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Kitada S, Kawada Y, Nakasuka K, Mizoguchi T, Yamamoto J, Yokoi M, Ito T, Goto T, Kikuchi S, Seo Y. Elevated arginine vasopressin levels surrogate acute lung injury in acute decompensated heart failure. Heart Vessels 2024:10.1007/s00380-024-02429-y. [PMID: 38861175 DOI: 10.1007/s00380-024-02429-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/30/2024] [Indexed: 06/12/2024]
Abstract
Activated arginine vasopressin (AVP) pathway worsens congestion in heart failure (HF), but its potential to relieve pulmonary congestion is also reported. The pathophysiological role and prognostic utility of AVP elevation in acute decompensated HF (ADHF) are poorly understood. We prospectively enrolled 52 hospitalized patients for ADHF to investigate the association between acute lung injury (ALI) in ADHF and AVP levels on admission. ALI was defined as respiratory failure leading to death, or requiring a respirator or a more than 12-h non-invasive intermittent positive pressure ventilation (NIPPV) support. In addition, we investigated the prognostic value of AVP levels on admission for cardiovascular death or recurrence of ADHF after discharge. ALI was documented in 7 patients (13.5%) during a median hospital stay of 14 days. And the patients with ALI demonstrated significantly higher AVP levels than those without (32.5 ± 21.6 vs. 6.4 ± 8.7 pg/ml, p = 0.018). Besides, the patients with ALI demonstrated significantly higher heart rates (HR) and lower E/e' on admission (HR: 127 ± 24 vs. 97 ± 28 bpm; E/e': 10.6 ± 3.7 vs. 17.4 ± 6.2, all p < 0.05, respectively). Of note, significant hemodilution assessed by hemoglobin and hematocrit values were observed in the patients with ALI 48 h after admission. A receiver operating characteristic curve analysis showed that higher than 7.2 pg/ml surrogate ALI in ADHF (AUC: 0.897, p = 0.001, Sensitivity: 85.7%, and Specificity: 77.8%). In contrast, increased AVP levels on admission could not predict cardiovascular events after discharge. Elevated AVP levels on admission are associated with ALI in ADHF but not cardiovascular events after discharge.
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Affiliation(s)
- Shuichi Kitada
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya, 467-8601, Japan.
| | - Yu Kawada
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya, 467-8601, Japan
| | - Kosuke Nakasuka
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya, 467-8601, Japan
| | - Tatsuya Mizoguchi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya, 467-8601, Japan
| | - Junki Yamamoto
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya, 467-8601, Japan
| | - Masashi Yokoi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya, 467-8601, Japan
| | - Tsuyoshi Ito
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya, 467-8601, Japan
| | - Toshihiko Goto
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya, 467-8601, Japan
| | - Shohei Kikuchi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya, 467-8601, Japan
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya, 467-8601, Japan
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Peltier AC. Autonomic Dysfunction from Diagnosis to Treatment. Prim Care 2024; 51:359-373. [PMID: 38692780 DOI: 10.1016/j.pop.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Autonomic disorders can present with hypotension, gastrointestinal, genitourinary symptoms, and heat intolerance. Diabetes is the most common causes of autonomic failure, and management should focus on glucose control to prevent developing autonomic symptoms. The most prevalent cause of dysautonomia, or autonomic dysfunction, is Postural Orthostatic Tachycardia Syndrome (POTS). Autonomic testing characterizes causes for nonspecific symptoms but is not necessary in patients with classic presentations. Treatment for autonomic dysfunction and failure focus on discontinuing offending medications, behavioral modification, and pharmacologic therapy to decrease symptom severity. Autonomic failure has no cure; therefore, the focus remains on improving quality of life.
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Affiliation(s)
- Amanda C Peltier
- Department of Neurology, Vanderbilt University Medical Center, 1611 21st Avenue South, Nashville, TN 37232, USA; Department of Medicine, Vanderbilt University Medical Center, 1611 21st Avenue South, Nashville, TN 37232, USA.
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Fu Z, Ma X, Zhao X, Du X, Wan Y. Associations between Total Atherosclerosis Burden of Baroreceptor-Resident Arteries and ECG Abnormalities after Acute Ischemic Stroke. Brain Sci 2024; 14:505. [PMID: 38790483 PMCID: PMC11118932 DOI: 10.3390/brainsci14050505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Electrocardiogram (ECG) abnormalities are the most common cardiac complications after acute ischemic stroke (AIS) and predict poor outcomes. The arterial baroreflex is an essential determinant of cardiovascular autonomic regulation, with receptors mainly residing in carotid sinuses and aortic arch. The atherosclerosis of these baroreceptor-resident arteries (BRA) is very common in AIS patients and might impair baroreflex function. However, the associations between the atherosclerosis of BRA and ECG abnormalities after AIS are still unknown. In total, 228 AIS patients within 7 days after onset without a pre-existing heart disease were prospectively recruited. With computed tomography angiography, atherosclerosis conditions in 10 segments of the carotid sinuses and aortic arch were scored and summed as the Total Atherosclerosis Burden of BRA (TAB-BRA), and asymptomatic coronary artery stenosis (ACAS) ≥50% was simultaneously assessed. We performed 12-lead ECG to dynamically detect abnormal repolarization, and 24 h Holter ECG to monitor arrhythmias and heart rate variability (HRV) parameters, which are reliable indicators to assess cardiac autonomic function. We found that TAB-BRA was positively associated with abnormal repolarization (OR 1.09; CI% 1.03-1.16; p = 0.003) and serious cardiac arrhythmias (OR 1.08; CI% 1.01-1.15; p = 0.021). In addition, TAB-BRA was an important predictor of abnormal repolarization, persisting over 3 days (OR 1.17; CI% 1.05-1.30; p = 0.003). However, ACAS ≥ 50% did not relate to these ECG abnormalities. TAB-BRA was negatively correlated with parasympathetic-related HRV parameters. Our results indicated that AIS patients with a high TAB-BRA are more likely to have ECG abnormalities and delayed normalization, which may relate to the decreased cardiac parasympathetic activity, but not the accompanied ACAS ≥ 50%.
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Affiliation(s)
- Zhiyong Fu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun St., Beijing 100053, China
- National Clinical Research Center for Geriatric Disorders, Beijing 100053, China
- Clinical Center for Cardio-Cerebrovascular Disease, Capital Medical University, Beijing 100053, China
| | - Xin Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun St., Beijing 100053, China
- National Clinical Research Center for Geriatric Disorders, Beijing 100053, China
- Clinical Center for Cardio-Cerebrovascular Disease, Capital Medical University, Beijing 100053, China
| | - Xiaoxi Zhao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun St., Beijing 100053, China
- National Clinical Research Center for Geriatric Disorders, Beijing 100053, China
- Clinical Center for Cardio-Cerebrovascular Disease, Capital Medical University, Beijing 100053, China
| | - Xiangying Du
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yungao Wan
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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彭 圣, 祁 雨, 孙 丽, 李 丹, 王 新, 韩 江, 陈 宝, 张 媛. [Afferent baroreflex failure with hyponatremia: A case report]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2024; 56:357-361. [PMID: 38595258 PMCID: PMC11004967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Indexed: 04/11/2024]
Abstract
Afferent baroreflex failure (ABF) is a rare disease. It refers to the clinical syndrome caused by the impairment of the afferent limb of the baroreflex or its central connections at the level of the medulla. The recognized causes include trauma, surgery in related areas (radical neck tumor surgery, carotid endarterectomy), neck radiotherapy, brain stem stroke, tumor growth paraganglioma and hereditary diseases, among which the most common cause is extensive neck surgery or radiotherapy for neck cancer. The main manifestations are fluctuating hypertension, orthostatic hypotension, paroxysmal tachycardia and bradycardia. This case is a young man, whose main feature is blood pressure fluctuation, accom-panied by neurogenic orthostatic hypotension (nOH). After examination, the common causes of hypertension and nOH were ruled out. Combined with the previous neck radiotherapy and neck lymph node dissection, it was considered that the blood pressure regulation was abnormal due to the damage of carotid sinus baroreceptor after radiotherapy for nasopharyngeal carcinoma and neck lymph node dissection, which was called ABF. At the same time, the patient was complicated with chronic hyponatremia. Combined with clinical and laboratory examination, the final consideration was caused by syndrome of in- appropriate antidiuretic hormone (SIADH). Baroreceptors controlled the secretion of heart rate, blood pressure and antidiuretic hormone through the mandatory "inhibition" signal. We speculate that the carotid sinus baroreceptor was damaged after neck radiotherapy and surgery, which leads to abnormal blood pressure regulation and nOH, while the function of inhibiting ADH secretion was weakened, resulting in higher ADH than normal level and mild hyponatremia. The goal of treating ABF patients was to reduce the frequency and amplitude of sudden changes in blood pressure and heart rate, and to alleviate the onset of symptomatic hypotension. At present, drug treatment is still controversial, and non-drug treatment may alleviate some patients' symptoms, but long-term effective treatment still needs further study. The incidence of ABF is not high, but it may lead to serious cardiovascular and cerebrovascular events, and the mechanism involved is extremely complicated, and there are few related studies. The reports of relevant medical records warn that patients undergoing neck radiotherapy or surgery should minimize the da-mage to the baroreceptor in the carotid sinus in order to reduce the adverse prognosis caused by complications.
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Affiliation(s)
- 圣嘉 彭
- />北京大学第三医院心内科, 卫生部心血管分子生物学与调节肽重点实验室, 北京 100191Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptide, Ministry of Health, Beijing 100191, China
| | - 雨 祁
- />北京大学第三医院心内科, 卫生部心血管分子生物学与调节肽重点实验室, 北京 100191Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptide, Ministry of Health, Beijing 100191, China
| | - 丽杰 孙
- />北京大学第三医院心内科, 卫生部心血管分子生物学与调节肽重点实验室, 北京 100191Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptide, Ministry of Health, Beijing 100191, China
| | - 丹 李
- />北京大学第三医院心内科, 卫生部心血管分子生物学与调节肽重点实验室, 北京 100191Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptide, Ministry of Health, Beijing 100191, China
| | - 新宇 王
- />北京大学第三医院心内科, 卫生部心血管分子生物学与调节肽重点实验室, 北京 100191Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptide, Ministry of Health, Beijing 100191, China
| | - 江莉 韩
- />北京大学第三医院心内科, 卫生部心血管分子生物学与调节肽重点实验室, 北京 100191Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptide, Ministry of Health, Beijing 100191, China
| | - 宝霞 陈
- />北京大学第三医院心内科, 卫生部心血管分子生物学与调节肽重点实验室, 北京 100191Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptide, Ministry of Health, Beijing 100191, China
| | - 媛 张
- />北京大学第三医院心内科, 卫生部心血管分子生物学与调节肽重点实验室, 北京 100191Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptide, Ministry of Health, Beijing 100191, China
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Palma JA. Dysautonomia and response to guanfacine in individuals with an SCN9A variant. Clin Auton Res 2024; 34:303-305. [PMID: 38652422 DOI: 10.1007/s10286-024-01029-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Jose-Alberto Palma
- Department of Neurology, Dysautonomia Center and Autonomic Disorders Division, New York University Langone Health and New York University Grossman School of Medicine, 530 First Av, Suite 9Q, New York, NY, 10016, USA.
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Mier Y Teran-Ellis S, Estrada-Rodriguez HA, Anaya-Ayala JE, Lopez-Pena G, Contreras-Jimenez E, Dominguez-Vega RX, Gonzalez-Duarte A, Hinojosa CA. Physiological and clinical impact in the carotid baroreceptor function following the surgical management of bilateral carotid body tumors. Vascular 2024; 32:440-446. [PMID: 36394214 DOI: 10.1177/17085381221140167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The bilateral presentation of Carotid Body Tumors (CBT) is rare; the surgical resection of these masses remains the mainstay management due to the malignant potential. We aim to describe, classify, and quantify baroreceptor failure (BRF) after the surgical management of patients with bilateral CBT to better understand the clinical consequences. METHODS Retrospective review of patients that underwent bilateral CBT resection to assess the changes in baroreceptor function. We describe the clinical events associated to BRF after surgery, baseline patient's demographics, characteristics, comorbidities. Additionally, clinical and a quantitative evaluation of baroreceptor sensitivity were conducted using the Composite Autonomic Severity Score (CASS). RESULTS From 1986 to 2020, a total 146 CBT resections were performed in 132 patients in our institution. Tumors were removed bilaterally in staged procedures in seven patients with a mean age of 61 years (Standard Deviation 11), six (85%) were females, and there was no family history of paragangliomas. The clinical presentation were palpable masses in 5 (71%), and odynophagia in 2 (29%) cases; malignant histopathology following surgery was found in one case. BRF occurred in one patient after unilateral CBT resection, consisting of bradycardia and a 40 s asystole that was not previously associated to BR sensitivity. Three (43%) patients presented BRF in the immediate postoperative period of the contralateral CBT excision, consisting of volatile hypertensive crisis in two cases, and supraventricular tachycardia in one. All the patients developed (100%) chronic baroreceptor sensitivity symptoms consisting in syncope, vertigo and fatigue in 4 (57%), tachycardia in 2 (28%), and orthostatic headache in one (14%). Autonomic testing showed mixed sympathetic and parasympathetic failure in five (71%), severe sympathetic failure in 1 (14%), and parasympathetic dysfunction in one patient (14%). CONCLUSIONS Postoperative autonomic assessment confirmed BRF in all studied patients that underwent staged bilateral CBT resection with mixed, sympathetic, and parasympathetic dysfunction. Further studies are necessary to evaluate the incidence and physiological mechanisms of these sequelae to anticipate possible complications and offer the appropriate perioperative management.
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Affiliation(s)
- Santiago Mier Y Teran-Ellis
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Humberto A Estrada-Rodriguez
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Javier E Anaya-Ayala
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Gabriel Lopez-Pena
- Leicester Vascular Institute, University Hospitals of Leicester, Leicester, UK
| | - Emmanuel Contreras-Jimenez
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Rosa X Dominguez-Vega
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Alejandra Gonzalez-Duarte
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
- Department of Neurology at NYU Langone Health, New York, NY, USA
| | - Carlos A Hinojosa
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
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Kubota Y, Oya F, Higashiyama F. A Case of Carotid Sinus Reflex Caused by Manual Aspiration Thrombectomy Using a Balloon Guide Catheter. Cureus 2024; 16:e56253. [PMID: 38623094 PMCID: PMC11017137 DOI: 10.7759/cureus.56253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 04/17/2024] Open
Abstract
When starting a mechanical thrombectomy, manual aspiration with balloon guide catheters inserted into the internal carotid artery (ICA) is an efficient method for thrombus aspiration. However, no complications associated with this procedure have been reported. This study describes the case of a 76-year-old man who presented to our hospital with total aphasia and complete right-sided paralysis due to chronic atrial fibrillation and left occlusion of the ICA. When the balloon guide catheter was inserted and inflated at the origin of the left ICA, the patient's systolic blood pressure suddenly decreased from 114 mm Hg to 44 mm Hg. This sudden hypotension may have been caused by the carotid sinus reflex. Hypotension improved following balloon deflation. The procedure was continued, resulting in complete recanalization of the left ICA. The patient died from acute exacerbation of interstitial pneumonia. Although this complication is rare, similar phenomena have been recognized in carotid artery stenting and the use of flow-diverting devices. To the best of our knowledge, this is the first report of a case wherein the carotid sinus reflex was induced by manual aspiration using a balloon guide catheter placed in the ICA. Clinicians should recognize the importance of ensuring that the proximal end of the balloon crosses the carotid sinus when dilating and occluding the ICA with a balloon to avoid the carotid sinus reflex.
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Affiliation(s)
- Yuki Kubota
- Neurosurgery, Shinshu Ueda Medical Center, Ueda, JPN
| | - Fusakazu Oya
- Neurosurgery, Shinshu Ueda Medical Center, Ueda, JPN
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Juraschek SP, Cortez MM, Flack JM, Ghazi L, Kenny RA, Rahman M, Spikes T, Shibao CA, Biaggioni I. Orthostatic Hypotension in Adults With Hypertension: A Scientific Statement From the American Heart Association. Hypertension 2024; 81:e16-e30. [PMID: 38205630 PMCID: PMC11067441 DOI: 10.1161/hyp.0000000000000236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Although orthostatic hypotension (OH) has long been recognized as a manifestation of autonomic dysfunction, a growing body of literature has identified OH as a common comorbidity of hypertension. This connection is complex, related to pathophysiology in blood pressure regulation and the manner by which OH is derived as the difference between 2 blood pressure measurements. While traditional therapeutic approaches to OH among patients with neurodegenerative disorders focus on increasing upright blood pressure to prevent cerebral hypoperfusion, the management of OH among patients with hypertension is more nuanced; resting hypertension is itself associated with adverse outcomes among these patients. Although there is substantial evidence that intensive blood pressure treatment does not cause OH in the majority of patients with essential hypertension, some classes of antihypertensive agents may unmask OH in patients with an underlying autonomic impairment. Practical steps to manage OH among adults with hypertension start with (1) a thorough characterization of its patterns, triggers, and cause; (2) review and removal of aggravating factors (often pharmacological agents not related to hypertension treatment); (3) optimization of an antihypertensive regimen; and (4) adoption of a tailored treatment strategy that avoids exacerbating hypertension. These strategies include countermaneuvers and short-acting vasoactive agents (midodrine, droxidopa). Ultimately, further research is needed on the epidemiology of OH, the impact of hypertension treatment on OH, approaches to the screening and diagnosis of OH, and OH treatment among adults with hypertension to improve the care of these patients and their complex blood pressure pathophysiology.
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Xue F, Knight S, Connolly E, O’Halloran A, Shirsath MA, Newman L, Duggan E, Kenny RA, Romero-Ortuno R. Were Frailty Identification Criteria Created Equal? A Comparative Case Study on Continuous Non-Invasively Collected Neurocardiovascular Signals during an Active Standing Test in the Irish Longitudinal Study on Ageing (TILDA). SENSORS (BASEL, SWITZERLAND) 2024; 24:442. [PMID: 38257535 PMCID: PMC10818961 DOI: 10.3390/s24020442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND In this observational study, we compared continuous physiological signals during an active standing test in adults aged 50 years and over, characterised as frail by three different criteria, using data from The Irish Longitudinal Study on Ageing (TILDA). METHODS This study utilised data from TILDA, an ongoing landmark prospective cohort study of community-dwelling adults aged 50 years or older in Ireland. The initial sampling strategy in TILDA was based on random geodirectory sampling. Four independent groups were identified: those characterised as frail only by one of the frailty tools used (the physical Frailty Phenotype (FP), the 32-item Frailty Index (FI), or the Clinical Frailty Scale (CFS) classification tree), and a fourth group where participants were not characterised as frail by any of these tools. Continuous non-invasive physiological signals were collected during an active standing test, including systolic (sBP) and diastolic (dBP) blood pressure, as well as heart rate (HR), using digital artery photoplethysmography. Additionally, the frontal lobe cerebral oxygenation (Oxy), deoxygenation (Deoxy), and tissue saturation index (TSI) were also non-invasively measured using near-infrared spectroscopy (NIRS). The signals were visualised across frailty groups and statistically compared using one-dimensional statistical parametric mapping (SPM). RESULTS A total of 1124 participants (mean age of 63.5 years; 50.2% women) were included: 23 were characterised as frail only by the FP, 97 by the FI, 38 by the CFS, and 966 by none of these criteria. The SPM analyses revealed that only the group characterised as frail by the FI had significantly different signals (p < 0.001) compared to the non-frail group. Specifically, they exhibited an attenuated gain in HR between 10 and 15 s post-stand and larger deficits in sBP and dBP between 15 and 20 s post-stand. CONCLUSIONS The FI proved to be more adept at capturing distinct physiological responses to standing, likely due to its direct inclusion of cardiovascular morbidities in its definition. Significant differences were observed in the dynamics of cardiovascular signals among the frail populations identified by different frailty criteria, suggesting that caution should be taken when employing frailty identification tools on physiological signals, particularly the neurocardiovascular signals in an active standing test.
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Affiliation(s)
- Feng Xue
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Silvin Knight
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Emma Connolly
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Aisling O’Halloran
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Morgana Afonso Shirsath
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Louise Newman
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Eoin Duggan
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Rose Anne Kenny
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Roman Romero-Ortuno
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, D02 PN40 Dublin, Ireland
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Jordan J, Biaggioni I. Raising awareness for cardiovascular autonomic dysfunction: the 2023 European Society of Hypertension guidelines revisited. Clin Auton Res 2023; 33:609-611. [PMID: 37725270 PMCID: PMC10751266 DOI: 10.1007/s10286-023-00980-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023]
Affiliation(s)
- Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Linder Hoehe, 51147, Cologne, Germany.
- Medical Faculty, University of Cologne, Cologne, Germany.
| | - Italo Biaggioni
- Autonomic Dysfunction Center and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Ohyama-Tamagake A, Kaneko K, Itami R, Nakano M, Namioka Y, Izumi R, Sato H, Suzuki H, Takeda A, Okazaki Y, Yatsuka Y, Abe T, Murayama K, Sugeno N, Misu T, Aoki M. Adult-onset Leigh Syndrome with a m.9176T>C Mutation Manifested As Reversible Cerebral Vasoconstriction Syndrome. Intern Med 2023; 62:1995-1998. [PMID: 36543208 PMCID: PMC10372267 DOI: 10.2169/internalmedicine.0773-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/13/2022] [Indexed: 12/24/2022] Open
Abstract
A 26-year-old woman developed a sudden headache, ptosis, and diplopia. Magnetic resonance imaging and angiography demonstrated a symmetrical lesion from the midbrain to the brainstem, involving the solitary nucleus and multifocal cerebral artery narrowing. Reversible cerebral vasoconstriction syndrome (RCVS) was suspected, and the patient improved after vasodilatation. Leigh syndrome was suspected due to the elevated serum pyruvate level, so mitochondrial DNA was analyzed, and an m.9176T>C mutation was detected. The final diagnosis was adult-onset Leigh syndrome manifesting as RCVS. An uncontrolled baroreflex due to a solitary nuclear lesion or endothelial dysfunction may have contributed to her unique presentation.
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Affiliation(s)
| | | | - Ryo Itami
- Department of Neurology, Tokyo General Hospital, Japan
| | | | | | - Rumiko Izumi
- Department of Neurology, Tohoku University Hospital, Japan
| | - Haruka Sato
- Department of Cardiology, Tohoku University Hospital, Japan
| | - Hideaki Suzuki
- Department of Cardiology, Tohoku University Hospital, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University Hospital, Japan
| | - Yasushi Okazaki
- Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Japan
- Laboratory for Comprehensive Genomic Analysis, RIKEN Center for Integrative Medical Sciences, Japan
| | - Yukiko Yatsuka
- Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Japan
| | - Takaaki Abe
- Department of Clinical Biology and Hormonal Regulation, Graduate School of Medicine, Tohoku University, Japan
| | - Kei Murayama
- Department of Metabolism, Chiba Children's Hospital, Japan
| | - Naoto Sugeno
- Department of Neurology, Tohoku University Hospital, Japan
| | - Tatsuro Misu
- Department of Neurology, Tohoku University Hospital, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Hospital, Japan
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12
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Elkholey K, Wahba A, Paranjape SY, Saleem M, Kirabo A, Joos KM, Diedrich A, Shibao CA, Biaggioni I. Post-COVID-19 Afferent Baroreflex Failure. Hypertension 2023; 80:895-900. [PMID: 36802914 PMCID: PMC10112935 DOI: 10.1161/hypertensionaha.123.20316] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- Khaled Elkholey
- Divisions of Clinical Pharmacology, Department of Medicine (K.E., A.W., S.P., M.S., S.K., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
- Autonomic Dysfunction Center (K.E., A.W., S.Y.P., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
| | - Amr Wahba
- Divisions of Clinical Pharmacology, Department of Medicine (K.E., A.W., S.P., M.S., S.K., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
- Autonomic Dysfunction Center (K.E., A.W., S.Y.P., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
| | - Sachin Y. Paranjape
- Divisions of Clinical Pharmacology, Department of Medicine (K.E., A.W., S.P., M.S., S.K., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
- Autonomic Dysfunction Center (K.E., A.W., S.Y.P., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
| | - Mohammad Saleem
- Divisions of Clinical Pharmacology, Department of Medicine (K.E., A.W., S.P., M.S., S.K., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
| | - Annet Kirabo
- Divisions of Clinical Pharmacology, Department of Medicine (K.E., A.W., S.P., M.S., S.K., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
- Autonomic Dysfunction Center (K.E., A.W., S.Y.P., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
- and Vanderbilt Eye Institute (K.M.J.), Vanderbilt University Medical Center, Nashville, TN
| | - Karen M. Joos
- and Vanderbilt Eye Institute (K.M.J.), Vanderbilt University Medical Center, Nashville, TN
| | - André Diedrich
- Divisions of Clinical Pharmacology, Department of Medicine (K.E., A.W., S.P., M.S., S.K., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
- Autonomic Dysfunction Center (K.E., A.W., S.Y.P., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
| | - Cyndya A. Shibao
- Divisions of Clinical Pharmacology, Department of Medicine (K.E., A.W., S.P., M.S., S.K., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
- Autonomic Dysfunction Center (K.E., A.W., S.Y.P., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
| | - Italo Biaggioni
- Divisions of Clinical Pharmacology, Department of Medicine (K.E., A.W., S.P., M.S., S.K., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
- Autonomic Dysfunction Center (K.E., A.W., S.Y.P., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
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13
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Cui Q, Che L, Zang H, Yu J, Xu L, Huang Y. Association between preoperative autonomic nervous system function and post-induction hypotension in elderly patients: a protocol for a cohort study. BMJ Open 2023; 13:e067400. [PMID: 36717143 PMCID: PMC9887722 DOI: 10.1136/bmjopen-2022-067400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Post-induction hypotension (PIH), which is prevalent among elderly patients, is associated with adverse perioperative outcomes. As a critical part of blood pressure regulation, baroreflex control is believed to be closely related to intraoperative blood pressure fluctuations. Spontaneous baroreflex sensitivity and heart rate variability measurement can aid evaluation of patients' autonomic function. This study aims to determine the association between preoperative decreased baroreflex function and PIH in elderly patients. METHODS AND ANALYSIS This prospective cohort study will enrol patients who are 65 years old and above, scheduled for elective non-cardiac surgery under general anaesthesia, and American Society of Anesthesiologists physical status I-III (n=180). Baseline assessment will include routine preoperative evaluations as well as symptoms and anamneses associated with baroreflex failure. Preoperative autonomic function monitoring will be performed through 20 min of continuous beat-to-beat heart rate and blood pressure monitoring using LiDCO rapid (Masimo Corporation, USA). The primary outcome will be PIH. Detailed use of anaesthetic agents during induction and maintenance will be documented for adjustment in multivariable analyses. ETHICS AND DISSEMINATION The Research Ethics Committee of Peking Union Medical College Hospital approved the study protocol (I-22PJ008). We aim to publish and disseminate our findings in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05425147.
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Affiliation(s)
- Quexuan Cui
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lu Che
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Han Zang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiawen Yu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Li Xu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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14
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Orthostatic hypotension with nondipping: phenotype of neurodegenerative disease. Hypertens Res 2022; 45:1514-1516. [PMID: 35836000 DOI: 10.1038/s41440-022-00980-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 06/12/2022] [Indexed: 11/08/2022]
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15
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Lin YD, Diedrich A. Editorial: Methods on the Assessment of Human Baroreflex Function. Front Neurosci 2022; 16:965406. [PMID: 35837120 PMCID: PMC9274245 DOI: 10.3389/fnins.2022.965406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Yue-Der Lin
- Department of Autonomic Control Engineering, Feng Chia University, Taichung, Taiwan
- Master's Program of Biomedical Informatics and Biomedical Engineering, Feng Chia University, Taichung, Taiwan
| | - André Diedrich
- Vanderbilt Autonomic Dysfunction Center, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, United States
- *Correspondence: André Diedrich
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16
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Carmona-Torre F, Mínguez-Olaondo A, López-Bravo A, Tijero B, Grozeva V, Walcker M, Azkune-Galparsoro H, López de Munain A, Alcaide AB, Quiroga J, Del Pozo JL, Gómez-Esteban JC. Dysautonomia in COVID-19 Patients: A Narrative Review on Clinical Course, Diagnostic and Therapeutic Strategies. Front Neurol 2022; 13:886609. [PMID: 35720084 PMCID: PMC9198643 DOI: 10.3389/fneur.2022.886609] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/28/2022] [Indexed: 12/27/2022] Open
Abstract
Introduction On March 11, 2020, the World Health Organization sounded the COVID-19 pandemic alarm. While efforts in the first few months focused on reducing the mortality of infected patients, there is increasing data on the effects of long-term infection (Post-COVID-19 condition). Among the different symptoms described after acute infection, those derived from autonomic dysfunction are especially frequent and limiting. Objective To conduct a narrative review synthesizing current evidence of the signs and symptoms of dysautonomia in patients diagnosed with COVID-19, together with a compilation of available treatment guidelines. Results Autonomic dysfunction associated with SARS-CoV-2 infection occurs at different temporal stages. Some of the proposed pathophysiological mechanisms include direct tissue damage, immune dysregulation, hormonal disturbances, elevated cytokine levels, and persistent low-grade infection. Acute autonomic dysfunction has a direct impact on the mortality risk, given its repercussions on the respiratory, cardiovascular, and neurological systems. Iatrogenic autonomic dysfunction is a side effect caused by the drugs used and/or admission to the intensive care unit. Finally, late dysautonomia occurs in 2.5% of patients with Post-COVID-19 condition. While orthostatic hypotension and neurally-mediated syncope should be considered, postural orthostatic tachycardia syndrome (POTS) appears to be the most common autonomic phenotype among these patients. A review of diagnostic and treatment guidelines focused on each type of dysautonomic condition was done. Conclusion Symptoms deriving from autonomic dysfunction involvement are common in those affected by COVID-19. These symptoms have a great impact on the quality of life both in the short and medium to long term. A better understanding of the pathophysiological mechanisms of Post-COVID manifestations that affect the autonomic nervous system, and targeted therapeutic management could help reduce the sequelae of COVID-19, especially if we act in the earliest phases of the disease.
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Affiliation(s)
- Francisco Carmona-Torre
- Infectious Disease Service, University Clinic of Navarra, Pamplona, Spain.,COVID-19 Department, University Clinic of Navarra, Pamplona, Spain.,Immune and Infectious Inflammatory Diseases Research, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Ane Mínguez-Olaondo
- Neurology Department, Donostia University Hospital-OSAKIDETZA, San Sebastián, Spain.,ATHENEA Neuroclinics, Policlínica Gipuzkoa Grupo Quironsalud, Donostia, Spain.,Neuroscience Area, Biodonostia Research Institute, San Sebastián, Spain.,Neurology Department, Faculty of Medicine, University of Deusto, Bilbao, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain
| | - Alba López-Bravo
- Neurology Department, Hospital Reina Sofía de Tudela-OSASUNBIDEA, Tudela, Spain.,Aragon Institute for Health Research (IIS-A), Zaragoza, Spain
| | - Beatriz Tijero
- Neurology Department, Faculty of Medicine, University of Deusto, Bilbao, Spain.,Neurodegenerative Diseases Group Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Neurology Department, Cruces University Hospital-OSAKIDETZA, Barakaldo, Spain
| | | | - Michaela Walcker
- ATHENEA Neuroclinics, Policlínica Gipuzkoa Grupo Quironsalud, Donostia, Spain
| | - Harkaitz Azkune-Galparsoro
- Neuroscience Area, Biodonostia Research Institute, San Sebastián, Spain.,Infectious Disease Department, Donostia University Hospital-OSAKIDETZA, San Sebastián, Spain.,Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Adolfo López de Munain
- Neurology Department, Donostia University Hospital-OSAKIDETZA, San Sebastián, Spain.,ATHENEA Neuroclinics, Policlínica Gipuzkoa Grupo Quironsalud, Donostia, Spain.,Neuroscience Area, Biodonostia Research Institute, San Sebastián, Spain.,Neurology Department, Faculty of Medicine, University of Deusto, Bilbao, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain.,Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Ana Belen Alcaide
- COVID-19 Department, University Clinic of Navarra, Pamplona, Spain.,Pulmonary Department, University Clinic of Navarra, Pamplona, Spain
| | - Jorge Quiroga
- COVID-19 Department, University Clinic of Navarra, Pamplona, Spain.,Immune and Infectious Inflammatory Diseases Research, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,Internal Medicine Department, University Clinic of Navarra, Pamplona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Institute Carlos III, Madrid, Spain
| | - Jose Luis Del Pozo
- Infectious Disease Service, University Clinic of Navarra, Pamplona, Spain.,COVID-19 Department, University Clinic of Navarra, Pamplona, Spain.,Immune and Infectious Inflammatory Diseases Research, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Juan Carlos Gómez-Esteban
- ATHENEA Neuroclinics, Policlínica Gipuzkoa Grupo Quironsalud, Donostia, Spain.,Neurology Department, Faculty of Medicine, University of Deusto, Bilbao, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain.,Neurodegenerative Diseases Group Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Neurology Department, Cruces University Hospital-OSAKIDETZA, Barakaldo, Spain.,Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Spain
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17
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da Silva AA, Moak SP, Dai X, Borges GC, Omoto ACM, Wang Z, Li X, Mouton AJ, Hall JE, do Carmo JM. Parental obesity alters offspring blood pressure regulation and cardiovascular responses to stress: role of P2X7R and sex differences. Am J Physiol Regul Integr Comp Physiol 2022; 322:R421-R433. [PMID: 35318854 PMCID: PMC9018009 DOI: 10.1152/ajpregu.00300.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/07/2022] [Accepted: 03/17/2022] [Indexed: 11/22/2022]
Abstract
We examined the impact of parental obesity on offspring blood pressure (BP) regulation and cardiovascular responses to stress. Offspring from normal (N) diet-fed C57BL/6J parents were fed either N (NN) or a high-fat (H) diet (NH) from weaning until adulthood. Offspring from obese H diet-fed parents were also fed N (HN) or H diet (HH). Body weight, calorie intake, and fat mass were measured at 22 wk of age when cardiovascular phenotyping was performed. Male and female HH offspring were 15% heavier than NH and 70% heavier than NN offspring. Male HH and HN offspring had elevated BP (121 ± 2 and 115 ± 1 mmHg, by telemetry) compared with male NH and NN offspring (108 ± 6 and 107 ± 3 mmHg, respectively) and augmented BP responses to angiotensin II, losartan, and hexamethonium. Male HH and HN offspring also showed increased BP responses to air-jet stress (37 ± 2 and 38 ± 2 mmHg) compared with only 24 ± 3 and 25 ± 3 mmHg in NH and NN offspring. Baseline heart rate (HR) and HR responses to air-jet stress were similar among groups. In females, BP and cardiovascular responses to stress were similar among all offspring. Male H diet-fed offspring from obese H diet-fed purinoreceptor 7-deficient (HH-P2X7R-KO) parents had normal BP that was similar to control NN-P2X7R-KO offspring from lean parents. These results indicate that parental obesity leads to increased BP and augmented BP responses to stress in their offspring in a sex-dependent manner, and the impact of parental obesity on male offspring BP regulation is markedly attenuated in P2X7R-KO mice.
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Affiliation(s)
- Alexandre A da Silva
- Department of Physiology and Biophysics, Mississippi Center for Obesity Research, Cardiorenal and Metabolic Diseases Research Center, University of Mississippi Medical Center, Jackson, Mississippi
| | - Sydney P Moak
- Department of Physiology and Biophysics, Mississippi Center for Obesity Research, Cardiorenal and Metabolic Diseases Research Center, University of Mississippi Medical Center, Jackson, Mississippi
| | - Xuemei Dai
- Department of Physiology and Biophysics, Mississippi Center for Obesity Research, Cardiorenal and Metabolic Diseases Research Center, University of Mississippi Medical Center, Jackson, Mississippi
| | - Gisele C Borges
- Department of Physiology and Biophysics, Mississippi Center for Obesity Research, Cardiorenal and Metabolic Diseases Research Center, University of Mississippi Medical Center, Jackson, Mississippi
- Centro Universitário Barão de Mauá, Ribeirão Preto, Brazil
| | - Ana C M Omoto
- Department of Physiology and Biophysics, Mississippi Center for Obesity Research, Cardiorenal and Metabolic Diseases Research Center, University of Mississippi Medical Center, Jackson, Mississippi
| | - Zhen Wang
- Department of Physiology and Biophysics, Mississippi Center for Obesity Research, Cardiorenal and Metabolic Diseases Research Center, University of Mississippi Medical Center, Jackson, Mississippi
| | - Xuan Li
- Department of Physiology and Biophysics, Mississippi Center for Obesity Research, Cardiorenal and Metabolic Diseases Research Center, University of Mississippi Medical Center, Jackson, Mississippi
| | - Alan J Mouton
- Department of Physiology and Biophysics, Mississippi Center for Obesity Research, Cardiorenal and Metabolic Diseases Research Center, University of Mississippi Medical Center, Jackson, Mississippi
| | - John E Hall
- Department of Physiology and Biophysics, Mississippi Center for Obesity Research, Cardiorenal and Metabolic Diseases Research Center, University of Mississippi Medical Center, Jackson, Mississippi
| | - Jussara M do Carmo
- Department of Physiology and Biophysics, Mississippi Center for Obesity Research, Cardiorenal and Metabolic Diseases Research Center, University of Mississippi Medical Center, Jackson, Mississippi
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18
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A Novel Methodology for the Synchronous Collection and Multimodal Visualization of Continuous Neurocardiovascular and Neuromuscular Physiological Data in Adults with Long COVID. SENSORS 2022; 22:s22051758. [PMID: 35270905 PMCID: PMC8914998 DOI: 10.3390/s22051758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/13/2022] [Accepted: 02/16/2022] [Indexed: 12/12/2022]
Abstract
Background: Reports suggest that adults with post-COVID-19 syndrome or long COVID may be affected by orthostatic intolerance syndromes, with autonomic nervous system dysfunction as a possible causal factor of neurocardiovascular instability (NCVI). Long COVID can also manifest as prolonged fatigue, which may be linked to neuromuscular function impairment (NMFI). The current clinical assessment for NCVI monitors neurocardiovascular performance upon the application of orthostatic stressors such as an active (i.e., self-induced) stand or a passive (tilt table) standing test. Lower limb muscle contractions may be important in orthostatic recovery via the skeletal muscle pump. In this study, adults with long COVID were assessed with a protocol that, in addition to the standard NCVI tests, incorporated simultaneous lower limb muscle monitoring for NMFI assessment. Methods: To conduct such an investigation, a wide range of continuous non-invasive biomedical sensing technologies were employed, including digital artery photoplethysmography for the extraction of cardiovascular signals, near-infrared spectroscopy for the extraction of regional tissue oxygenation in brain and muscle, and electromyography for assessment of timed muscle contractions in the lower limbs. Results: With the proposed methodology described and exemplified in this paper, we were able to collect relevant physiological data for the assessment of neurocardiovascular and neuromuscular functioning. We were also able to integrate signals from a variety of instruments in a synchronized fashion and visualize the interactions between different physiological signals during the combined NCVI/NMFI assessment. Multiple counts of evidence were collected, which can capture the dynamics between skeletal muscle contractions and neurocardiovascular responses. Conclusions: The proposed methodology can offer an overview of the functioning of the neurocardiovascular and neuromuscular systems in a combined NCVI/NMFI setup and is capable of conducting comparative studies with signals from multiple participants at any given time in the assessment. This could help clinicians and researchers generate and test hypotheses based on the multimodal inspection of raw data in long COVID and other cohorts.
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19
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A rare cause of arterial hypertension in a child with developmental delay: Answers. Pediatr Nephrol 2022; 37:333-336. [PMID: 34668059 DOI: 10.1007/s00467-021-05302-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
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20
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Lamotte G, Sandroni P. Updates on the Diagnosis and Treatment of Peripheral Autonomic Neuropathies. Curr Neurol Neurosci Rep 2022; 22:823-837. [PMID: 36376534 PMCID: PMC9663281 DOI: 10.1007/s11910-022-01240-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE OF REVIEW Autonomic neuropathies are a complex group of disorders and result in diverse clinical manifestations that affect the cardiovascular, gastrointestinal, urogenital, and sudomotor systems. We focus this review on the diagnosis and treatment of peripheral autonomic neuropathies. We summarize the diagnostic tools and current treatment options that will help the clinician care for individuals with peripheral autonomic neuropathies. RECENT FINDINGS Autonomic neuropathies occur often in conjunction with somatic neuropathies but they can also occur in isolation. The autonomic reflex screen is a validated tool to assess sympathetic postganglionic sudomotor, cardiovascular sympathetic noradrenergic, and cardiac parasympathetic (i.e., cardiovagal) function. Initial laboratory evaluation for autonomic neuropathies includes fasting glucose or oral glucose tolerance test, thyroid function tests, kidney function tests, vitamin-B12, serum, and urine protein electrophoresis with immunofixation. Other laboratory tests should be guided by the clinical context. Reduced intraepidermal nerve density on skin biopsy is a finding, not a diagnosis. Skin biopsy can be helpful in selected individuals for the diagnosis of disorders affecting small nerve fibers; however, we strongly discourage the use of skin biopsy without clinical-physiological correlation. Ambulatory blood pressure monitoring may lead to early identification of patients with cardiovascular autonomic neuropathy in the primary care setting. Disease-modifying therapies should be used when available in combination with nonpharmacological management and symptomatic pharmacologic therapies. Autonomic function testing can guide the therapeutic decisions and document improvement with treatment. A systematic approach guided by the autonomic history and standardized autonomic function testing may help clinicians when identifying and/or counseling patients with autonomic neuropathies. Treatment should be individualized and disease-modifying therapies should be used when available.
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Affiliation(s)
- Guillaume Lamotte
- Department of Neurology, University of Utah, Salt Lake City, UT, USA.
| | - Paola Sandroni
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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21
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Lamotte G, Coon EA, Suarez MD, Sandroni P, Benarroch E, Cutsforth-Gregory JK, Mauermann ML, Berini SE, Shouman K, Sletten D, Goodman BP, Low PA, Singer W. Standardized Autonomic Testing in Patients With Probable Radiation-Induced Afferent Baroreflex Failure. Hypertension 2022; 79:50-56. [PMID: 34739766 PMCID: PMC8665095 DOI: 10.1161/hypertensionaha.121.17805] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Injury of the afferent limb of the baroreflex from neck radiation causes radiation-induced afferent baroreflex failure (R-ABF). Identification and management of R-ABF is challenging. We aimed to investigate the pattern of autonomic dysfunction on standardized autonomic testing in patients with probable R-ABF. We retrospectively analyzed all autonomic reflex screens performed at Mayo Clinic in Rochester, MN, between 2000 and 2020 in patients with probable R-ABF. Additional tests reviewed included ambulatory blood pressure monitoring, plasma norepinephrine, and thermoregulatory sweat test. We identified 90 patients with probable R-ABF. Median total composite autonomic severity score (range, 0-10) was 7 (interquartile range, 6-7). Cardiovascular adrenergic impairment was seen in 85 patients (94.4%), increased blood pressure recovery time after Valsalva maneuver in 71 patients (78.9%; median 17.4 seconds), and orthostatic hypotension in 68 patients (75.6%). Cardiovagal impairment was demonstrated by abnormal heart rate responses to deep breathing (79.5%), Valsalva ratio (87.2%), and vagal baroreflex sensitivity (57.9%). Plasma norepinephrine was elevated and rose appropriately upon standing (722-1207 pg/mL). Ambulatory blood pressure monitoring revealed hypertension, postural hypotension, hypertensive surges, tachycardia, and absence of nocturnal dipping. Blood pressure lability correlated with impaired vagal baroreflex function. Postganglionic sympathetic sudomotor function was normal in most cases; the most frequent thermoregulatory sweat test finding was focal neck anhidrosis (78.9%). Standardized autonomic testing in R-ABF demonstrates cardiovascular adrenergic impairment with orthostatic hypotension, blood pressure lability, and elevated plasma norepinephrine. Cardiovagal impairment is common, while sudomotor deficits are limited to direct radiation effects.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Wolfgang Singer
- Department of Neurology, Mayo Clinic, Rochester, MN,,Corresponding author: Wolfgang Singer, MD, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA, , Phone: 507-284-3375
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22
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Affiliation(s)
- Italo Biaggioni
- Autonomic Dysfunction Center and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center
| | - Cyndya A Shibao
- Autonomic Dysfunction Center and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center (DLR) and University of Cologne, Cologne – Germany
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23
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Jacobsen KS, Schou RF, Poulsen FR, Pedersen CB. Orthostatic hypotension after cervicomedullary junction surgery: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21448. [PMID: 36061095 PMCID: PMC9435566 DOI: 10.3171/case21448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/09/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Surgery at the cervicomedullary junction carries a risk of damaging vital brainstem functions. Because the nucleus of the solitary tract (NS) is involved in the baroreceptor reflex, damage to its integrity may lead to orthostatic hypotension.
OBSERVATIONS
A 56-year-old man with a medical history of hypertension, von Hippel-Lindau disease, and previous bilateral adrenalectomy due to pheochromocytoma was referred with symptoms of dysphagia and paralysis of the left vocal cord. Paralysis of the left vagus nerve was suspected. Magnetic resonance imaging revealed a contrast-enhancing cystic process in the cervicomedullary junction. Twenty-three years earlier, the patient had undergone surgical treatment for a hemangioblastoma in the same region. After repeated surgery, the patient temporarily developed orthostatic hypotension. At discharge, the patient no longer needed antihypertensive medication.
LESSONS
Surgery near the cervicomedullary junction can affect the NS, leading to disruption of the baroreceptor response that regulates blood pressure.
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Affiliation(s)
- Kasper S. Jacobsen
- Department of Neurosurgery, Odense University Hospital, Southern Denmark, Denmark
- BRIDGE (Brain Research-Interdisciplinary Guided Excellence), Department of Clinical Research, University of Southern Denmark, Odense, Denmark; and
| | - Rico F. Schou
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Southern Denmark, Denmark
| | - Frantz R. Poulsen
- Department of Neurosurgery, Odense University Hospital, Southern Denmark, Denmark
- BRIDGE (Brain Research-Interdisciplinary Guided Excellence), Department of Clinical Research, University of Southern Denmark, Odense, Denmark; and
| | - Christian B. Pedersen
- Department of Neurosurgery, Odense University Hospital, Southern Denmark, Denmark
- BRIDGE (Brain Research-Interdisciplinary Guided Excellence), Department of Clinical Research, University of Southern Denmark, Odense, Denmark; and
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24
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周 政, 吴 牡, 李 维, 艾 金, 张 晓, 陈 玉, 宋 业, 王 芳, 沈 阳, 谭 国. [Baroreceptor failure syndrome after head and neck tumor surgery]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:1052-1056. [PMID: 34886615 PMCID: PMC10128367 DOI: 10.13201/j.issn.2096-7993.2021.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Indexed: 04/30/2023]
Abstract
With the continuous updating of head and neck surgery concepts and techniques, more and more head and neck surgeries are developing in the direction of refinement.however, the more complete the surgery, the greater the possibility of subsequent nerve exposure and injury. Even a slight perturbation of the nerve may cause serious complications, such as pressure receptor failure.It is necessary to review the mechanisms and the characteristics of baroreceptor failure syndrome after head and neck tumor surgery.
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Affiliation(s)
- 政 周
- 中南大学湘雅三医院耳鼻咽喉头颈外科(长沙,410005)
| | - 牡丽 吴
- 中南大学湘雅三医院耳鼻咽喉头颈外科(长沙,410005)
| | - 维 李
- 中南大学湘雅三医院耳鼻咽喉头颈外科(长沙,410005)
| | - 金刚 艾
- 中南大学湘雅三医院耳鼻咽喉头颈外科(长沙,410005)
| | - 晓伟 张
- 中南大学湘雅三医院耳鼻咽喉头颈外科(长沙,410005)
| | - 玉 陈
- 中南大学湘雅三医院耳鼻咽喉头颈外科(长沙,410005)
| | - 业勋 宋
- 中南大学湘雅三医院耳鼻咽喉头颈外科(长沙,410005)
| | - 芳 王
- 中南大学湘雅三医院耳鼻咽喉头颈外科(长沙,410005)
| | - 阳 沈
- 中南大学湘雅三医院耳鼻咽喉头颈外科(长沙,410005)
| | - 国林 谭
- 中南大学湘雅三医院耳鼻咽喉头颈外科(长沙,410005)
- 谭国林,
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25
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Mitchell JD, Cehic DA, Morgia M, Bergom C, Toohey J, Guerrero PA, Ferencik M, Kikuchi R, Carver JR, Zaha VG, Alvarez-Cardona JA, Szmit S, Daniele AJ, Lopez-Mattei J, Zhang L, Herrmann J, Nohria A, Lenihan DJ, Dent SF. Cardiovascular Manifestations From Therapeutic Radiation: A Multidisciplinary Expert Consensus Statement From the International Cardio-Oncology Society. JACC: CARDIOONCOLOGY 2021; 3:360-380. [PMID: 34604797 PMCID: PMC8463721 DOI: 10.1016/j.jaccao.2021.06.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 06/09/2021] [Accepted: 06/14/2021] [Indexed: 01/09/2023]
Abstract
Radiation therapy is a cornerstone of cancer therapy, with >50% of patients undergoing therapeutic radiation. As a result of widespread use and improved survival, there is increasing focus on the potential long-term effects of ionizing radiation, especially cardiovascular toxicity. Radiation therapy can lead to atherosclerosis of the vasculature as well as valvular, myocardial, and pericardial dysfunction. We present a consensus statement from the International Cardio-Oncology Society based on general principles of radiotherapy delivery and cardiovascular risk assessment and risk mitigation in this population. Anatomical-based recommendations for cardiovascular management and follow-up are provided, and a priority is given to the early detection of atherosclerotic vascular disease on imaging to help guide preventive therapy. Unique management considerations in radiation-induced cardiovascular disease are also discussed. Recommendations are based on the most current literature and represent a unanimous consensus by the multidisciplinary expert panel. Radiation therapy leads to short- and long-term cardiovascular adverse effects of the vasculature and the heart, including valvular, myocardial, and pericardial disease. Computed tomography scans conducted for radiation planning or cancer staging provide an available opportunity to detect asymptomatic atherosclerosis and direct preventive therapies. Additional practical screening recommendations for cardiovascular disease based on anatomical exposure are provided. There are unique considerations in the management of radiation-induced cardiovascular disease; contemporary percutaneous treatment is often preferred over surgical options.
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Key Words
- CABG, coronary artery bypass graft
- CAC, coronary artery calcium
- CAD, coronary artery disease
- CI, confidence interval
- CT, computed tomography
- CTCA, computed tomography coronary angiography
- CV, cardiovascular
- DIBH, deep inspiratory breath hold
- HF, heart failure
- HL, Hodgkin lymphoma
- HNC, head and neck cancer
- HR, hazard ratio
- LIMA, left internal mammary artery
- MRI, magnetic resonance imaging
- NT-proBNP, N-terminal pro–B-type natriuretic peptide
- OR, odds ratio
- PAD, peripheral arterial disease
- RT, radiation therapy
- SAVR, surgical aortic valve replacement
- SVC, superior vena cava
- TAVR, transcatheter aortic valve replacement
- TTE, transthoracic echocardiogram
- aHR, adjusted hazard ratio
- cancer
- cardiovascular disease
- imaging
- prevention
- radiation therapy
- screening
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Affiliation(s)
- Joshua D. Mitchell
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri, USA
- Address for correspondence: Dr Joshua D. Mitchell, Cardio-Oncology Center of Excellence, Washington University in St Louis, 660 South Euclid Avenue, Campus Box 8086, St. Louis, Missouri 63110-1093, USA. @joshmitchellmd@Dr_Daniel_Cehic@carmenbergom@ICOSociety
| | | | - Marita Morgia
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Carmen Bergom
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Joanne Toohey
- Department of Radiation Oncology, GenesisCare, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | | | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Robin Kikuchi
- Division of Medical Oncology, Duke Cancer Institute, Duke University, Durham, North Carolina, USA
| | - Joseph R. Carver
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vlad G. Zaha
- Cardiology Division, Department of Internal Medicine, Harold C. Simmons Comprehensive Cancer Center, Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Parkland Health and Hospital System, Dallas, Texas, USA
| | - Jose A. Alvarez-Cardona
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Sebastian Szmit
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | | | - Juan Lopez-Mattei
- Departments of Cardiology and Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lili Zhang
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jörg Herrmann
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Anju Nohria
- Cardio-Oncology Program, Dana Farber Cancer Institute/Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Daniel J. Lenihan
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Susan F. Dent
- Division of Medical Oncology, Duke Cancer Institute, Duke University, Durham, North Carolina, USA
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26
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Abstract
Orthostatic hypotension (OH) refers to a significant reduction in blood pressure (BP) that occurs on standing. It mainly results when autonomic reflexes are impaired or when the intravascular volume is depleted. Symptoms can range from syncope, dizziness, even angina or stroke. Major mechanisms causing OH are autonomic dysfunction affecting the baroreflex, severe volume depletion, and adverse medication effects. Case reports have described neurologic symptom association with coronavirus disease 2019 (COVID-19) including dysautonomia. Although most common symptoms of COVID have been primarily respiratory including fever, cough, shortness of breath, myriad other presentations including neurological, gastrointestinal, cardiac, and thromboembolic presentations have also been described. We describe a patient who was found to have OH and recurrent falls secondary to underlying COVID-19 infection and associated dysautonomia who was successfully treated with midodrine and fludrocortisone.
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Affiliation(s)
- Krithika Suresh
- Internal Medicine, Conemaugh Memorial Medical Center, Johnstown, USA
| | - Md Didar Ul Alam
- Internal Medicine, Conemaugh Memorial Medical Center, Johnstown, USA
| | - Emily Satkovich
- Internal Medicine, Conemaugh Memorial Medical Center, Johnstown, USA
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27
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Abstract
PURPOSE OF THE REVIEW The review focuses on the practical evaluation and management of patients with autonomic neuropathies. RECENT FINDINGS Autonomic neuropathies are complex disorders and result in diverse clinical manifestations that affect the cardiovascular, gastrointestinal, urogenital, and sudomotor systems. The autonomic medical history is key when seeing a patient with suspected autonomic neuropathy. The history guides the clinical evaluation, laboratory testing, and autonomic testing in patients with autonomic neuropathies. The treatment of autonomic neuropathies is based on the combination of disease-modifying therapies, symptomatic pharmacologic therapies, and nonpharmacological management. Response to treatment can be assessed with quantitative autonomic biomarkers. SUMMARY Treatment of autonomic neuropathies should be individualized, guided by disease state, medications' mechanism of action and adverse event profile as well as cost. Genetic discoveries and pathologic understanding lead to the development of disease-modifying therapies as seen in familial amyloid polyneuropathy.
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28
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Lamotte G, Coon EA, Suarez MD, Sandroni P, Benarroch EE, Cutsforth-Gregory JK, Mauermann ML, Berini SE, Shouman K, Sletten D, Goodman BP, Low PA, Singer W. Natural History of Afferent Baroreflex Failure in Adults. Neurology 2021; 97:e136-e144. [PMID: 33947784 DOI: 10.1212/wnl.0000000000012149] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/29/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the natural history of afferent baroreflex failure (ABF) based on systematic review of clinical and laboratory data in patients with a diagnosis of ABF at Mayo Clinic Rochester. METHODS We performed a retrospective chart review of all patients who underwent standardized autonomic reflex testing between 2000 and 2020 and had confirmation of the diagnosis of ABF by an autonomic disorders specialist. Patients were identified using a data repository of medical records. Variables included demographic, all-cause mortality, medications, ABF manifestations, comorbidities, and laboratory (autonomic testing, blood pressure monitoring, echocardiogram, brain imaging, plasma catecholamines, serum sodium level, and kidney function tests). RESULTS A total of 104 patients with ABF were identified. Head and neck radiation was the most common etiology (86.5%), followed by neck surgery (5.8%) and other causes (7.7%). The most common findings were hypertension (87.5%), fluctuating blood pressure (78.8%), orthostatic hypotension (91.3%), syncope (58.6%), headache (22.1%), and tachycardia (20.2%). Patients commonly received antihypertensives (66.3%), pressor agents (41.3%), or a combination of both (19.2%). The median latency from completion of radiation to ABF was longer compared to the latency in the surgery group (p < 0.0001). Comorbidities, including complications from neck radiation, were frequently seen and all-cause mortality was 39.4% over a 20-year period. CONCLUSIONS ABF should be suspected in patients with prior head and neck cancer treated by radiation or surgery who present with labile hypertension and orthostatic hypotension. Management may require both antihypertensive and pressor medications. The morbidity and mortality in ABF are high.
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Affiliation(s)
- Guillaume Lamotte
- From the Department of Neurology (G.L., E.A.C., M.D.S., P.S., E.E.B., J.K.C.-G., M.L.M., S.E.B., K.S., D.S., P.A.L., W.S.), Mayo Clinic, Rochester, MN; and Department of Neurology (B.P.G.), Mayo Clinic, Scottsdale, AZ
| | - Elizabeth A Coon
- From the Department of Neurology (G.L., E.A.C., M.D.S., P.S., E.E.B., J.K.C.-G., M.L.M., S.E.B., K.S., D.S., P.A.L., W.S.), Mayo Clinic, Rochester, MN; and Department of Neurology (B.P.G.), Mayo Clinic, Scottsdale, AZ
| | - Mariana D Suarez
- From the Department of Neurology (G.L., E.A.C., M.D.S., P.S., E.E.B., J.K.C.-G., M.L.M., S.E.B., K.S., D.S., P.A.L., W.S.), Mayo Clinic, Rochester, MN; and Department of Neurology (B.P.G.), Mayo Clinic, Scottsdale, AZ
| | - Paola Sandroni
- From the Department of Neurology (G.L., E.A.C., M.D.S., P.S., E.E.B., J.K.C.-G., M.L.M., S.E.B., K.S., D.S., P.A.L., W.S.), Mayo Clinic, Rochester, MN; and Department of Neurology (B.P.G.), Mayo Clinic, Scottsdale, AZ
| | - Eduardo E Benarroch
- From the Department of Neurology (G.L., E.A.C., M.D.S., P.S., E.E.B., J.K.C.-G., M.L.M., S.E.B., K.S., D.S., P.A.L., W.S.), Mayo Clinic, Rochester, MN; and Department of Neurology (B.P.G.), Mayo Clinic, Scottsdale, AZ
| | - Jeremy K Cutsforth-Gregory
- From the Department of Neurology (G.L., E.A.C., M.D.S., P.S., E.E.B., J.K.C.-G., M.L.M., S.E.B., K.S., D.S., P.A.L., W.S.), Mayo Clinic, Rochester, MN; and Department of Neurology (B.P.G.), Mayo Clinic, Scottsdale, AZ
| | - Michelle L Mauermann
- From the Department of Neurology (G.L., E.A.C., M.D.S., P.S., E.E.B., J.K.C.-G., M.L.M., S.E.B., K.S., D.S., P.A.L., W.S.), Mayo Clinic, Rochester, MN; and Department of Neurology (B.P.G.), Mayo Clinic, Scottsdale, AZ
| | - Sarah E Berini
- From the Department of Neurology (G.L., E.A.C., M.D.S., P.S., E.E.B., J.K.C.-G., M.L.M., S.E.B., K.S., D.S., P.A.L., W.S.), Mayo Clinic, Rochester, MN; and Department of Neurology (B.P.G.), Mayo Clinic, Scottsdale, AZ
| | - Kamal Shouman
- From the Department of Neurology (G.L., E.A.C., M.D.S., P.S., E.E.B., J.K.C.-G., M.L.M., S.E.B., K.S., D.S., P.A.L., W.S.), Mayo Clinic, Rochester, MN; and Department of Neurology (B.P.G.), Mayo Clinic, Scottsdale, AZ
| | - David Sletten
- From the Department of Neurology (G.L., E.A.C., M.D.S., P.S., E.E.B., J.K.C.-G., M.L.M., S.E.B., K.S., D.S., P.A.L., W.S.), Mayo Clinic, Rochester, MN; and Department of Neurology (B.P.G.), Mayo Clinic, Scottsdale, AZ
| | - Brent P Goodman
- From the Department of Neurology (G.L., E.A.C., M.D.S., P.S., E.E.B., J.K.C.-G., M.L.M., S.E.B., K.S., D.S., P.A.L., W.S.), Mayo Clinic, Rochester, MN; and Department of Neurology (B.P.G.), Mayo Clinic, Scottsdale, AZ
| | - Phillip A Low
- From the Department of Neurology (G.L., E.A.C., M.D.S., P.S., E.E.B., J.K.C.-G., M.L.M., S.E.B., K.S., D.S., P.A.L., W.S.), Mayo Clinic, Rochester, MN; and Department of Neurology (B.P.G.), Mayo Clinic, Scottsdale, AZ
| | - Wolfgang Singer
- From the Department of Neurology (G.L., E.A.C., M.D.S., P.S., E.E.B., J.K.C.-G., M.L.M., S.E.B., K.S., D.S., P.A.L., W.S.), Mayo Clinic, Rochester, MN; and Department of Neurology (B.P.G.), Mayo Clinic, Scottsdale, AZ.
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29
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Ferreira-Junior NC, Crestani CC, Lagatta DC, Resstel LBM, Correa FMA, Alves FHF. Nitric oxide in the insular cortex modulates baroreflex responses in a cGMP-independent pathway. Brain Res 2020; 1747:147037. [PMID: 32738232 DOI: 10.1016/j.brainres.2020.147037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/01/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
Insular cortex is a brain structure involved in the modulation of autonomic activity and cardiovascular function. The nitric oxide/cyclic guanosine-3',5'-monophosphate pathway is a prominent signaling mechanism in the central nervous system, controlling behavioral and physiological responses. Nevertheless, despite evidence regarding the presence of nitric oxide-synthesizing neurons in the insular cortex, its role in the control of autonomic and cardiovascular function has never been reported. Thus, the present study aimed to investigate the involvement of nitric oxide/cyclic guanosine-3',5'-monophosphate pathway mediated by neuronal nitric oxide synthase (nNOS) activation within the insular cortex in the modulation of baroreflex responses in unanesthetized rats. For this, we evaluated the effect of bilateral microinjection of either the nitric oxide scavenger carboxy-PTIO, the selective neuronal nitric oxide synthase inhibitor Nω-Propyl-l-arginine or the soluble guanylate cyclase inhibitor ODQ into the insular cortex on the bradycardia evoked by blood pressure increases in response to intravenous infusion of phenylephrine, and the tachycardia caused by blood pressure decreases evoked by intravenous infusion of sodium nitroprusside. Bilateral microinjection of either NPLA or carboxy-PTIO into the insular cortex increased the reflex bradycardic response, whereas the reflex tachycardia was decreased by these treatments. Bilateral microinjection of the soluble guanylate cyclase inhibitor into the insular cortex did not affect any parameter of baroreflex function evaluated. Overall, our findings provide evidence that insular cortex nitrergic signaling, acting via neuronal nitric oxide synthase, plays a prominent role in control of baroreflex function. However, control of reflex responses seems to be independent of soluble guanylate cyclase activation.
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Affiliation(s)
- Nilson C Ferreira-Junior
- Department of Pharmacology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Carlos C Crestani
- Laboratory of Pharmacology, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, SP, Brazil
| | - Davi C Lagatta
- Department of Pharmacology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Leonardo B M Resstel
- Department of Pharmacology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Fernando M A Correa
- Department of Pharmacology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Fernando H F Alves
- Department of Health Sciences, Faculty of Medicine - Federal University of Lavras, Lavras, MG, Brazil.
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30
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Nashawi M, Sheikh O, Battisha A, Ghali A, Chilton R. Neural tone and cardio-renal outcomes in patients with type 2 diabetes mellitus: a review of the literature with a focus on SGLT2 inhibitors. Heart Fail Rev 2020; 26:643-652. [PMID: 33169337 DOI: 10.1007/s10741-020-10046-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 12/18/2022]
Abstract
Recent clinical trials involving the systemic effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) have revealed beneficial outcomes pertaining to the microvascular sequelae of type 2 diabetes mellitus (T2DM) such as nephropathy, as well as macrovascular effects such as major adverse cardiovascular effects (MACE). Such findings have spurred the elevation of these agents to level A-tiers of recommendation within clinical guidelines addressing the management of complicated T2DM. While the mechanisms of SGLTi (-flozin drugs) are still being elucidated, a paucity of data exists within the literature appraising the role of neuromodulation and associated mechanisms in the aforementioned outcome studies. Given the role of the nervous system in orchestrating the pathologic processes that hamper cardio-renal status, insight into this topic offers an expanded perspective on T2DM. In this review we investigate the mechanisms by which SGLTi improve cardio-renal function in T2DM patients with emphases on neural tone and nervous system physiology.
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Affiliation(s)
- Mouhamed Nashawi
- Division of Medicine-Cardiology, UT Health San Antonio, 7872, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
| | - Omar Sheikh
- Division of Medicine-Cardiology, UT Health San Antonio, 7872, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Ayman Battisha
- Department of Internal Medicine, University of Massachusetts Medical School-Bay State, 759 Chestnut Street, Springfield, MA, 01199, USA
| | - Abdullah Ghali
- Division of Medicine-Cardiology, UT Health San Antonio, 7872, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Robert Chilton
- Division of Medicine-Cardiology, UT Health San Antonio, 7872, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
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31
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Norcliffe-Kaufmann L, Millar Vernetti P, Palma JA, Balgobin BJ, Kaufmann H. Afferent Baroreflex Dysfunction: Decreased or Excessive Signaling Results in Distinct Phenotypes. Semin Neurol 2020; 40:540-549. [PMID: 32906172 DOI: 10.1055/s-0040-1713892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Head and neck tumors can affect afferent baroreceptor neurons and either interrupt or intermittently increase their signaling, causing blood pressure to become erratic. When the afferent fibers of the baroreflex are injured by surgery or radiotherapy or fail to develop as in familial dysautonomia, their sensory information is no longer present to regulate arterial blood pressure, resulting in afferent baroreflex failure. When the baroreflex afferents are abnormally activated, such as by paragangliomas in the neck, presumably by direct compression, they trigger acute hypotension and bradycardia and frequently syncope, by a mechanism similar to the carotid sinus syndrome. We describe our observations in a large series of 23 patients with afferent baroreflex dysfunction and the cardiovascular autonomic features that arise when the sensory baroreceptor neurons are injured or compressed. The management of afferent baroreceptor dysfunction is limited, but pharmacological strategies can mitigate blood pressure swings, improve symptoms, and may reduce hypertensive organ damage. Although rare, the prevalence of afferent baroreflex dysfunction appears to be increasing in middle-aged men due to human papillomavirus related oropharyngeal cancer.
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Affiliation(s)
| | | | - Jose-Alberto Palma
- Department of Neurology, New York University School of Medicine, New York, New York
| | - Bhumika J Balgobin
- Department of Neurology, New York University School of Medicine, New York, New York
| | - Horacio Kaufmann
- Department of Neurology, New York University School of Medicine, New York, New York
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32
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Norcliffe-Kaufmann L, Palma JA. Blood pressure instability in head and neck cancer survivors. Clin Auton Res 2020; 30:291-293. [PMID: 32691261 PMCID: PMC7449596 DOI: 10.1007/s10286-020-00711-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Lucy Norcliffe-Kaufmann
- Department of Neurology, New York University School of Medicine, 530 First Avenue, Suite 9Q, New York, NY, 10016, USA.
| | - Jose-Alberto Palma
- Department of Neurology, New York University School of Medicine, 530 First Avenue, Suite 9Q, New York, NY, 10016, USA
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33
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Eshak N, Abdelnabi M, Ball S, Elgwairi E, Creed K, Test V, Nugent K. Dysautonomia: An Overlooked Neurological Manifestation in a Critically ill COVID-19 Patient. Am J Med Sci 2020; 360:427-429. [PMID: 32739039 PMCID: PMC7366085 DOI: 10.1016/j.amjms.2020.07.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/15/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Nouran Eshak
- Texas Tech University Health Sciences Center, Lubbock, Texas.
| | - Mahmoud Abdelnabi
- Clinical and Experimental Internal Medicine Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Somedeb Ball
- Texas Tech University Health Sciences Center, Lubbock, Texas
| | | | - Kendall Creed
- Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Victor Test
- Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Kenneth Nugent
- Texas Tech University Health Sciences Center, Lubbock, Texas
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Norcliffe-Kaufmann L, Palma JA, Martinez J, Kaufmann H. Carbidopa for Afferent Baroreflex Failure in Familial Dysautonomia: A Double-Blind Randomized Crossover Clinical Trial. Hypertension 2020; 76:724-731. [PMID: 32654554 DOI: 10.1161/hypertensionaha.120.15267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Afferent lesions of the arterial baroreflex occur in familial dysautonomia. This leads to excessive blood pressure variability with falls and frequent surges that damage the organs. These hypertensive surges are the result of excess peripheral catecholamine release and have no adequate treatment. Carbidopa is a selective DOPA-decarboxylase inhibitor that suppresses catecholamines production outside the brain. To learn whether carbidopa can inhibit catecholamine-induced hypertensive surges in patients with severe afferent baroreflex failure, we conducted a double-blind randomized crossover trial in which patients with familial dysautonomia received high dose carbidopa (600 mg/day), low-dose carbidopa (300 mg/day), or matching placebo in 3 4-week treatment periods. Among the 22 patients enrolled (13 females/8 males), the median age was 26 (range, 12-59 years). At enrollment, patients had hypertensive peaks to 164/116 (range, 144/92 to 213/150 mm Hg). Twenty-four hour urinary norepinephrine excretion, a marker of peripheral catecholamine release, was significantly suppressed on both high dose and low dose carbidopa, compared with placebo (P=0.0075). The 2 co-primary end points of the trial were met. The SD of systolic BP variability was reduced at both carbidopa doses (low dose: 17±4; high dose: 18±5 mm Hg) compared with placebo (23±7 mm Hg; P=0.0013), and there was a significant reduction in the systolic BP peaks on active treatment (P=0.0015). High- and low-dose carbidopa were similarly effective and well tolerated. This study provides class Ib evidence that carbidopa can reduce blood pressure variability in patients with congenital afferent baroreflex failure. Similar beneficial effects are observed in patients with acquired baroreflex lesions.
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Affiliation(s)
- Lucy Norcliffe-Kaufmann
- From the Department of Neurology, NYU Dysautonomia Center, New York University School of Medicine
| | - Jose-Alberto Palma
- From the Department of Neurology, NYU Dysautonomia Center, New York University School of Medicine
| | - Jose Martinez
- From the Department of Neurology, NYU Dysautonomia Center, New York University School of Medicine
| | - Horacio Kaufmann
- From the Department of Neurology, NYU Dysautonomia Center, New York University School of Medicine
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Jordan J, Ricci F, Hoffmann F, Hamrefors V, Fedorowski A. Orthostatic Hypertension: Critical Appraisal of an Overlooked Condition. Hypertension 2020; 75:1151-1158. [PMID: 32223382 DOI: 10.1161/hypertensionaha.120.14340] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Orthostatic hypertension, which appears to be mediated through excess neurohumoral activation while standing, is a common blood pressure trait among patients with and without arterial hypertension. However, lack of consensus regarding the definition of orthostatic hypertension makes it difficult to assess the true prevalence of this condition. Orthostatic hypertension appears to predict the risk for progression to arterial hypertension in younger and risk of cardiovascular morbidity and mortality in older persons. Yet, the risk may differ between populations. Whether orthostatic hypertension indicates a generally increased risk of death, constitutes an intermediate variable in the causal pathway of cardiovascular risk factors, a simple measure of disease severity, or an independently acting mechanism is not known. Since both orthostatic hypotension and orthostatic hypertension herald increased risk of cardiovascular disease, it appears reasonable to screen the patients for abnormal orthostatic blood pressure responses using simple orthostatic testing. However, how presence of orthostatic hypertension may affect clinical management decisions such as the choice of antihypertensive drugs is currently difficult to ascertain. Clearly, this issue deserves more attention.
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Affiliation(s)
- Jens Jordan
- From the Institute of Aerospace Medicine, German Aerospace Center (DLR) and Chair of Aerospace Medicine (J.J., F.H.), University of Cologne, Germany.,University Hypertension Center (J.J., F.H.), University of Cologne, Germany
| | - Fabrizio Ricci
- Department of Clinical Sciences, Lund University, Malmö, Sweden (F.R., V.H., A.F.).,Department of Neuroscience, Imaging and Clinical Sciences, "G.d'Annunzio" University, Chieti-Pescara, Italy (F.R.)
| | - Fabian Hoffmann
- From the Institute of Aerospace Medicine, German Aerospace Center (DLR) and Chair of Aerospace Medicine (J.J., F.H.), University of Cologne, Germany.,University Hypertension Center (J.J., F.H.), University of Cologne, Germany
| | - Viktor Hamrefors
- Department of Clinical Sciences, Lund University, Malmö, Sweden (F.R., V.H., A.F.).,Department of Internal Medicine (V.H.), Skåne University Hospital, Malmö, Sweden
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Malmö, Sweden (F.R., V.H., A.F.).,Department of Cardiology (A.F.), Skåne University Hospital, Malmö, Sweden
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