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Clonidine for the treatment of supine hypertension and pressure natriuresis in autonomic failure.
Hypertension. 2006 Mar; 47(3):522-6.H

Abstract

Patients with autonomic failure are disabled by orthostatic hypotension, which can be worsened by the nighttime pressure natriuresis induced by associated supine hypertension. Several pharmacological agents are available that effectively reduce nighttime hypertension, but none of them prevent pressure natriuresis. Because hypertension of autonomic failure can be driven by residual sympathetic tone, we hypothesized that clonidine would be effective in reducing blood pressure (BP) and nocturnal natriuresis. Therefore, we determined the effect of placebo, 0.1 mg clonidine, and 0.1-mg/h nitroglycerin transdermal patch on supine BP, orthostatic hypotension, and pressure natriuresis in 23 patients with primary autonomic failure and supine hypertension. Medications were given at 8:00 PM, and BP was recorded every 2 hours for 12 hours. The maximal decrease in BP was seen 6 to 8 hours after drug administration and was similar to clonidine and nitroglycerin (-29+/-9 and -30+/-10 mm Hg, respectively), as was the average fall in BP throughout the night. However, only clonidine effectively reduced nocturnal natriuresis (-0.09 mmol/mg Cr; 95% CI, -0.13 to -0.04; P=0.004), but this was not associated with improvement in morning orthostatic hypotension because of a residual hypotensive effect. The decrease in BP induced by clonidine was modestly but significantly correlated with the magnitude of residual sympathetic tone determined in 10 subjects by the fall in BP induced by ganglionic blockade (r=0.66; P=0.043). These results are consistent with residual sympathetic tone contributing to supine hypertension in autonomic failure, which can be targeted with clonidine to decrease BP and nocturnal natriuresis.

Authors+Show Affiliations

Division of Clinical Pharmacology, Department of Medicine and Pharmacology, The Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, TN, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16391172

Citation

Shibao, Cyndya, et al. "Clonidine for the Treatment of Supine Hypertension and Pressure Natriuresis in Autonomic Failure." Hypertension (Dallas, Tex. : 1979), vol. 47, no. 3, 2006, pp. 522-6.
Shibao C, Gamboa A, Abraham R, et al. Clonidine for the treatment of supine hypertension and pressure natriuresis in autonomic failure. Hypertension. 2006;47(3):522-6.
Shibao, C., Gamboa, A., Abraham, R., Raj, S. R., Diedrich, A., Black, B., Robertson, D., & Biaggioni, I. (2006). Clonidine for the treatment of supine hypertension and pressure natriuresis in autonomic failure. Hypertension (Dallas, Tex. : 1979), 47(3), 522-6.
Shibao C, et al. Clonidine for the Treatment of Supine Hypertension and Pressure Natriuresis in Autonomic Failure. Hypertension. 2006;47(3):522-6. PubMed PMID: 16391172.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clonidine for the treatment of supine hypertension and pressure natriuresis in autonomic failure. AU - Shibao,Cyndya, AU - Gamboa,Alfredo, AU - Abraham,Robert, AU - Raj,Satish R, AU - Diedrich,Andre, AU - Black,Bonnie, AU - Robertson,David, AU - Biaggioni,Italo, Y1 - 2006/01/03/ PY - 2006/1/5/pubmed PY - 2006/3/18/medline PY - 2006/1/5/entrez SP - 522 EP - 6 JF - Hypertension (Dallas, Tex. : 1979) JO - Hypertension VL - 47 IS - 3 N2 - Patients with autonomic failure are disabled by orthostatic hypotension, which can be worsened by the nighttime pressure natriuresis induced by associated supine hypertension. Several pharmacological agents are available that effectively reduce nighttime hypertension, but none of them prevent pressure natriuresis. Because hypertension of autonomic failure can be driven by residual sympathetic tone, we hypothesized that clonidine would be effective in reducing blood pressure (BP) and nocturnal natriuresis. Therefore, we determined the effect of placebo, 0.1 mg clonidine, and 0.1-mg/h nitroglycerin transdermal patch on supine BP, orthostatic hypotension, and pressure natriuresis in 23 patients with primary autonomic failure and supine hypertension. Medications were given at 8:00 PM, and BP was recorded every 2 hours for 12 hours. The maximal decrease in BP was seen 6 to 8 hours after drug administration and was similar to clonidine and nitroglycerin (-29+/-9 and -30+/-10 mm Hg, respectively), as was the average fall in BP throughout the night. However, only clonidine effectively reduced nocturnal natriuresis (-0.09 mmol/mg Cr; 95% CI, -0.13 to -0.04; P=0.004), but this was not associated with improvement in morning orthostatic hypotension because of a residual hypotensive effect. The decrease in BP induced by clonidine was modestly but significantly correlated with the magnitude of residual sympathetic tone determined in 10 subjects by the fall in BP induced by ganglionic blockade (r=0.66; P=0.043). These results are consistent with residual sympathetic tone contributing to supine hypertension in autonomic failure, which can be targeted with clonidine to decrease BP and nocturnal natriuresis. SN - 1524-4563 UR - https://www.unboundmedicine.com/medline/citation/16391172/Clonidine_for_the_treatment_of_supine_hypertension_and_pressure_natriuresis_in_autonomic_failure_ L2 - https://www.ahajournals.org/doi/10.1161/01.HYP.0000199982.71858.11?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -