Cardiovascular responses to water drinking: does osmolality play a role?

Simple standing test predicts and water ingestion prevents vasovagal reaction in the high-risk blood donors

BACKGROUND

One of the serious complications of blood donation is vasovagal reaction (VVR) with syncope. This study was performed to determine if the measurement of hemodynamic responses to standing before blood collection (BC) was useful to identify the high-risk donors for VVR and also examined the effect of 300 mL of water ingestion in the prevention of VVR.

STUDY DESIGN AND METHODS

Blood pressure and heart rate (HR) during 5 minutes of standing were examined before and after BC in 93 donors. Because HR increase of 6 of 7 donors who developed syncopal VVR during standing after BC was 15 beats per minute (bpm) or greater, those with HR increase of 15 bpm or greater were determined as high-risk donors (n = 31). In another group (n = 117), 45 donors were identified as high risk based on the HR response before BC (15 bpm). The effect of 300 mL of water ingestion 15 minutes before BC on hemodynamic responses to standing and the rate of VVR after BC were analyzed.

RESULTS

Water ingestion given to the high-risk donors of the second group reduced HR increase with standing before BC (-6.6 ± 13.6 bpm, p < 0.02 vs. HR increase before water ingestion) and significantly suppressed VVR rate (2 of 45 donors with high risk, 4.4%,p < 0.04 vs. the first group; 6 of 31 high-risk donors, 19.4%).

CONCLUSION

HR response to standing before BC may detect the high-risk donors for VVR. For the high-risk donors, 300 mL of water ingestion may be a simple and effective way of prevention against syncopal VVR.

Acute fluid ingestion in the treatment of orthostatic intolerance - important implications for daily practice

BACKGROUND

Rapid water ingestion improves orthostatic intolerance (OI) in multiple system atrophy (MSA) and postural tachycardia syndrome (PoTS). We compared haemodynamic changes after water and clear soup intake, the latter being a common treatment strategy for OI in daily practice.

METHODS

Seven MSA and seven PoTS patients underwent head-up tilt (HUT) without fluid intake and 30 min after drinking 450 ml of water and clear soup, respectively. All patients suffered from moderate to severe OI because of neurogenic orthostatic hypotension (OH) and excessive orthostatic heart rate (HR) increase, respectively. Beat-to-beat cardiovascular indices were measured non-invasively.

RESULTS

In MSA, HUT had to be terminated prematurely in 2/7 patients after water, but in 6/7 after clear soup. At 3 min of HUT, there was an increase in blood pressure of 15.7(8.2)/8.3(2.3) mmHg after water, but a decrease of 11.6(18.9)/8.1(9.2) mmHg after clear soup (P < 0.05). In PoTS, HUT could always be completed for 10 min, but OI subjectively improved after both water and clear soup. The attenuation of excessive orthostatic HR increase did not differ significantly after water and clear soup drinking.

CONCLUSIONS

In MSA, clear soup cannot substitute water for eliciting a pressor effect, but even worsens OI after rapid ingestion. In PoTS, acute water and clear soup intake both result in improvement of OI. These findings cannot solely be explained by difference in osmolarity but may reflect some degree of superimposed postprandial hypotension in widespread autonomic failure in MSA compared to the mild and limited autonomic dysfunction in PoTS.

Predonation hydration and applied muscle tension combine to reduce presyncopal reactions to blood donation

BACKGROUND

A randomized controlled trial was conducted to test the effects of hydration and applied muscle tensing on presyncopal reactions to blood donation. Both interventions are designed to prevent the decreases in blood pressure that can contribute to such reactions, but due to the distinct physiologic mechanisms underlying their pressor responses it was hypothesized that a combined intervention would yield the greatest benefit.

STUDY DESIGN AND METHODS

Before blood donation, first- and second-time blood donors (mean age, 20.2 years; SD, 4.9) were randomly assigned to 1) standard donation, 2) placebo (leg exercise before venipuncture), 3) predonation water, or 4) predonation water and leg exercise during donation.

RESULTS

Main effects of group were observed for phlebotomist classification of vasovagal reactions (chi(2)(3) = 8.38, p < 0.05) and donor reports of presyncopal reactions (chi(2)(3) = 13.16, p < 0.01). Follow-up analyses of phlebotomist classifications revealed fewer reactions in the predonation water and predonation water and leg exercise groups relative to placebo but not standard donation. Follow-up analyses of self-reported reactions revealed that women, but not men, had lower scores in both the predonation water and the predonation water and leg exercise groups relative to both placebo and standard donation.

CONCLUSIONS

Predonation hydration and a combination of hydration and leg exercise may help attenuate presyncopal reactions in relatively novice donors, although future studies with larger samples are required to confirm this effect.

Sympathetic nervous system overactivity and its role in the development of cardiovascular disease

This review examines how the sympathetic nervous system plays a major role in the regulation of cardiovascular function over multiple time scales. This is achieved through differential regulation of sympathetic outflow to a variety of organs. This differential control is a product of the topographical organization of the central nervous system and a myriad of afferent inputs. Together this organization produces sympathetic responses tailored to match stimuli. The long-term control of sympathetic nerve activity (SNA) is an area of considerable interest and involves a variety of mediators acting in a quite distinct fashion. These mediators include arterial baroreflexes, angiotensin II, blood volume and osmolarity, and a host of humoral factors. A key feature of many cardiovascular diseases is increased SNA. However, rather than there being a generalized increase in SNA, it is organ specific, in particular to the heart and kidneys. These increases in regional SNA are associated with increased mortality. Understanding the regulation of organ-specific SNA is likely to offer new targets for drug therapy. There is a need for the research community to develop better animal models and technologies that reflect the disease progression seen in humans. A particular focus is required on models in which SNA is chronically elevated.

Spontaneous variability analysis for characterizing cardiovascular responses to water ingestion

This paper examines the effect of water ingestion on the cardiovascular system, utilizing advanced fluctuation analysis. The ingestion of water has been known to significantly raise the blood pressure in subjects with autonomic disorders, resulting in the effect of preventing syncope occurrences. For precise characterization of the effect of water ingestion, head-up tilt experiments at 80 degrees have been conducted for fourteen healthy subjects, ranging in age from 16 to 24. Systolic/diastolic blood pressures (sBP/dBP), total peripheral resistance index (TRPI) and ECG RR intervals (RRIs) were measured for thirty minutes before and after the isotonic water ingestion of 340 ml. Blood pressures: sBP (2.8%), dBP(3.6%), and TPRI (5.3%) showed statistically significant increases after the water ingestion. RRIs also tended to increase (2.3%), although they were not statistically significant. The data analysis confirmed that the water injection of 340 ml has the acute effect against the syncope occurrences that are mainly due to the increase in TPRI. Then heart rate (HR) spectral analysis with the derivative of the cubic spline interpolation (DCSI) method, and a closed loop system identification technique, which associate fluctuations in sBP and HR, are utilized for further precise characterization of the change in recorded physiologic quantities.

Comparative effects of oral and intraduodenal glucose on blood pressure, heart rate, and splanchnic blood flow in healthy older subjects

Postprandial hypotension occurs frequently, particularly in the elderly. The magnitude of the fall in blood pressure (BP) and rise in heart rate (HR) in response to enteral glucose are greater when gastric emptying (GE) or small intestinal infusion are more rapid. Meal ingestion is associated with an increase in splanchnic blood flow. In contrast, gastric distension may attenuate the postprandial fall in BP. The aims of this study were to evaluate, in older subjects, the comparative effects of intraduodenal glucose infusion, at a rate similar to GE of oral glucose, on BP, HR, superior mesenteric artery (SMA) flow, and blood glucose. Eight healthy subjects (5 men, 3 women, age 66-75 yr) were studied on two occasions. On day 1, each subject ingested 300 ml of water containing 75 g glucose. GE was quantified by three-dimensional ultrasonography between time t = 0-120 min, and the rate of emptying (kcal/min) was calculated. On day 2, glucose was infused intraduodenally at the same rate as that on day 1. On both days, BP, HR, SMA flow, and blood glucose were measured. The mean GE of oral glucose was 1.3 +/- 0.1 kcal/min. Systolic BP (P < 0.01), SMA flow (P < 0.05), and blood glucose (P < 0.01) were greater and HR less (P < 0.01) after oral, compared with intraduodenal, glucose. There were comparable falls in diastolic BP during the study days (P < 0.01 for both). We conclude that the magnitude of the fall in systolic BP and rise in HR are less after oral, compared with intraduodenal, glucose, presumably reflecting the "protective" effect of gastric distension.

The beta-adrenergic antagonist propranolol partly abolishes thermogenic response to bioactive food ingredients

A combination of tyrosine, capsaicin, catechins, and caffeine has been shown to possess a thermogenic effect in humans. The present objective was to investigate whether the thermogenic response to the bioactive combination (BC) could be diminished or abolished by propranolol. Twenty-two men (age, 29.0 +/- 7.1 years; body mass index, 26.0 +/- 3.6 kg/m(2); mean +/- SD) participated in a 4-way, randomized, double-blind, placebo-controlled crossover study. The effect of the following was tested: (1) placebo, (2) BC, (3) BC + 5 mg propranolol, and (4) BC + 10 mg propranolol. Resting metabolic rate, respiratory quotient, and the thermogenic response were measured for 5 hours postintake. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, and appetite ratings were assessed every half hour. The BC increased resting metabolic rate by 5% (73 [36; 110] kJ/5 h, mean [95% confidence interval], P < .0001) compared with placebo. Both propranolol doses blunted the thermogenic response by 50% compared with placebo (P < .01). The BC increased SBP by 3% (4 +/- 1 mm Hg, P = .003) compared with placebo. The effect of BC on SBP was reduced by 25% by propranolol (P = .07). The BC (with or without propranolol) increased DBP by 6% (4 +/- 1 mm Hg, P </= .0002). Propranolol decreased heart rate by 5% (3 +/- 1 beats per minute, P < .0001) compared with placebo and BC. No effects were observed on appetite ratings. In conclusion, the study confirms the thermogenic properties of BC. The 50% reduction of the thermogenic response by propranolol indicates that beta-adrenergic pathways are partly responsible for the thermogenic response.

Acute effects of food on postprandial blood pressure and measures of arterial stiffness in healthy humans

BACKGROUND

Recent research suggests that central pulse pressure may be a better indicator of cardiovascular disease outcomes than brachial pressure. Little information is available regarding the effect of food intake on postprandial central pressure and other measures of arterial stiffness when measured with a noninvasive pulse wave analysis (PWA) technique.

OBJECTIVE

The objective was to investigate the effects of water and food plus water intake on brachial and central blood pressure (BP) and measures of arterial stiffness, including augmentation pressure and augmentation index, by using the PWA technique.

DESIGN

Measurements of BP and PWA were made at fasting and for 2 h after the intake of water or breakfast (1300 kJ) in random order in 35 subjects.

RESULTS

Baseline fasting measures of BP and arterial stiffness were not significantly different before the 2 interventions. Consumption of food plus water, compared with water alone, led to a significantly lower (all P < 0.01) brachial diastolic pressure (difference: -3.8 mm Hg), central BP (difference: systolic, -6.1 mm Hg; diastolic, -3.8 mm Hg), central pulse pressure (difference: -2.4 mm Hg), mean arterial pressure (difference: -4.6 mm Hg), augmentation pressure (difference: -2.9 mm Hg), and augmentation index (difference: -5.3 mm Hg).

CONCLUSIONS

Markers of central hemodynamics are sensitive to feeding state and therefore should be measured at fasting to avoid variability due to recent (within 2-3 h) food intake. This is especially important when measurements are repeated over time to assess the effect of medication or lifestyle changes on cardiovascular disease risk factors.

Glucose reduces the effect of water to promote orthostatic tolerance

BACKGROUND

Recent studies have shown that ingestion of glucose water lowers blood pressure (BP) in patients with perturbed autonomic control and more modestly lowers BP in elderly normal subjects. Whether glucose water affects cardiovascular control during orthostatic stress in normal young healthy subjects is unknown. We hypothesized that glucose water ingestion will reduce orthostatic tolerance in young healthy volunteers.

METHODS

In a randomized, controlled, within-subject study, 15 healthy male subjects (21-28 years of age) ingested water or 10% glucose water 5 min before tilt-table testing. We measured finger BP, brachial BP, heart rate, and peripheral vascular resistance. Orthostatic tolerance was measured as the time to presyncope during a 70 degrees head-up tilt, in which the head was tilted for 45 min or until presyncopal symptoms were observed.

RESULTS

During the first 45 min of tilt, 8 of 15 subjects who ingested 10% glucose water experienced presyncope, but only 2 of 15 who ingested water (P = 0.029) experienced presyncope. Ingestion of 10% glucose water increased the heart rate significantly more than pure water during head-up tilt (P = 0.026). Ingestion of water increased the peripheral vascular resistance significantly >10% glucose water during the head-up tilt test (P = 0.013).

CONCLUSIONS

Ingestion of 10% glucose water impairs head-up tilt tolerance relative to water ingestion. The contrasting effect of 10% glucose water vs. pure water on orthostatic tolerance is associated with increased heart rate and attenuation of the increase in peripheral vascular resistance in head-up tilt testing.

Vasodilation in vasovagal syncope and the effect of water ingestion

Abnormal (increased, but also decreased) vasodilative responses have been observed in patients with vasovagal syncope (VVS). The objective was to assess reactive vasodilation in supine patients with VVS and its relation to severity of the syndrome. Reactive vasodilation was also assessed after a simple therapeutic intervention (water drinking). Thirty-four patients were studied, all with recurrent VVS and a recent positive head-up tilt test result. Seventeen matched healthy subjects served as controls. Venous occlusion plethysmography was used to assess forearm blood flow (FBF) and forearm vascular resistance resistance (1) at rest and (2) during reactive hyperemia. Clinical severity of the syndrome was related to the intensity and duration of the vasodilative reflex. The same plethysmographic measurements were repeated 60 minutes after drinking 500 ml of water. Before water drinking, no difference was observed between groups in baseline measurements. However, duration of hyperemia was longer in patients (p <0.05) and was related to the duration of the previous positive tilt test (r = -0.69, p <0.05) and total number of each patient's symptomatic vasovagal episodes (r = 0.49, p <0.05). After water ingestion, baseline FBF decreased in patients (p <0.05) and remained stable in controls. In patients, duration of hyperemia decreased to normal values. Hyperemic FBF remained similar between groups. In conclusion, increased reactive vasodilative reflexes were observed in patients with VVS. They seemed to be of significant pathophysiologic significance. Water drinking can normalize them for >or=60 minutes.

Gastric distension attenuates the hypotensive effect of intraduodenal glucose in healthy older subjects

Postprandial hypotension occurs frequently, and current management is suboptimal. Recent studies suggest that the magnitude of the fall in postprandial blood pressure (BP) may be attenuated by gastric distension. The aim of this study was to determine the effect of gastric distension on the hypotensive response to intraduodenal (ID) glucose. Eight healthy subjects (5 males, 3 females, aged 65-76 years) received an ID infusion of either 1) 50 g glucose in 300 ml saline (ID glucose) over 60 min (t=0-60 min), 2) 50 g glucose in 300 ml saline over 60 min and intragastric (4) infusion of 500 ml water between t=7-10 min (IG water and ID glucose), or 3) ID saline (0.9%) infusion over 60 min and IG infusion of 500 ml water (IG water and ID saline) all followed by ID saline infusion for another 60 min (t=60-120 min) on three separate days. BP and heart rate (HR) were measured. Gastric emptying (GE) of the IG water was quantified by two-dimensional ultrasonography. Between t=0-60 min, systolic and diastolic BP was greater (P<0.05 for both) with IG water and ID saline compared with IG water and ID glucose, and less (P<0.05 for both) with ID glucose compared with IG water and ID glucose. These effects were evident at relatively low IG volumes (approximately 300 ml). GE was faster with IG water and ID saline when compared with IG water and ID glucose. We conclude that, in healthy older subjects, IG administration of water markedly attenuates the hypotensive response to ID glucose, presumably as a result of gastric distension.

Fructose ingestion acutely elevates blood pressure in healthy young humans

Overconsumption of fructose, particularly in the form of soft drinks, is increasingly recognized as a public health concern. The acute cardiovascular responses to ingesting fructose have not, however, been well-studied in humans. In this randomized crossover study, we compared cardiovascular autonomic regulation after ingesting water and drinks containing either glucose or fructose in 15 healthy volunteers (aged 21–33 yr). The total volume of each drink was 500 ml, and the sugar content 60 g. For 30 min before and 2 h after each drink, we recorded beat-to-beat heart rate, arterial blood pressure, and cardiac output. Energy expenditure was determined on a minute-by-minute basis. Ingesting the fructose drink significantly increased blood pressure, heart rate, and cardiac output but not total peripheral resistance. Glucose ingestion resulted in a significantly greater increase in cardiac output than fructose but no change in blood pressure and a concomitant decrease in total peripheral resistance. Ingesting glucose and fructose, but not water, significantly increased blood pressure variability and decreased cardiovagal baroreflex sensitivity. Energy expenditure increased by a similar amount after glucose and fructose ingestion, but fructose elicited a significantly greater increase in respiratory quotient. These results show that ingestion of glucose and fructose drinks is characterized by specific hemodynamic responses. In particular, fructose ingestion elicits an increase in blood pressure that is probably mediated by an increase in cardiac output without compensatory peripheral vasodilatation.

Water intake accelerates post-exercise cardiac vagal reactivation in humans

Post-exercise cardiac vagal reactivation is well-investigated; however, the effect of water intake during this period has not been well studied. Therefore, our aim was to assess the influence of water intake on the cardiac vagal reactivation after 30 min of a submaximal cycling exercise. Ten healthy subjects (eight men) aged 23-35 years were evaluated. A 3-day testing cycle duration, subjects were randomly chosen to drink either 500 ml (experimental visit) or 50 ml (control visit) of water immediately after the 30-min cycling exercise at a workload representing 80% of a previously measured anaerobic threshold. A cardiac vagal index (CVI) was obtained using the 4-s exercise test measured before and after (10 and 30 min) exercise at each testing day. Data analysis (2 x 3 ANOVA for repeated measures) showed higher cardiac vagal activity at the 30-min post-exercise period when 500 ml of water was ingested. CVI values for the 500 and 50 ml trials were 1.55 +/- 0.04 vs. 1.49 +/- 0.04, P = 0.003 (mean +/- SEM), respectively. Heart rate and blood pressure values were relatively the same. In conclusion, water intake of about 500 ml immediately after 30 min of cycling exercise accelerates post-exercise cardiac vagal reactivation. These results suggest that post-exercise hydration might be beneficial not only for thermoregulation, but also for vagal reactivation.

Water drinking induces thermogenesis through osmosensitive mechanisms

CONTEXT

Recently, we showed that drinking 500 ml water induces thermogenesis in normal-weight men and women.

OBJECTIVE

We now repeated these studies in a randomized, controlled, crossover trial in overweight or obese otherwise healthy subjects (eight men and eight women), comparing also the effects of 500 ml isoosmotic saline or 50 ml water.

RESULTS

Only 500 ml water increased energy expenditure by 24% over the course of 60 min after ingestion, whereas isoosmotic saline and 50 ml water had no effect. Heart rate and blood pressure did not change in these young, healthy subjects.

CONCLUSIONS

Our data exclude volume-related effects or gastric distension as the mediator of the thermogenic response to water drinking. Instead, we hypothesize the existence of a portal osmoreceptor, most likely an ion channel.

Acute water ingestion increases arterial blood pressure in hypertensive and normotensive subjects

In patients with severe autonomic dysfunction, water ingestion elicits an acute pressor response. Hypertension may be associated with changes in cardiovascular autonomic modulation, but there is no information on the acute effects of water ingestion in patients with hypertension. In this study, we compared the effect of acute water ingestion on haemodynamic and autonomic responses of hypertensive and normotensive individuals. Eight patients with mild hypertension were compared to 10 normotensive individuals. After 30 min resting in the supine position all subjects ingested 500 ml of water. At baseline and after water ingestion, venous blood samples for plasma volume determination were collected, and electrocardiographic tracings, finger blood pressure, forearm blood flow and muscle sympathetic nerve activity (MSNA) were obtained. Water ingestion resulted in similar and minor reduction in plasma volume. Systolic and diastolic blood pressure increased in both hypertensive (mean+/-s.d.: 19/14+/-6/3 mm Hg) and normotensive subjects (17/14+/-6/3 mm Hg). There was an increase in forearm vascular resistance and in MSNA. Heart rate was reduced (hypertensive: 5+/-1 beats/min, normotensive: 5+/-6 beats/min) and the high-frequency component of heart rate and systolic blood pressure variability was increased. In hypertensive and normotensive individuals, acute water ingestion elicits a pressor response, an effect that is most likely determined by an increased vasoconstrictor sympathetic activity, and is counterbalanced by an increase in blood pressure and heart rate vagal modulation.

Time course of synergistic interaction between DOCA and salt on blood pressure: roles of vasopressin and hepatic osmoreceptors

In DOCA-salt rats, the time course of the synergistic interaction between osmolality and DOCA to produce hypertension is unknown. Therefore, in rats 2 wk after implantation of subcutaneous silicone pellets containing DOCA (65 mg) or no drug (sham), we determined blood pressure (BP) and heart rate (HR) responses, using telemetric pressure transducers, during 2 wk of excess salt ingestion (1% NaCl in drinking water). BP was unaltered in sham rats after increased salt, but in DOCA rats BP increased within 4 h. The initial hypertension of 30–35 mmHg stabilized within 2 days, followed ∼5 days later by a further increment of ∼30 mmHg. HR first decreased during the dark phase; the second phase was linked to an abrupt increase in HR and BP variability and decreased HR variability. Pressor responses to acute intravenous hypertonic saline infusion were doubled in DOCA-treated rats via vasopressin and nonvasopressin mechanisms. Only in DOCA-treated rats, portal vein hypertonic saline infusion increased BP, which was prevented by V1 vasopressin blockade. After 2 wk of DOCA-salt, oral ingestion of water rapidly decreased BP. Intraportal infusion of water did not lower BP in DOCA-salt rats, suggesting that hepatic osmoreceptors were not involved. In summary, the hypertension of DOCA-treated rats consuming excess salt exhibits multiple phases and can be rapidly reversed. Hypertonicity-induced vasopressin and nonvasopressin pressor mechanisms that are augmented by DOCA, and hepatic osmoreceptors may contribute to the initial developmental phase. With time, combined DOCA-salt induces marked changes in the regulation of the autonomic nervous system, which may favor hypertension development.

A spinal vasopressinergic mechanism mediates hyperosmolality-induced sympathoexcitation

An elevation in plasma osmolality elicits a complex neurohumoral response, including an activation of the sympathetic nervous system and an increase in arterial pressure. Using a combination of in vivo and in situ rat preparations, we sought to investigate whether hypothalamic vasopressinergic spinally projecting neurones are activated during increases in plasma osmolality to elicit sympathoexcitation. Hypertonic saline (HS, i.v. bolus), which produced a physiological increase in plasma osmolality to 299 +/- 1 mosmol (kg water)(-1), elicited an immediate increase in mean arterial pressure (MAP) (from 101 +/- 1 to 121 +/- 3 mmHg) in vivo. Pre-treatment with prazosin reversed the HS-induced pressor response to a hypotensive response (from 121 +/- 3 to 68 +/- 2 mmHg), indicating significant activation of the sympathetic nervous system. In an in situ arterially perfused decorticate rat preparation, hyperosmotic perfusate consisted of either 135 mm NaCl, or a non-NaCl osmolyte, mannitol (0.5%); both increased lumbar sympathetic nerve activity (LSNA) by 32 +/- 5% (NaCl) and 21 +/- 1% (mannitol), which was attenuated after precollicular transection (7 +/- 3% and 1 +/- 1%, respectively). Remaining experiments used the NaCl hyperosmotic stimulus. In separate preparations the hyperosmotic-induced sympathoexcitation (21 +/- 2%) was also significantly attenuated after transection of the circumventricular organs (2 +/- 1%). Either isoguvacine (a GABA(A) receptor agonist) or kynurenic acid (a non-selective ionotropic glutamate receptor antagonist) microinjected bilaterally into the paraventricular nucleus (PVN) attenuated the increase in LSNA induced by the hyperosmotic stimulus (control: 25 +/- 2%; after isoguvacine: 7 +/- 2%; after kynurenic: 8 +/- 3%). Intrathecal injection of a V(1a) receptor antagonist also reduced the increase in LSNA elicited by the hyperosmotic stimulus (control: 29 +/- 6%; after blocker: 4 +/- 1%). These results suggest that a physiological hyperosmotic stimulus produces sympathetically mediated hypertension in conscious rats. These data are substantiated by the in situ decorticate preparation in which sympathoexcitation was also evoked by comparable hyperosmotic stimulation. Our findings demonstrate the importance of vasopressin acting on spinal V(1a) receptors for mediating sympathoexcitatory response to acute salt loading.

Sodium Paradoxically Reduces the Gastropressor Response in Patients With Orthostatic Hypotension

Orthostatic hypotension (OH) can cause syncope that is difficult to treat. We have found that 473 mL (16 oz) of water can increase systolic blood pressure (SBP) by >30 mm Hg in many OH patients (the gastropressor response). OH patients are routinely advised to increase their sodium intake to augment their blood volume. We tested the hypothesis that the ingestion of salt with water would increase the magnitude of the acute pressor response compared with water alone in patients with OH. Patients with OH (n=9; female=5; 65±3 years) underwent a randomized crossover trial of drinking water (H 2 O) and salt water (NaCl-H 2 O). Noninvasive heart rate and BP were measured with the patient seated for ≥60 minutes after ingestion. The area under the curve for SBP was greater with H 2 O than NaCl-H 2 O for the 30 minutes (714±388 mm Hg×min versus 364±369 mm Hg×min; P =0.002) and 60 minutes (1454±827 mm Hg×min versus 812±734 mm Hg×min; P =0.048) after ingestion. The increase in SBP with H 2 O was greater than with NaCl-H 2 O at 30 minutes (37±6 versus 18±5 mm Hg; P =0.006) but not at 60 minutes (17±6 versus 10±6 mm Hg; P =0.4). Norepinephrine increased after H 2 O ( P =0.018) but not after NaCl-H 2 O ( P =0.195). Both oral water and salt water increase BP in patients with OH. Instead of augmenting the gastropressor response, the additional salt paradoxically attenuates the pressor response to water. These data suggest a potentially important role for gastrointestinal osmolality in the activation of the sympathetic nervous system leading to cardiovascular reflexes responsible for the gastropressor response.

Body fat loss achieved by stimulation of thermogenesis by a combination of bioactive food ingredients: a placebo-controlled, double-blind 8-week intervention in obese subjects

BACKGROUND

A combination of tyrosine, capsaicin, catechines and caffeine may stimulate the sympathetic nervous system and promote satiety, lipolysis and thermogenesis. In addition, dietary calcium may increase fecal fat excretion.

OBJECTIVE

To investigate the acute and subchronic effect of a supplement containing the above mentioned agents or placebo taken t.i.d on thermogenesis, body fat loss and fecal fat excretion.

DESIGN

In total, 80 overweight-obese subjects ((body mass index) 31.2+/-2.5 kg/m(2), mean+/-s.d.) underwent an initial 4-week hypocaloric diet (3.4 MJ/day). Those who lost>4% body weight were instructed to consume a hypocaloric diet (-1.3 MJ/day) and were randomized to receive either placebo (n=23) or bioactive supplement (n=57) in a double-blind, 8-week intervention. The thermogenic effect of the compound was tested at the first and last day of intervention, and blood pressure, heart rate, body weight and composition were assessed.

RESULTS

Weight loss during the induction phase was 6.8+/-1.9 kg. At the first exposure the thermogenic effect of the bioactive supplement exceeded that of placebo by 87.3 kJ/4 h (95%CI: 50.9;123.7, P=0.005) and after 8 weeks this effect was sustained (85.5 kJ/4 h (47.6;123.4), P=0.03). Body fat mass decreased more in the supplement group by 0.9 kg (0.5; 1.3) compared with placebo (P<0.05). The bioactive supplement had no effect on fecal fat excretion, blood pressure or heart rate.

CONCLUSION

The bioactive supplement increased 4-h thermogenesis by 90 kJ more than placebo, and the effect was maintained after 8 weeks and accompanied by a slight reduction in fat mass. These bioactive components may support weight maintenance after a hypocaloric diet.