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Treatment of orthostatic hypotension with erythropoietin.
N Engl J Med. 1993 Aug 26; 329(9):611-5.NEJM

Abstract

BACKGROUND AND METHODS

Patients with orthostatic hypotension caused by autonomic neuropathy frequently have a decreased red-cell mass. This would be expected to compromise their effective circulating blood volume and aggravate the orthostatic hypotension. We studied the effect of increasing the red-cell mass with erythropoietin, given subcutaneously in a dose of 50 U per kilogram of body weight three times a week for 6 to 10 weeks to eight patients with orthostatic hypotension--four men, one teenage boy, and three women (age range, 17 to 68 years). Four patients had type I diabetes mellitus and autonomic neuropathy, three patients had pure autonomic failure, and one patient had sympathotonic orthostatic hypotension. Seven patients received fludrocortisone (0.1 or 0.2 mg per day) before, during, and after the trial of erythropoietin. The red-cell volume, plasma volume, and hemodynamic response to orthostatic stress were measured before and after therapy.

RESULTS

Erythropoietin increased the mean (+/- SD) hematocrit from 0.34 +/- 0.04 to 0.45 +/- 0.04 (P < 0.005) and increased the red-cell volume from 16.8 +/- 3.9 to 25.3 +/- 3.1 ml per kilogram (P < 0.005), but had no effect on plasma volume. The systolic blood pressure increased from 81 +/- 11 to 100 +/- 24 mm Hg (P < 0.01) and the diastolic blood pressure increased from 46 +/- 10 to 63 +/- 18 mm Hg (P < 0.01) while the patients were standing. The average systolic and diastolic blood pressure while the patients were supine did not increase significantly, although hypertension in the supine position developed in three patients. Orthostatic dizziness improved during treatment in six of the eight patients.

CONCLUSIONS

In patients with orthostatic hypotension, increasing the red-cell volume with erythropoietin elevates blood pressure while standing. Possible long-term adverse effects are not known.

Authors+Show Affiliations

Department of Medicine, Temple University, Philadelphia.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

8341335

Citation

Hoeldtke, R D., and D H. Streeten. "Treatment of Orthostatic Hypotension With Erythropoietin." The New England Journal of Medicine, vol. 329, no. 9, 1993, pp. 611-5.
Hoeldtke RD, Streeten DH. Treatment of orthostatic hypotension with erythropoietin. N Engl J Med. 1993;329(9):611-5.
Hoeldtke, R. D., & Streeten, D. H. (1993). Treatment of orthostatic hypotension with erythropoietin. The New England Journal of Medicine, 329(9), 611-5.
Hoeldtke RD, Streeten DH. Treatment of Orthostatic Hypotension With Erythropoietin. N Engl J Med. 1993 Aug 26;329(9):611-5. PubMed PMID: 8341335.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of orthostatic hypotension with erythropoietin. AU - Hoeldtke,R D, AU - Streeten,D H, PY - 1993/8/26/pubmed PY - 1993/8/26/medline PY - 1993/8/26/entrez SP - 611 EP - 5 JF - The New England journal of medicine JO - N Engl J Med VL - 329 IS - 9 N2 - BACKGROUND AND METHODS: Patients with orthostatic hypotension caused by autonomic neuropathy frequently have a decreased red-cell mass. This would be expected to compromise their effective circulating blood volume and aggravate the orthostatic hypotension. We studied the effect of increasing the red-cell mass with erythropoietin, given subcutaneously in a dose of 50 U per kilogram of body weight three times a week for 6 to 10 weeks to eight patients with orthostatic hypotension--four men, one teenage boy, and three women (age range, 17 to 68 years). Four patients had type I diabetes mellitus and autonomic neuropathy, three patients had pure autonomic failure, and one patient had sympathotonic orthostatic hypotension. Seven patients received fludrocortisone (0.1 or 0.2 mg per day) before, during, and after the trial of erythropoietin. The red-cell volume, plasma volume, and hemodynamic response to orthostatic stress were measured before and after therapy. RESULTS: Erythropoietin increased the mean (+/- SD) hematocrit from 0.34 +/- 0.04 to 0.45 +/- 0.04 (P < 0.005) and increased the red-cell volume from 16.8 +/- 3.9 to 25.3 +/- 3.1 ml per kilogram (P < 0.005), but had no effect on plasma volume. The systolic blood pressure increased from 81 +/- 11 to 100 +/- 24 mm Hg (P < 0.01) and the diastolic blood pressure increased from 46 +/- 10 to 63 +/- 18 mm Hg (P < 0.01) while the patients were standing. The average systolic and diastolic blood pressure while the patients were supine did not increase significantly, although hypertension in the supine position developed in three patients. Orthostatic dizziness improved during treatment in six of the eight patients. CONCLUSIONS: In patients with orthostatic hypotension, increasing the red-cell volume with erythropoietin elevates blood pressure while standing. Possible long-term adverse effects are not known. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/8341335/Treatment_of_orthostatic_hypotension_with_erythropoietin_ L2 - https://www.nejm.org/doi/10.1056/NEJM199308263290904?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -