Local Passive Heat for the Treatment of Hypertension in Autonomic Failure.

Autor: Okamoto LE; Vanderbilt Autonomic Dysfunction Center Vanderbilt University Medical Center Nashville TN.; Division of Clinical Pharmacology Vanderbilt University Medical Center Nashville TN.; Department of Medicine Vanderbilt University Medical Center Nashville TN., Celedonio JE; Vanderbilt Autonomic Dysfunction Center Vanderbilt University Medical Center Nashville TN.; Division of Clinical Pharmacology Vanderbilt University Medical Center Nashville TN.; Department of Medicine Vanderbilt University Medical Center Nashville TN., Smith EC; Vanderbilt Autonomic Dysfunction Center Vanderbilt University Medical Center Nashville TN.; Division of Clinical Pharmacology Vanderbilt University Medical Center Nashville TN.; Department of Medicine Vanderbilt University Medical Center Nashville TN., Gamboa A; Vanderbilt Autonomic Dysfunction Center Vanderbilt University Medical Center Nashville TN.; Division of Clinical Pharmacology Vanderbilt University Medical Center Nashville TN.; Department of Medicine Vanderbilt University Medical Center Nashville TN., Shibao CA; Vanderbilt Autonomic Dysfunction Center Vanderbilt University Medical Center Nashville TN.; Division of Clinical Pharmacology Vanderbilt University Medical Center Nashville TN.; Department of Medicine Vanderbilt University Medical Center Nashville TN., Diedrich A; Vanderbilt Autonomic Dysfunction Center Vanderbilt University Medical Center Nashville TN.; Division of Clinical Pharmacology Vanderbilt University Medical Center Nashville TN.; Department of Medicine Vanderbilt University Medical Center Nashville TN.; Department of Biomedical Engineering Vanderbilt University Medical Center Nashville TN., Paranjape SY; Vanderbilt Autonomic Dysfunction Center Vanderbilt University Medical Center Nashville TN.; Division of Clinical Pharmacology Vanderbilt University Medical Center Nashville TN.; Department of Medicine Vanderbilt University Medical Center Nashville TN., Black BK; Vanderbilt Autonomic Dysfunction Center Vanderbilt University Medical Center Nashville TN.; Division of Clinical Pharmacology Vanderbilt University Medical Center Nashville TN.; Department of Medicine Vanderbilt University Medical Center Nashville TN., Muldowney JAS 3rd; Vanderbilt Autonomic Dysfunction Center Vanderbilt University Medical Center Nashville TN.; Division of Clinical Pharmacology Vanderbilt University Medical Center Nashville TN.; Division of Cardiology Vanderbilt University Medical Center Nashville TN.; Department of Medicine Vanderbilt University Medical Center Nashville TN., Peltier AC; Vanderbilt Autonomic Dysfunction Center Vanderbilt University Medical Center Nashville TN.; Division of Clinical Pharmacology Vanderbilt University Medical Center Nashville TN.; Department of Neurology Vanderbilt University Medical Center Nashville TN., Habermann R; Vanderbilt Autonomic Dysfunction Center Vanderbilt University Medical Center Nashville TN.; Division of Clinical Pharmacology Vanderbilt University Medical Center Nashville TN.; Division of Geriatrics Vanderbilt University Medical Center Nashville TN.; Department of Medicine Vanderbilt University Medical Center Nashville TN., Crandall CG; Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital and UT Southwestern Medical Center Dallas TX., Biaggioni I; Vanderbilt Autonomic Dysfunction Center Vanderbilt University Medical Center Nashville TN.; Division of Clinical Pharmacology Vanderbilt University Medical Center Nashville TN.; Department of Medicine Vanderbilt University Medical Center Nashville TN.; Department of Pharmacology Vanderbilt University Medical Center Nashville TN.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2021 Apr 06; Vol. 10 (7), pp. e018979. Date of Electronic Publication: 2021 Mar 19.
DOI: 10.1161/JAHA.120.018979
Abstrakt: Background Supine hypertension affects a majority of patients with autonomic failure; it is associated with end-organ damage and can worsen daytime orthostatic hypotension by inducing pressure diuresis and volume loss during the night. Because sympathetic activation prevents blood pressure (BP) from falling in healthy subjects exposed to heat, we hypothesized that passive heat had a BP-lowering effect in patients with autonomic failure and could be used to treat their supine hypertension. Methods and Results In Protocol 1 (n=22), the acute effects of local heat (40-42°C applied with a heating pad placed over the abdomen for 2 hours) versus sham control were assessed in a randomized crossover fashion. Heat acutely decreased systolic BP by -19±4 mm Hg (versus 3±4 with sham, P <0.001) owing to decreases in stroke volume (-18±5% versus -4±4%, P =0.013 ) and cardiac output (-15±5% versus -2±4%, P =0.013). In Protocol 2 (proof-of-concept overnight study; n=12), we compared the effects of local heat (38°C applied with a water-perfused heating pad placed under the torso from 10 pm to 6 am) versus placebo pill. Heat decreased nighttime systolic BP (maximal change -28±6 versus -2±6 mm Hg, P <0.001). BP returned to baseline by 8 am. The nocturnal systolic BP decrease correlated with a decrease in urinary volume ( r =0.57, P =0.072) and an improvement in the morning upright systolic BP ( r =-0.76, P =0.007). Conclusions Local heat therapy effectively lowered overnight BP in patients with autonomic failure and supine hypertension and offers a novel approach to treat this condition. Future studies are needed to assess the long-term safety and efficacy in improving nighttime fluid loss and daytime orthostatic hypotension. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT02417415 and NCT03042988.
Databáze: MEDLINE
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