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Treatment of orthostatic hypotension with sleeping in the head‐up tilt position, alone and in combination with fludrocortisone
Author(s) -
HARKEL A. D. J. TEN,
LIESHOUT J. J.,
WIELING W.
Publication year - 1992
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/j.1365-2796.1992.tb00563.x
Subject(s) - fludrocortisone , orthostatic vital signs , medicine , blood pressure , diastole , anesthesia , supine position , endocrinology , hydrocortisone
We studied the effect of sleeping in the head‐up tilt (HUT) position, alone and in combination with fludrocortisone, on orthostatic tolerance and blood pressure (BP) in six patients with hypoadrenergic orthostatic hypotension. A high salt diet of 150–200 mmol Na+ d −1 was also administered. Combined treatment reduced orthostatic dizziness in all patients ( P < 0.001), and increased the maximal standing period to at least 10 min. HUT alone ( n = 4) reduced the BP decrease after 1 min of standing from −64/‐42/‐25 ± 29/21/17mmHg to −53/‐37/‐23 ± 31/24/20 mmHg ( P < 0.01 for systolic BP). Addition of fludrocortisone to HUT (HUT/fludro) ( n = 5) further reduced the BP decrease after 1 min of standing from −63/ −40/ −24 ± 20/12/11 mmHg to −21/‐19/‐8 ± 12/10/5 mmHg ( P < 0.05 for systolic, mean and diastolic BP, respectively). BP at maximal standing time increased from 58/47/42 ± 9/8/7 mmHg initially to 95/69/57 ± 27/22/20 mmHg during combined treatment ( P < 0.05 for systolic and mean BP), and remained unchanged during the 14‐month (range 8–70 month) follow‐up period. Nocturnal sodium excretion decreased from 8.0 ± 2.3 mmol h −1 to 5.9 ± 1.9 mmol h −1 with combined treatment; body weight increased by 1.6 kg on average (range 0.5‐2.4 kg) ( P < 0.01). We conclude that the combination of HUT and fludrocortisone effectively minimizes orthostatic symptoms and increases orthostatic BP in patients with hypo‐adrenergic orthostatic hypotension.