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Contrasting effects of vasodilators on blood pressure and sodium balance in the hypertension of autonomic failureSupine hypertension, which is very common in patients with autonomic failure, limits the use of pressor agents and induces nighttime natriuresis. In 13 patients with severe orthostatic hypotension due to autonomic failure (7 women, 6 men, 72 +/- 3 yr) and supine hypertension, the effect of 30 mg nifedipine (n = 10) and 0.025 to 0.2 mg/h nitroglycerin patch (n = 11) on supine BP, renal sodium handling, and orthostatic tolerance was determined. Medications were given at 8 p.m.; patients stood up at 8 a.m. Nitroglycerin was removed at 6 a.m. Compared with placebo, nifedipine and nitroglycerin decreased systolic BP during the night by a maximum of 37 +/- 9 and 36 +/- 10 mmHg, respectively (P < 0.01). At 8 a.m., supine systolic BP was 23 +/- 7 mmHg lower with nifedipine than with placebo (P < 0.05), but was similar with nitroglycerin and placebo. Sodium excretion during the night was not reduced with nitroglycerin (0.13 +/- 0.02 mmol/mg creatinine [Cr] versus 0.15 +/- 0.03 mmol/mg Cr with placebo), but it was increased with nifedipine (0.35 +/- 0.06 mmol/mg Cr versus 0.13 +/- 0.02 mmol/mg Cr with placebo, P < 0.05). Nifedipine but not nitroglycerin worsened orthostatic hypotension in the morning. It is concluded that nifedipine and transdermal nitroglycerin are effective in controlling supine hypertension in patients with autonomic failure. However, nifedipine has a prolonged depressor effect and worsens orthostatic hypotension in the morning. The decrease in pressure natriuresis that would be expected with the substantial decrease in BP obtained with nitroglycerin and nifedipine may be offset by a direct effect of both drugs on renal sodium handling.
Document ID
20040142109
Acquisition Source
Legacy CDMS
Document Type
Reprint (Version printed in journal)
Authors
Jordan, J.
(Clinical Research Center, Franz Volhard Clinic Berlin, Germany)
Shannon, J. R.
Pohar, B.
Paranjape, S. Y.
Robertson, D.
Robertson, R. M.
Biaggioni, I.
Date Acquired
August 22, 2013
Publication Date
January 1, 1999
Publication Information
Publication: Journal of the American Society of Nephrology : JASN
Volume: 10
Issue: 1
ISSN: 1046-6673
Subject Category
Life Sciences (General)
Funding Number(s)
CONTRACT_GRANT: 1PO1 HL56693
CONTRACT_GRANT: RR00095
CONTRACT_GRANT: 1UO1 NS 33460
Distribution Limits
Public
Copyright
Other
Keywords
Clinical Trial
NASA Discipline Regulatory Physiology
Non-NASA Center
Controlled Clinical Trial

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