Temporary elimination of orthostatic hypotension by norepinephrine infusion

Abstract

A cardinal manifestation of chronic autonomic failure is neurogenic orthostatic hypotension (OH), which often is associated with supine hypertension, posing a therapeutic dilemma. We report here success in a first step toward development of a "prosthetic baroreceptor system" to maintain blood pressure during orthostasis without worsening supine hypertension. In all of four patients with neurogenic OH, titrated i.v. NE infusion kept directly recorded intra-arterial pressure at or above baseline during progressive head-up tilt. We conclude that titrated i.v. NE infusion temporarily eliminates OH.

Figures

Fig. 1

Mean (±SEM) blood pressure and arterial plasma norepinephrine (NE) as a function of tilt angle in patients with neurogenic OH. (Left) systolic blood pressure; (right) arterial plasma norepinephrine. Numbers are numbers of patients. White circles show data for i.v. infusion of saline (Placebo); gray circles data on the baseline day; and black circles data during NE infusion. Note tilt angle-related falls in systolic pressure on the baseline day and during placebo administration and elimination of OH by titrated NE infusion