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Related Experiment Videos

Fludrocortisone and sleeping in the head-up position limit the postural decrease in cardiac output in autonomic

J J van Lieshout1, A D ten Harkel, W Wieling

  • 1Cardiovascular Research Institute Amsterdam, Department of Internal Medicine, Academic Medical Centre, The Netherlands. j.j.vanlieshout@amc.uva.nl

Clinical Autonomic Research : Official Journal of the Clinical Autonomic Research Society
|April 6, 2000
PubMed
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Combined treatment for neurogenic orthostatic hypotension with head-up tilt sleeping and fludrocortisone improves blood pressure by reducing cardiac output decrease. This therapy enhances standing tolerance and upright blood pressure in patients.

Area of Science:

  • Cardiovascular Physiology
  • Autonomic Nervous System Disorders
  • Pharmacological Interventions

Background:

  • Neurogenic orthostatic hypotension (NOH) is characterized by a significant drop in blood pressure upon standing.
  • Current treatments aim to minimize orthostatic symptoms and increase blood pressure, but the underlying mechanisms require further elucidation.
  • Combined therapy using head-up tilt sleeping and fludrocortisone has shown promise in managing NOH.

Purpose of the Study:

  • To determine if improved orthostatic blood pressure in NOH patients treated with fludrocortisone and head-up tilt is due to plasma volume expansion or increased total peripheral resistance.
  • To evaluate the impact of this combined treatment on postural changes in hemodynamic parameters.

Main Methods:

  • Eight consecutive NOH patients received 3 weeks of fludrocortisone and nocturnal head-up tilt therapy.

Related Experiment Videos

  • Evaluated postural changes in arterial pressure, heart rate, and cardiac output (using pulse contour analysis).
  • Assessed changes in body weight, hematocrit, leg pressure-volume relationships, and hormonal responses (renin, aldosterone).

    • Main Results:

    • Treatment significantly increased upright systolic blood pressure (83 to 114 mm Hg) and diastolic blood pressure (55 to 60 mm Hg).
    • The improvement in blood pressure was achieved by limiting the orthostatic decrease in cardiac output, not by increasing total peripheral resistance.
    • Standing tolerance increased from 3 to 10 minutes; body weight increased, but hematocrit and hormonal responses did not indicate significant intravascular volume expansion.

    Conclusions:

    • The beneficial effect of fludrocortisone and head-up tilt sleeping in NOH is primarily due to a reduction in the orthostatic decrease in cardiac output.
    • Preliminary findings suggest that expanded body fluid volume may be allocated to the perivascular space rather than the intravascular space.
    • This treatment strategy effectively improves hemodynamic stability and reduces orthostatic symptoms in patients with neurogenic orthostatic hypotension.