups are likely an exaggerated response to decreased blood flow not compensated by higher norepinephrine levels, as observed in POTS subjects. These different compensatory mechanisms support the role of measuring neurohumoral profiles toward the goal of selecting more focused and mechanistic-based treatment options for pediatric patients with OI.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Distinct neurohumoral biomarker profiles in children with hemodynamically defined orthostatic intolerance may predict treatment options

Wagoner

Shaltout

Fortunato

et al. 2016

American Journal of Physiology-Heart and Circulatory Physiology

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“…Carotid sinus stimulation or renal sympathetic radiofrequency ablation may attenuate refractory hypertension (Krum et al, 2009; Lohmeier et al, 2011). Intravenous infusion of norepinephrine or an automated abdominal binder may mitigate neurogenic orthostatic hypotension (Goldstein et al, 2012; Okamoto et al, 2016; Polinsky et al, 1983; Zekeridou et al, 2015); and vagus nerve stimulation, by directly or reflexively evoking effects on elaboration of cytokines, may be useful to treat conditions involving auto-immunity such as rheumatoid arthritis (Koopman et al, 2016). …”

Section: 20 Cybernetic Medicine (Scientific Integrative Medicine)mentioning

confidence: 99%

Homeostatic systems, biocybernetics, and autonomic neuroscience

Goldstein

Kopin²

2017

Autonomic Neuroscience

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In this review we describe a series of major concepts introduced during the past 150 years that have contributed to our current understanding about how physiological processes required for well-being and survival are regulated. One can theorize that hierarchical networks involving input-output relationships continuously orchestrate and learn adaptive patterns of observable behaviors, cognition, memory, mood, and autonomic systems. Taken together, these networks function as “good regulators” determining levels of internal variables and act as if there were homeostatic comparators (“homeostats”). The consequences of models with vs. without homeostats remain the same in terms of allostatic load and the eventual switch from stabilizing negative feedback loops to destabilizing, pathogenic positive feedback loops. Understanding this switch seems important for comprehending senescence-related, neurodegenerative disorders that involve the autonomic nervous system. Our general proposal is that disintegration of homeostatic systems causes disorders of regulation in degenerative diseases and that medical cybernetics can inspire and rationalize new approaches to treatment and prevention.

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Management of Neurogenic Orthostatic Hypotension in Patients with Autonomic Failure

Schroeder

Jordan

2013

Drugs

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The maintenance of blood pressure in the upright position requires intact autonomic cardiovascular reflexes. Diseases that affect the sympathetic innervation of the cardiovascular system result in a sustained fall in blood pressure upon standing (i.e., neurogenic orthostatic hypotension) that can impair the blood supply to the brain and other organs and cause considerable morbidity and mortality. Here we review treatment options for neurogenic orthostatic hypotension and include an algorithm for its management that emphasizes the importance of non-pharmacologic measures and provides guidance on pharmacologic treatment options.

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Temporary elimination of orthostatic hypotension by norepinephrine infusion

Cited by 7 publications

References 10 publications

Distinct neurohumoral biomarker profiles in children with hemodynamically defined orthostatic intolerance may predict treatment options

Distinct neurohumoral biomarker profiles in children with hemodynamically defined orthostatic intolerance may predict treatment options

Homeostatic systems, biocybernetics, and autonomic neuroscience

Management of Neurogenic Orthostatic Hypotension in Patients with Autonomic Failure

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