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Stocker SD, Kinsman BJ, Farquhar WB, Gyarmati G, Peti-Peterdi J, Sved AF. Physiological Mechanisms of Dietary Salt Sensing in the Brain, Kidney, and Gastrointestinal Tract. Hypertension 2024; 81:447-455. [PMID: 37671571 PMCID: PMC10915107 DOI: 10.1161/hypertensionaha.123.19488] [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: 09/07/2023]
Abstract
Excess dietary salt (NaCl) intake is strongly correlated with cardiovascular disease and is a major contributing factor to the pathogenesis of hypertension. NaCl-sensitive hypertension is a multisystem disorder that involves renal dysfunction, vascular abnormalities, and neurogenically-mediated increases in peripheral resistance. Despite a major research focus on organ systems and these effector mechanisms causing NaCl-induced increases in arterial blood pressure, relatively less research has been directed at elucidating how NaCl is sensed by various tissues to elicit these downstream effects. The purpose of this review is to discuss how the brain, kidney, and gastrointestinal tract sense NaCl including key cell types, the role of NaCl versus osmolality, and the underlying molecular and electrochemical mechanisms.
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Affiliation(s)
- Sean D. Stocker
- Department of Neurobiology, University of Pittsburgh School of Medicine
| | - Brian J Kinsman
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital
| | | | - Georgina Gyarmati
- Department of Physiology and Neuroscience and Medicine, Zilkha Neurogenetic Institute, University of Southern California
| | - Janos Peti-Peterdi
- Department of Physiology and Neuroscience and Medicine, Zilkha Neurogenetic Institute, University of Southern California
| | - Alan F. Sved
- Department of Neuroscience, University of Pittsburgh
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Oyewunmi OA, Lei LY, Laurin JKH, Morillo CA, Sheldon RS, Raj SR. Hemodynamic Effects of the Osmopressor Response: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2023; 12:e029645. [PMID: 37929748 PMCID: PMC10727389 DOI: 10.1161/jaha.122.029645] [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: 02/02/2023] [Accepted: 09/27/2023] [Indexed: 11/07/2023]
Abstract
Background Rapidly consuming water may offer practical orthostatic hypotension therapy. However, its efficacy across disorders remains uncertain. This study aims to assess the impact of rapid 350- to 500-mL water intake on systolic and diastolic blood pressure (BP) and heart rate (HR) through a systematic review and meta-analysis. Methods and Results We systematically reviewed MEDLINE and Embase up to June 2023, including randomized controlled trials and prospective cohort studies. Using random-effects meta-analysis, we calculated pooled mean differences (MDs) for maximum hemodynamic effects of rapid 350- to 500-mL water bolus consumption. Participants with orthostatic hypotension experienced increased systolic BP (MD, 24.18 [95% CI, 15.48-32.88]) and diastolic BP (MD, 11.98 [95% CI, 8.87-15.09]) with decreased HR (MD, -3.46 [95% CI, -5.21 to -1.71]). Similar results were observed in multiple system atrophy and pure autonomic failure subgroup analysis. Healthy participants showed modest increases in systolic BP (MD, 2.33 [95% CI, 1.02-3.64]) and diastolic BP (MD, 2.73 [95% CI, 1.15-4.30]), but HR changes were not significant (MD, -2.06 [95% CI, -5.25 to 1.13]). Water had no significant hemodynamic effects in patients with seated or supine postural tachycardia syndrome, although standing effects were unassessed. Our data do not exclude water's potential standing effect in postural tachycardia syndrome. Conclusions In patients with orthostatic hypotension, rapid water intake elevated short-term systolic BP and diastolic BP, with mild HR reduction when seated or supine. Healthy participants exhibited similar but milder effects. However, patients with postural tachycardia syndrome did not experience these changes in seated or supine positions. Further research is needed to evaluate the promising impact of rapid water ingestion on patients with postural tachycardia syndrome in a standing position, which was not addressed in our study.
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Affiliation(s)
- Oyebimbola A. Oyewunmi
- Department of Cardiac SciencesLibin Cardiovascular Institute, Cumming School of Medicine, University of CalgaryABCanada
| | - Lucy Y. Lei
- Department of Cardiac SciencesLibin Cardiovascular Institute, Cumming School of Medicine, University of CalgaryABCanada
| | - Jill K. H. Laurin
- Department of Cardiac SciencesLibin Cardiovascular Institute, Cumming School of Medicine, University of CalgaryABCanada
| | - Carlos A. Morillo
- Department of Cardiac SciencesLibin Cardiovascular Institute, Cumming School of Medicine, University of CalgaryABCanada
| | - Robert S. Sheldon
- Department of Cardiac SciencesLibin Cardiovascular Institute, Cumming School of Medicine, University of CalgaryABCanada
| | - Satish R. Raj
- Department of Cardiac SciencesLibin Cardiovascular Institute, Cumming School of Medicine, University of CalgaryABCanada
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Palma JA, Thijs RD. Non-Pharmacological Treatment of Autonomic Dysfunction in Parkinson's Disease and Other Synucleinopathies. JOURNAL OF PARKINSON'S DISEASE 2023:JPD230173. [PMID: 37694308 DOI: 10.3233/jpd-230173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Symptoms of autonomic dysfunction are prevalent and can be very debilitating, reducing the quality of life in patients with Parkinson's disease (PD) and other synucleinopathies such as dementia with Lewy bodies and multiple system atrophy. Non-pharmacological therapies are key to effective management and are frequently used alone in patients with mild autonomic symptoms, or in combination with pharmacological therapies in patients with moderate and severe symptoms. This article focuses on non-pharmacological approaches. Our objective was to review the non-drug and non-surgical approaches to treating autonomic symptoms in patients with PD and other synucleinopathies, focusing on cardiovascular, gastrointestinal, and genitourinary autonomic dysfunction. Evidence supporting the effectiveness of non-pharmacological treatment for the management of neurogenic orthostatic hypotension, supine hypertension, constipation, and bladder and sexual dysfunction is available. High-quality prospective trials are scarce, yet some non-pharmacological interventions (e.g., physical counter maneuvers) can be evaluated relatively quickly on an individual basis and often seem effective. The emerging variety of clinical presentations advocates for a stepwise, individualized, and non-pharmacological approach for the management of autonomic symptoms. Often, the first step is to reduce or discontinue drugs that cause or aggravate autonomic symptoms followed by lifestyle measures. While non-pharmacological and non-surgical treatments are available and, in many cases, effective to improve symptoms of autonomic dysfunction in PD and other synucleinopathies, they are often overlooked. Large randomized trials testing and comparing non-pharmacological approaches are warranted.
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Affiliation(s)
- Jose-Alberto Palma
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Roland D Thijs
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands
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Laurino MJL, da Silva AKF, Santos LA, Vanderlei LCM. Water drinking during aerobic exercise improves the recovery of non-linear heart rate dynamics in coronary artery disease: crossover clinical trial. Front Neurosci 2023; 17:1147299. [PMID: 37424997 PMCID: PMC10323825 DOI: 10.3389/fnins.2023.1147299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/31/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction The post-exercise recovery is a period of vulnerability of the cardiovascular system in which autonomic nervous system plays a key role in cardiovascular deceleration. It is already known that individuals with coronary artery disease (CAD) are at greater risk due to delayed vagal reactivation in this period. Water ingestion has been studied as a strategy to improve autonomic recovery and mitigate the risks during recovery. However, the results are preliminary and need further confirmation. Therefore, our aim was to investigate the influence of individualized water drinking on the non-linear dynamics of heart rate during and after aerobic exercise in CAD subjects. Methods 30 males with CAD were submitted to a control protocol composed of initial rest, warming up, treadmill exercise, and passive recovery (60 min). After 48 hours they performed the hydration protocol, composed of the same activities, however, with individualized water drinking proportional to the body mass lost in the control protocol. The non-linear dynamics of heart rate were assessed by indices of heart rate variability extracted from the recurrence plot, detrended fluctuation analysis, and symbolic analysis. Results and discussion During exercise, the responses were physiological and similar in both protocols, indicating high sympathetic activity and reduced complexity. During recovery, the responses were also physiological, indicating the rise of parasympathetic activity and the return to a more complex state. However, during hydration protocol, the return to a more complex physiologic state occurred sooner and non-linear HRV indices returned to resting values between the 5th and 20th minutes of recovery. In contrast, during the control protocol, only a few indices returned to resting values within 60 minutes. Despite that, differences between protocols were not found. We conclude that the water drinking strategy accelerated the recovery of non-linear dynamics of heart rate in CAD subjects but did not influence responses during exercise. This is the first study to characterize the non-linear responses during and after exercise in CAD subjects.
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Čypienė A, Gimžauskaitė S, Rinkūnienė E, Jasiūnas E, Rugienė R, Kazėnaitė E, Ryliškytė L, Badarienė J. The Association between Water Consumption and Hyperuricemia and Its Relation with Early Arterial Aging in Middle-Aged Lithuanian Metabolic Patients. Nutrients 2023; 15:nu15030723. [PMID: 36771428 PMCID: PMC9921948 DOI: 10.3390/nu15030723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/25/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hyperuricemia is well-known as an independent risk factor for the development of hypertension, metabolic syndrome, and cardiovascular disease. Water is essential to most bodily functions, and its consumption rates appear to decline with age. The aim was to evaluate the influence of water intake on early vascular aging in metabolic middle-aged patients with hyperuricemia. MATERIALS AND METHODS The study included 241 men aged 40-55 years and 420 women aged 50-65 years from the Lithuanian High Cardiovascular Risk (LitHiR) primary prevention program. Anthropometric characteristics, blood pressure, laboratory testing, and the specialized nutrition profile questionnaire were evaluated. Carotid-femoral pulse wave velocity (cfPWV), assessed using applanation tonometry, was evaluated as an early vascular aging parameter in patients with hyperuricemia and with normal serum uric acid (sUA) levels. RESULTS 72.6% of men and 83.1% of women drink insufficient amounts of water (less than 1.5 L per day). However, our results showed statistically significant relationships only among a group of women. The women in the hyperuricemic group had a higher cfPWV than women with normal sUA levels. In hyperuricemic women, drinking less than 0.5 L per day in combination with other risk factors, such as age, increasing fasting glucose, and systolic blood pressure, was statistically significantly associated with an increased cfPWV (R2 = 0.45, Adj. R2 = 0.42, p < 0.001). CONCLUSION Drinking an insufficient amount of water daily is associated with increased arterial stiffness and has a negative effect on vascular health in metabolic women with hyperuricemia.
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Affiliation(s)
- Alma Čypienė
- State Research Institute Centre for Innovative Medicine, 08406 Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
| | - Silvija Gimžauskaitė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
- Correspondence:
| | | | - Eugenijus Jasiūnas
- Center of Informatics and Development, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
| | - Rita Rugienė
- State Research Institute Centre for Innovative Medicine, 08406 Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
| | - Edita Kazėnaitė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
| | - Ligita Ryliškytė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
| | - Jolita Badarienė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
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Jia S, Wang Q, Li H, Song X, Wang S, Zhang W, Wang G. Laterality of blood perfusion in the lower extremities after drinking saline at different temperatures. Sci Rep 2023; 13:1586. [PMID: 36709364 PMCID: PMC9884233 DOI: 10.1038/s41598-023-28758-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 01/24/2023] [Indexed: 01/30/2023] Open
Abstract
Skin blood flux (SkBF) changes caused by drinking cold water are generally associated with vagal tone and osmotic factors in the digestive system. However, there is still a lack of relevant research on whether there are left and right differences in these SkBF change. In the current study, a total of 60 subjects were recruited. Skin blood perfusion of the bilateral lower extremities was recorded simultaneously before and after drinking saline of different temperatures saline by using Laser Doppler flowmetry (LDF). The electrogastrogram (EGG) was also monitored, and the dominant frequency of the EGG and heart rate variability were analyzed. The results indicated that after drinking saline, the laterality index of SkBF at the lower extremities was different and the laterality index changes of SkBF were mainly reflected in the frequency interval V (0.4-1.6 Hz). There was a weak negative correlation between the laterality index of endothelial NO-dependent component and change rate of root mean square of successive differences (RMSSD) after drinking 4 °C saline. However, after drinking 30 °C saline, there was a weak positive correlation between neurogenic component and RMSSD The distribution and regulation of bilateral blood flow are not symmetrical but exhibit a certain laterality.
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Affiliation(s)
- Shuyong Jia
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qizhen Wang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hongyan Li
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaojing Song
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shuyou Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Weibo Zhang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Guangjun Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China.
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Ziadia H, Sassi I, Trudeau F, Fait P. Normative values of resting heart rate variability in young male contact sport athletes: Reference values for the assessment and treatment of concussion. Front Sports Act Living 2023; 4:730401. [PMID: 36699983 PMCID: PMC9869270 DOI: 10.3389/fspor.2022.730401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 12/07/2022] [Indexed: 01/12/2023] Open
Abstract
Objective The objective of this study was to identify the main determinants of heart rate variability (HRV) in male athletes aged 14 to 21 years who practice competitive contact sports and to integrate these determinants with the aim of defining normative values of short-term HRV in the time and frequency domains. Methods Participants (n = 369) were aged 14 to 21 years and included 221 football players and 148 ice hockey players. HRV was measured for 5 min at rest, and standard HRV parameters in the time and frequency domains were calculated. Heart rate (HR), age, body mass index (BMI), number of sports weekly practices (WSP) and concussion history (mTBI) were considered determinants potentially able to influence HRV. Results Multiple regression analysis revealed that HR was the primary determinant of standard HRV parameters. The models accounted for 13% to 55% of the total variance of HRV and the contribution of HR to this model was the strongest (β ranged from -0.34 to -0.75). HR was the only determinant that significantly contributes to all HRV parameters. To counteract this dependence, we calculated HRV corrected by the mean RR interval (RRm). Such corrections do not remove any physiological differences in HRV; they simply remove the mathematical bias. HRV parameters were therefore normalized, and their normative limits were developed relative to the mean heart rate. After correction, the correlation coefficients between HR and all corrected HRV parameters were not statistically significant and ranged from -0.001 to 0.045 (p > 0.40 for all). The automatically corrected HRV calculator, which recalculates standard HRV parameters and converts them into corrected parameters in addition to determining whether a given value is within normal limits, facilitates clinical interpretation. Conclusion This study provides for the first time corrected normative values of short-term and resting state HRV parameters in competitive contact sport athletes aged 14 to 21 years. These values were developed independently of the major determinants of HRV. The baseline values for HRV parameters given here could be used in clinical practice when assessing and monitoring cerebral concussions. They may assist in decision making for a safe return to play.
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Affiliation(s)
- Hatem Ziadia
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada,Exercise Physiology Laboratory, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada,Correspondence: Hatem Ziadia
| | - Idriss Sassi
- Exercise Physiology Laboratory, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada,Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - François Trudeau
- Exercise Physiology Laboratory, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada,Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Philippe Fait
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada,Research Group on Neuromusculoskeletal Conditions (GRAN), Trois-rivieres, QC, Canada,Centre for Research in Neuropsychology and Cognition (CERNEC), Montreal, QC, Canada,Cortex Concussion Clinic, Quebec City, QC, Canada
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Parsons IT, Hockin BCD, Taha OM, Heeney ND, Williams EL, Lucci VEM, Lee RHY, Stacey MJ, Gall N, Chowienczyk P, Woods DR, Claydon VE. The effect of water temperature on orthostatic tolerance: a randomised crossover trial. Clin Auton Res 2022; 32:131-141. [PMID: 35461434 PMCID: PMC9064858 DOI: 10.1007/s10286-022-00860-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/17/2022] [Indexed: 11/04/2022]
Abstract
Purpose Bolus water drinking, at room temperature, has been shown to improve orthostatic tolerance (OT), probably via sympathetic activation; however, it is not clear whether the temperature of the water bolus modifies the effect on OT or the cardiovascular responses to orthostatic stress. The aim of this study was to assess whether differing water temperature of the water bolus would alter time to presyncope and/or cardiovascular parameters during incremental orthostatic stress. Methods Fourteen participants underwent three head-up tilt (HUT) tests with graded lower body negative pressure (LBNP) continued until presyncope. Fifteen minutes prior to each HUT, participants drank a 500 mL bolus of water which was randomised, in single-blind crossover fashion, to either room temperature water (20 °C) (ROOM), ice-cold water (0–3 °C) (COLD) or warm water (45 °C) (WARM). Cardiovascular parameters were monitored continuously. Results There was no significant difference in OT in the COLD (33 ± 3 min; p = 0.3321) and WARM (32 ± 3 min; p = 0.6764) conditions in comparison to the ROOM condition (31 ± 3 min). During the HUT tests, heart rate and cardiac output were significantly reduced (p < 0.0073), with significantly increased systolic blood pressure, stroke volume, cerebral blood flow velocity and total peripheral resistance (p < 0.0054), in the COLD compared to ROOM conditions. Conclusions In healthy controls, bolus cold water drinking results in favourable orthostatic cardiovascular responses during HUT/LBNP without significantly altering OT. Using a cold water bolus may result in additional benefits in patients with orthostatic intolerance above those conferred by bolus water at room temperature (by ameliorating orthostatic tachycardia and enhancing vascular resistance responses). Further research in patients with orthostatic intolerance is warranted.
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Snapper H, Cheshire WP. Oral and intravenous hydration in the treatment of orthostatic hypotension and postural tachycardia syndrome. Auton Neurosci 2022; 238:102951. [PMID: 35123367 DOI: 10.1016/j.autneu.2022.102951] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/07/2021] [Accepted: 01/25/2022] [Indexed: 01/21/2023]
Abstract
Hydration with water and salt is the mainstay of treatment for autonomic nervous system disorders that impair orthostatic tolerance. The goal is to expand intravascular volume to compensate for the downward displacement of blood volume that occurs when standing and thereby sustain cerebral perfusion and restore quality of life. Despite strong consensus recommendations for salt supplementation as standard treatment of these disorders, published evidence of benefit is relatively weak, and no randomized clinical trials have occurred. This review summarizes the physiological rationale for hydration and evaluates the literature on oral and intravenous hydration in the treatment of neurogenic orthostatic hypotension, postural tachycardia syndrome, and recurrent vasovagal syncope. We conclude that oral salt replacement is indicated for treatment of neurogenic orthostatic hypotension because these patients have excessive renal sodium excretion, and for treatment of chronic orthostatic intolerance because these patients are often hypovolemic. As not all patients are able to tolerate sufficient oral hydration, there is also a role for intravenous volume-loading in severe cases of postural tachycardia syndrome. We offer guidance, based on review of the literature and the clinical judgment of a cardiologist and neurologist with experience treating autonomic disorders, regarding the option of ongoing intravenous hydration for treatment of severe, refractory cases of postural tachycardia syndrome.
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Affiliation(s)
- Howard Snapper
- Department of Cardiology, Wellstar Healthcare System, Marietta, GA 30060, USA.
| | - William P Cheshire
- Division of Autonomic Disorders, Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA
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Kubota S, Endo Y, Kubota M, Miyazaki H, Shigemasa T. The Pressor Response to the Drinking of Cold Water and Cold Carbonated Water in Healthy Younger and Older Adults. Front Neurol 2022; 12:788954. [PMID: 35095733 PMCID: PMC8793880 DOI: 10.3389/fneur.2021.788954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/06/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose: Water drinking has been proposed for the treatment of orthostatic hypotension because it can increase blood pressure in patients. This study aimed to investigate whether drinking water with a cold or carbonation stimulus would cause a more effective pressor response, and whether it would be greater in older than in younger adults. Methods: We assessed blood pressure and heart rate from non-invasive arterial pressure (a volume-clamp method) and type II electrocardiography in 13 healthy young adults (6 females, 7 males; mean age, 19.9 ± 1.1 years) and nine healthy older adults (all females; mean age, 71.4 ± 4.2 years) who drank 200 mL of cold, cold carbonated, and room temperature water. Results: The pressor response to the drinking of cold and cold carbonated water was greater than that to room temperature water in both younger and older participants (p < 0.05; changes in systolic blood pressure of room temperature water, cold water and cold carbonated water in young: 15.31 ± 9.66, 22.56 ± 11.51 and 32.6 ± 17.98 mmHg, respectively; changes in systolic blood pressure of room temperature water, cold water and cold carbonated water in elderly: 21.84 ± 14.31, 41.53 ± 19.82 and 48.16 ± 16.77 mmHg, respectively). In addition, the pressor response to cold and cold carbonated water was persistent during the recovery period by about 5–10 mmHg (p < 0.05). Furthermore, the pressor response during the drinking and recovery periods was greater in the older than in the younger participants (p < 0.05). Conclusion: Our data suggest that even smaller amounts of water are able to elicit a sustained pressor response, in particular if the water is cold and carbonated. We speculate that the pressor effect may render cold and carbonated water an appropriate first aid method against certain forms of acute hypotension.
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Affiliation(s)
- Satoshi Kubota
- School of Health Sciences at Odawara, International University of Health and Welfare, Odawara, Japan
| | - Yutaka Endo
- School of Health Sciences at Odawara, International University of Health and Welfare, Odawara, Japan
| | - Mitsue Kubota
- Graduate School, Japanese Red Cross College of Nursing, Tokyo, Japan
| | - Hiroko Miyazaki
- School of Health Sciences at Odawara, International University of Health and Welfare, Odawara, Japan
| | - Tomohiko Shigemasa
- Department of Cardiology, Yokohama Brain and Spine Center, Yokohama, Japan
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Majdi M, Hosseini F, Naghshi S, Djafarian K, Shab-Bidar S. Total and drinking water intake and risk of all-cause and cardiovascular mortality: A systematic review and dose-response meta-analysis of prospective cohort studies. Int J Clin Pract 2021; 75:e14878. [PMID: 34525269 DOI: 10.1111/ijcp.14878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/05/2021] [Accepted: 07/29/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Understanding the association between water consumption and mortality is important for guiding consumers and prioritizing dietary guidelines to reduce the risk. Therefore, in the current study, we conducted a systematic review and dose-response meta-analysis of prospective cohort studies to summarise the association between total water and drinking intake and risk of mortality from all causes and CVD. METHOD A comprehensive search was performed on PubMed/Medline, Scopus, and ISI Web of Science up to February 2020. The random-effects model was used to calculate the pooled effect size (ES) and 95% confidence interval. RESULT Seven prospective cohort studies were included in the systematic review and meta-analysis. During the follow-up period of 6 to 19.1 years, 14 754 deaths (7611 from cardiovascular disease) occurred among 116 816 participants. No significant association was found between drinking water intake and all-cause mortality (ES: 0.82; 95% CI: 0.63-1.08, I2 = 77.3%, P = .16). Total water intake was not associated with all-cause mortality (ES: 0.94; 95% CI: 0.82-1.08, I2 = 66.5%, P = .41). However, a significant inverse association was seen between total water intake and risk of CVD mortality (ES: 0.86; 95% CI: 0.78-0.95, I2 = 0%, P = .002). Linear dose-response meta-analysis revealed a significant inverse association between total water intake and all-cause mortality by an additional one cup per day (pooled ES: 0.98; 95% CI: 0.97-0.99, P = .001). Furthermore, each additional cup of total water intake per day was associated with a 3% lower risk of death from CVD (pooled ES: 0.97; 95% CI: 0.96-0.98, P < .001). CONCLUSION High consumption of total water is associated with a lower risk of CVD mortality. However, total water intake was not associated with risk of all-cause mortality.
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Affiliation(s)
- Maryam Majdi
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hosseini
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Naghshi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Kurosh Djafarian
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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Harada Y, Guptill JT. Management/Treatment of Lambert-Eaton Myasthenic Syndrome. Curr Treat Options Neurol 2021. [DOI: 10.1007/s11940-021-00690-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Effect of ice slurry ingestion on core temperature and blood pressure response after exercise in a hot environment. J Therm Biol 2021; 98:102922. [PMID: 34016346 DOI: 10.1016/j.jtherbio.2021.102922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/21/2021] [Accepted: 03/27/2021] [Indexed: 11/23/2022]
Abstract
Delays in the restoration of thermoregulation after exercise in a hot environment has been associated with post-exercise hypotension. This study tested the hypothesis that simultaneous internal cooling and rehydration by ingesting ice slurry prevents the excessive decrease in mean arterial pressure (MAP) and promotes recovery of core and skin temperatures in male athletes. Seven male athletes participated in this randomized controlled trial with a crossover design. The participants ran on a treadmill at 75% of their maximal oxygen uptake in the heat (35 °C, 60% relative humidity), up to exhaustion. Immediately after exercise, participants ingested either 4 g⋅kg -1 body weight of ice slurry (0.5 °C, ICE) or a control beverage (28 °C, CON). The participants then recovered by sitting for 20 min. We measured participants' rectal temperature (Tre), skin temperature (Tsk), mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), total peripheral resistance (TPR), and physiological strain index (PSI) before exercise (Pre), after running to exhaustion (PEx), and at 0 (P0), 10 (P10), and 20 (P20) minutes after ice slurry or control beverage ingestion. MAP, CO, HR, TPR, or PSI did not change significantly during the recovery period. At P10 and P20, Tre and Tsk significantly decreased in the ICE group compared to the CON group (p < 0.05). These results suggested that ingestion of ice slurry, post-exercise, promoted core and skin temperature recovery but did not affect the central and peripheral cardiovascular responses during the acute recovery period.
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Coon EA, Ahlskog JE. My Treatment Approach to Multiple System Atrophy. Mayo Clin Proc 2021; 96:708-719. [PMID: 33673922 DOI: 10.1016/j.mayocp.2020.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/07/2020] [Accepted: 10/13/2020] [Indexed: 11/28/2022]
Abstract
Multiple system atrophy (MSA) is a neurodegenerative disorder primarily characterized by autonomic failure plus parkinsonism or cerebellar ataxia. The diagnosis may be challenging and is usually made at a tertiary care center. The long-term management issues are equally challenging and frequently require collaboration with the patient's local care providers. Whereas there is currently no cure for MSA, treatment focuses on the most problematic symptoms experienced by the patient. Autonomic symptoms may include severe orthostatic hypotension with syncope, urinary symptoms culminating in incontinence, constipation, anhidrosis, and erectile dysfunction. Motor symptoms include parkinsonism, cerebellar ataxia, and falls. Although certain motor symptoms may respond partially to medications, some of these medications may exacerbate autonomic problems. In this manuscript, we seek to bridge the gap between tertiary care providers and the patient's local care providers to provide multidisciplinary care to the MSA patient. Patients are often best served by management of their chronic and evolving complex problems with a team approach involving their primary care providers and subspecialists. Treatment guidelines typically list myriad therapeutic options without clarifying the most efficacious and simplest treatment strategies. Herein, we provide a guideline based on what has worked in our MSA clinic, a clinic designed to provide care throughout the disease course with subspecialty integration with the goal of empowering a partnership with the patient's home primary care providers.
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Abstract
PURPOSE OF REVIEW This article reviews the management of orthostatic hypotension with emphasis on neurogenic orthostatic hypotension. RECENT FINDINGS Establishing whether the cause of orthostatic hypotension is a pathologic lesion in sympathetic neurons (ie, neurogenic orthostatic hypotension) or secondary to other medical causes (ie, non-neurogenic orthostatic hypotension) can be achieved by measuring blood pressure and heart rate at the bedside. Whereas fludrocortisone has been extensively used as first-line treatment in the past, it is associated with adverse events including renal and cardiac failure and increased risk of all-cause hospitalization. Distinguishing whether neurogenic orthostatic hypotension is caused by central or peripheral dysfunction has therapeutic implications. Patients with peripheral sympathetic denervation respond better to norepinephrine agonists/precursors such as droxidopa, whereas patients with central autonomic dysfunction respond better to norepinephrine reuptake inhibitors. SUMMARY Management of orthostatic hypotension is aimed at improving quality of life and reducing symptoms rather than at normalizing blood pressure. Nonpharmacologic measures are the key to success. Pharmacologic options include volume expansion with fludrocortisone and sympathetic enhancement with midodrine, droxidopa, and norepinephrine reuptake inhibitors. Neurogenic supine hypertension complicates management of orthostatic hypotension and is primarily ameliorated by avoiding the supine position and sleeping with the head of the bed elevated.
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Palma JA, Kaufmann H. Clinical Trials for Neurogenic Orthostatic Hypotension: A Comprehensive Review of Endpoints, Pitfalls, and Challenges. Semin Neurol 2020; 40:523-539. [PMID: 32906173 DOI: 10.1055/s-0040-1713846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Neurogenic orthostatic hypotension (nOH) is among the most debilitating nonmotor features of patients with Parkinson's disease (PD) and other synucleinopathies. Patients with PD and nOH generate more hospitalizations, make more emergency room visits, create more telephone calls/mails to doctors, and have earlier mortality than those with PD but without nOH. Overall, the health-related cost in patients with PD and OH is 2.5-fold higher compared with patients with PD without OH. Hence, developing effective therapies for nOH should be a research priority. In the last few decades, improved understanding of the pathophysiology of nOH has led to the identification of therapeutic targets and the development and approval of two drugs, midodrine and droxidopa. More effective and safer therapies, however, are still needed, particularly agents that could selectively increase blood pressure only in the standing position because supine hypertension is the main limitation of available drugs. Here we review the design and conduct of nOH clinical trials in patients with PD and other synucleinopathies, summarize the results of the most recently completed and ongoing trials, and discuss challenges, bottlenecks, and potential remedies.
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Affiliation(s)
- Jose-Alberto Palma
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, New York
| | - Horacio Kaufmann
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, New York
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17
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Tsai SH, Lin JY, Lin YC, Liu YP, Tung CS. Portal vein innervation underlying the pressor effect of water ingestion with and without cold stress. CHINESE J PHYSIOL 2020; 63:53-59. [PMID: 32341230 DOI: 10.4103/cjp.cjp_96_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Water-induced pressor response appears mediated through the activation of transient receptor potential channel TRPV4 on hepatic portal circulation in animals. We sought to elucidate the mechanism of portal vein signaling in this response. Forty-five rats were divided into four groups: control rats without water ingestion (WI), control rats with WI, portal vein denervation rats with WI (PVDWI), and TRPV4 antagonist-treated rats with WI (anti-TRPV4WI). Cardiovascular responses were monitored throughout the experiments. Data analysis was performed using descriptive methods and spectral and cross-spectral analysis of blood pressure variability (BPV) and heart rate variability (HRV). Key results showed that at baseline (PreCS) before cold stress trial (CS), WI elicited robust pressor and tachycardia responses accompanied by spectral power changes, in particular, increases of low-frequency BPV (LFBPV) and very-LFBPV (VLFBPV), but decrease of very-low-frequency HRV. PVDWI, likewise, elicited pressor and tachycardia responses accompanied by increases of high-frequency BPV, high-frequency HRV, LFBPV, low-frequency HRV, and VLFBPV. When compared with WI at PreCS, WI at CS elicited pressor and tachycardia responses accompanied by increases of high-frequency BPV, LFBPV, and VLFBPV, whereas in WI, the CS-evoked pressor response and the accompanied LFBPV and VLFBPV increases were all tended augmented by PVDWI. When compared with WI and PVDWI at both PreCS and CS, however, anti-TRPV4WI attenuated their pressor responses and attenuated their increased LFBPV, VLFBPV, and very-low-frequency HRV. The results indicate that the portal vein innervation is critical for a buffering mechanism in splanchnic sympathetic activation and water-induced pressor response.
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Affiliation(s)
- Shi-Hung Tsai
- Department of Emergency Medicine, National Defense Medical Center, Tri-service General Hospital, Taipei, Taiwan
| | - Jou-Yu Lin
- Department of Rehabilitation, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Yu-Chieh Lin
- Division of Medical Research and Education, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Yia-Ping Liu
- Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Che-Se Tung
- Division of Medical Research and Education, Cheng Hsin General Hospital, Taipei, Taiwan
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Bordoni L, Jiménez EG, Nielsen S, Østergaard L, Frische S. A new experimental mouse model of water intoxication with sustained increased intracranial pressure and mild hyponatremia without side effects of antidiuretics. Exp Anim 2019; 69:92-103. [PMID: 31534063 PMCID: PMC7004811 DOI: 10.1538/expanim.19-0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The most used experimental mouse model of hyponatremia and elevated intracranial pressure (ICP) is intraperitoneal injection of water in combination with antidiuretics. This model of water intoxication (WI) results in extreme pathological changes and death within 1 h. To improve preclinical studies of the pathophysiology of elevated ICP, we characterized diuresis, cardiovascular parameters, blood ionogram and effects of antidiuretics in this model. We subsequently developed a new mouse model with mild hyponatremia and sustained increased ICP. To investigate the classical protocol (severe WI), C57BL/6mice were anesthetized and received an intraperitoneal injection of 20% body weight of MilliQ water with or without 0.4 µg·kg-1 desmopressin acetate (dDAVP). Corresponding Sham groups were also studied. In the new WI protocol (mild WI), 10% body weight of a solution containing 6.5 mM NaHCO3, 1.125 mM KCl and 29.75 mM NaCl was intraperitoneally injected. By severe WI, ICP and mean arterial pressure increased until brain stem herniation occurred (23 ± 3 min after injection). The cardiovascular effects were accelerated by dDAVP. Severe WI induced a halt to urine production irrespective of the use of dDAVP. Following the new mild WI protocol, ICP also increased but was sustained at a pathologically high level without inducing herniation. Mean arterial pressure and urine production were not affected during mild WI. In conclusion, the new mild WI protocol is a superior experimental model to study the pathophysiological effects of elevated ICP induced by water intoxication.
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Affiliation(s)
- Luca Bordoni
- Department of Biomedicine, Wilhelm Meyers Allé 3, Aarhus University, 8000, Aarhus, Denmark
| | - Eugenio Gutiérrez Jiménez
- Center of Functionally Integrative Neuroscience, Department of Clinical Medicine, Palle Juul-Jensens Blvd. 99, Aarhus University Hospital, 8200, Aarhus N, Denmark
| | - Søren Nielsen
- Aalborg University, Fredrik Bajers Vej 7, 9220 Aalborg Ø, Denmark
| | - Leif Østergaard
- Center of Functionally Integrative Neuroscience, Department of Clinical Medicine, Palle Juul-Jensens Blvd. 99, Aarhus University Hospital, 8200, Aarhus N, Denmark.,Department of Neuroradiology, Nørrebrogade 44, Aarhus University Hospital, 8000, Aarhus, Denmark
| | - Sebastian Frische
- Department of Biomedicine, Wilhelm Meyers Allé 3, Aarhus University, 8000, Aarhus, Denmark
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19
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Abstract
Orthostatic hypotension (OH) is a sustained fall in blood pressure on standing that can cause symptoms of organ hypoperfusion. OH is associated with increased morbidity and mortality and leads to a significant number of hospital admissions. OH can be caused by volume depletion, blood loss, cardiac pump failure, large varicose veins, medications, or defective activation of sympathetic nerves and reduced norepinephrine release upon standing. Neurogenic OH is a frequent and disabling problem in patients with synucleinopathies such as Parkinson disease, multiple system atrophy, and pure autonomic failure, and it is commonly associated with supine hypertension. Several therapeutic options are available.
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20
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Orthostatic hypotension in hereditary transthyretin amyloidosis: epidemiology, diagnosis and management. Clin Auton Res 2019; 29:33-44. [PMID: 31452021 PMCID: PMC6763509 DOI: 10.1007/s10286-019-00623-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 07/30/2019] [Indexed: 02/06/2023]
Abstract
Purpose Neurogenic orthostatic hypotension is a prominent and disabling manifestation of autonomic dysfunction in patients with hereditary transthyretin (TTR) amyloidosis affecting an estimated 40–60% of patients, and reducing their quality of life. We reviewed the epidemiology and pathophysiology of neurogenic orthostatic hypotension in patients with hereditary TTR amyloidosis, summarize non-pharmacologic and pharmacological treatment strategies and discuss the impact of novel disease-modifying treatments such as transthyretin stabilizers (diflunisal, tafamidis) and RNA interference agents (patisiran, inotersen). Methods Literature review. Results Orthostatic hypotension in patients with hereditary transthyretin amyloidosis can be a consequence of heart failure due to amyloid cardiomyopathy or volume depletion due to diarrhea or drug effects. When none of these circumstances are apparent, orthostatic hypotension is usually neurogenic, i.e., caused by impaired norepinephrine release from sympathetic postganglionic neurons, because of neuronal amyloid fibril deposition. Conclusions When recognized, neurogenic orthostatic hypotension can be treated. Discontinuation of potentially aggravating medications, patient education and non-pharmacologic approaches should be applied first. Droxidopa (Northera®), a synthetic norepinephrine precursor, has shown efficacy in controlled trials of neurogenic orthostatic hypotension in patients with hereditary TTR amyloidosis and is now approved in the US and Asia. Although they may be useful to ameliorate autonomic dysfunction in hereditary TTR amyloidosis, the impact of disease-modifying treatments on neurogenic orthostatic hypotension is still uninvestigated.
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21
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Edmonds CJ, Skeete J, Klamerus E, Gardner M. At what stage in the drinking process does drinking water affect attention and memory? Effects of mouth rinsing and mouth drying in adults. PSYCHOLOGICAL RESEARCH 2019; 85:214-222. [PMID: 31300874 DOI: 10.1007/s00426-019-01229-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 07/06/2019] [Indexed: 11/28/2022]
Abstract
Drinking water is important for health and there is an agreement that drinking water facilitates certain cognitive processes. However, the mechanism underlying the effect of drinking water on cognition is unknown. While attention performance is improved by even a very small drink, memory performance seems to require larger drinks for performance enhancement. This suggests that attention could be affected earlier in the drinking process than memory. We aimed to elucidate further the mechanism involved by investigating the stage during the drinking process influencing performance on cognitive tasks. To this end, we compared mouth rinsing and mouth drying. Mouth rinsing was expected to result in improved attention performance and would suggest that the mechanism responsible is located in the mouth and occurs early in the drinking process, before swallowing. Eighty-seven adults participated in either a treatment (mouth rinsing or mouth drying) or control (no intervention) condition. They were assessed at baseline and 20 min later after intervention on measures of visual attention, short-term memory, subjective thirst and mood. Our results showed that mouth rinsing improved visual attention, but not short-term memory, mood or subjective thirst. Mouth drying did not affect performance. Our results support the hypothesis that different mechanisms underlie the effect of drinking water on different cognitive processes. They suggest that merely sipping water, as opposed to having a large drink, can improve attention.
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Affiliation(s)
- Caroline J Edmonds
- School of Psychology, University of East London, Water Lane, Stratford, E15 4LZ, UK.
| | - Jamila Skeete
- Department of Psychology, University of Westminster, 309 Regent Street, London, W1B 2UW, UK
| | - Eva Klamerus
- School of Psychology, University of East London, Water Lane, Stratford, E15 4LZ, UK
| | - Mark Gardner
- Department of Psychology, University of Westminster, 309 Regent Street, London, W1B 2UW, UK
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22
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Vianna LC, Fernandes IA, Martinez DG, Teixeira AL, Silva BM, Fadel PJ, Nóbrega ACL. Interpreting the impact of water drinking on arterial baroreflex function: When physiology speaks for itself. Exp Physiol 2019; 104:781-782. [PMID: 31034117 DOI: 10.1113/ep087612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 02/25/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Lauro C Vianna
- NeuroVASQ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, DF, Brazil
| | - Igor A Fernandes
- NeuroVASQ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, DF, Brazil
| | - Daniel G Martinez
- Research Unit for Cardiovascular and Exercise Physiology, Faculty of Physical Education and Sports, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - André L Teixeira
- NeuroVASQ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, DF, Brazil
| | - Bruno M Silva
- Department of Physiology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - Paul J Fadel
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, USA
| | - Antonio C L Nóbrega
- Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, RJ, Brazil
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Ziffra JB, Olshansky B. Acute Water Ingestion as a Treatment for Postural Orthostatic Tachycardia Syndrome. J Innov Card Rhythm Manag 2019; 10:3541-3544. [PMID: 32477718 PMCID: PMC7252788 DOI: 10.19102/icrm.2019.100206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/14/2018] [Indexed: 12/29/2022] Open
Abstract
A 24-year-old female presented to our clinic with symptomatic tachycardia. In the clinic, she was able to replicate her symptoms, which were due to tachycardia in a standing position that resolved upon sitting. The patient was then offered eight ounces (236.6 mL) of water and, after consumption of such, the standing tachycardia was no longer observed. A diagnosis of postural orthostatic tachycardia syndrome (POTS) was made. This case report discusses a novel approach to acute treatment for POTS.
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Affiliation(s)
- Jeffrey B Ziffra
- Department of Cardiology, Mercy Medical Center, Mason City, IA, USA
| | - Brian Olshansky
- Department of Cardiology, Mercy Medical Center, Mason City, IA, USA.,Department of Cardiology, University of Iowa, Iowa City, IA, USA
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24
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Kukadia S, Dehbi HM, Tillin T, Coady E, Chaturvedi N, Hughes AD. A Double-Blind Placebo-Controlled Crossover Study of the Effect of Beetroot Juice Containing Dietary Nitrate on Aortic and Brachial Blood Pressure Over 24 h. Front Physiol 2019; 10:47. [PMID: 30778302 PMCID: PMC6369216 DOI: 10.3389/fphys.2019.00047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 01/17/2019] [Indexed: 01/30/2023] Open
Abstract
Dietary inorganic nitrate in beetroot can act as a source of nitric oxide and has been reported to lower brachial blood pressure (BP). This study examined the effect of inorganic nitrate in beetroot juice on aortic (central) BP acutely and over the subsequent 24-h period. A double blind, randomized, placebo-controlled crossover trial was performed in fifteen healthy, normotensive men and women (age 22–40 years). Participants were randomized to receive beetroot juice containing nitrate (6.5–7.3 mmol) or placebo beetroot juice from which nitrate had been removed (<0.06 mmol nitrate). Effects on aortic systolic BP were measured at 30 min (primary endpoint), 60 min and over a subsequent 24 h period using an ambulatory BP monitor. Carotid-femoral pulse wave velocity (cfPWV) was also measured at 30 min. Following a washout period, the procedure was repeated within 7 days with crossover to the opposite arm of the trial. Compared with placebo, ingestion of beetroot juice containing nitrate lowered aortic systolic BP at 30 min by 5.2 (1.9–8.5) mmHg [mean (95% confidence interval); p < 0.01]. A smaller effect on aortic systolic BP was observed at 60 min. There were minimal effects on brachial BP or cfPWV. Effects on aortic systolic BP were not sustained over the subsequent 24 h and there were no effects on other hemodynamic parameters during ambulatory monitoring. A single dose of beetroot juice containing nitrate lowers aortic BP more effectively than brachial BP in the short term, but the effects are comparatively short-lived and do not persist over the course of the same day.
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Affiliation(s)
- Suraj Kukadia
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Hakim-Moulay Dehbi
- Institute of Cardiovascular Science, University College London, London, United Kingdom.,CRUK Cancer Trials Centre, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Therese Tillin
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Emma Coady
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Nish Chaturvedi
- Institute of Cardiovascular Science, University College London, London, United Kingdom.,MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, United Kingdom
| | - Alun D Hughes
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom.,Institute of Cardiovascular Science, University College London, London, United Kingdom.,MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, United Kingdom
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25
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MEHDIRAD ALI, FEIGOFSKY SUSAN, LEI LUCY, SHEIKH NASIA, RAJ SATISH, KANJWAL KHALIL, CANNOM DAVID. Water Ingestion in Postural Orthostatic Tachycardia Syndrome: A Feasible Treatment Option? J Innov Card Rhythm Manag 2019; 10:3545-3551. [PMID: 32494413 PMCID: PMC7252859 DOI: 10.19102/icrm.2019.100207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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27
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Edgell H, Grinberg A, Beavers KR, Gagné N, Hughson RL. Efficacy of fluid loading as a countermeasure to the hemodynamic and hormonal changes of 28-h head-down bed rest. Physiol Rep 2018; 6:e13874. [PMID: 30298552 PMCID: PMC6175712 DOI: 10.14814/phy2.13874] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 08/26/2018] [Indexed: 11/24/2022] Open
Abstract
After exposure to microgravity, or head-down bed rest (HDBR), fluid loading is often used with the intent of increasing plasma volume and maintaining mean arterial pressure during orthostatic stress. Nine men (aged 18-32 years) underwent three randomized trials with lower body negative pressure (LBNP) before and after: (1) 4-h of sitting with fluid loading (1 g sodium chloride/125 mL of water starting 2.5-h before LBNP), (2) 28-h of 6-degree HDBR without fluid loading, and (3) 28-h of 6-degree HDBR with fluid loading. LBNP was progressive from 0 to -40 mmHg. After 28-h HDBR, fluid loading did not protect against the loss of plasma volume (-280 ± 64 mL without fluid loading, -207 ± 86 with fluid loading, P = 0.472) nor did it protect against a drop of mean arterial pressure (P = 0.017) during LBNP (Post-28 h HDBR response from 0 to -40 mmHg LBNP: 88 ± 4 to 85 ± 4 mmHg without fluid loading and 93 ± 4 to 88 ± 5 mmHg with fluid loading, P = 0.557 between trials). However, fluid loading did protect against the loss of stroke volume index and central venous pressure observed after 28-h HDBR. Fluid loading also attenuated the increase of angiotensin II seen after 28-h HDBR and throughout the LBNP protocol (Post-28 h HDBR response from 0 to -40 mmHg LBNP: 16.6 ± 3.4 to 23.7 ± 5.0 pg/mL without fluid loading and 6.1 ± 0.8 to 12.2 ± 2.3 pg/mL with fluid loading, P < 0.001 between trials). Our results indicate that fluid loading did not protect against plasma volume loss due to HDBR or change blood pressure responses to LBNP. However, changes in central venous pressure, stroke volume and fluid regulatory hormones could potentially influence longer duration studies and those with more severe orthostatic stress.
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Affiliation(s)
- Heather Edgell
- Faculty of Applied Health SciencesUniversity of WaterlooWaterlooOntarioCanada
- School of Kinesiology and Health SciencesYork UniversityTorontoOntarioCanada
| | - Anna Grinberg
- Faculty of Applied Health SciencesUniversity of WaterlooWaterlooOntarioCanada
| | - Keith R. Beavers
- Faculty of Applied Health SciencesUniversity of WaterlooWaterlooOntarioCanada
| | - Nathalie Gagné
- Faculty of Applied Health SciencesUniversity of WaterlooWaterlooOntarioCanada
| | - Richard L. Hughson
- Faculty of Applied Health SciencesUniversity of WaterlooWaterlooOntarioCanada
- Schlegel‐University of Waterloo Research Institute for AgingWaterlooOntarioCanada
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Vianna LC, Fernandes IA, Martinez DG, Teixeira AL, Silva BM, Fadel PJ, Nóbrega ACL. Water drinking enhances the gain of arterial baroreflex control of muscle sympathetic nerve activity in healthy young humans. Exp Physiol 2018; 103:1318-1325. [DOI: 10.1113/ep087095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/26/2018] [Indexed: 01/29/2023]
Affiliation(s)
- Lauro C. Vianna
- NeuroVASQ - Integrative Physiology Laboratory; Faculty of Physical Education; University of Brasília; Brasília DF Brazil
| | - Igor A. Fernandes
- NeuroVASQ - Integrative Physiology Laboratory; Faculty of Physical Education; University of Brasília; Brasília DF Brazil
- Department of Physiology and Pharmacology; Fluminense Federal University; Niterói RJ Brazil
| | - Daniel G. Martinez
- Research Unit for Cardiovascular and Exercise Physiology; Faculty of Physical Education and Sports; Federal University of Juiz de Fora; Juiz de Fora MG Brazil
| | - André L. Teixeira
- NeuroVASQ - Integrative Physiology Laboratory; Faculty of Physical Education; University of Brasília; Brasília DF Brazil
| | - Bruno M. Silva
- Department of Physiology; Federal University of Sao Paulo (UNIFESP); Sao Paulo SP Brazil
| | - Paul J. Fadel
- Department of Kinesiology; University of Texas at Arlington; Arlington TX USA
| | - Antonio C. L. Nóbrega
- Department of Physiology and Pharmacology; Fluminense Federal University; Niterói RJ Brazil
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29
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Kazadi LC, Fletcher J, Barrow PA. Gastric cooling and menthol cause an increase in cardiac parasympathetic efferent activity in healthy adult human volunteers. Exp Physiol 2018; 103:1302-1308. [PMID: 30070742 DOI: 10.1113/ep087058] [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: 05/29/2018] [Accepted: 07/31/2018] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? How do gastric stretch and gastric cooling stimuli affect cardiac autonomic control? What is the main finding and its importance? Gastric stretch causes an increase in cardiac sympathetic activity. Stretch combined with cold stimulation result in an elimination of the sympathetic response to stretch and an increase in cardiac parasympathetic activity, in turn resulting in a reduction in heart rate. Gastric cold stimulation causes a shift in sympathovagal balance towards parasympathetic dominance. The cold-induced bradycardia has the potential to decrease cardiac workload, which might be significant in individuals with cardiovascular pathologies. ABSTRACT Gastric distension increases blood pressure and heart rate in young, healthy humans, but little is known about the effect of gastric stretch combined with cooling. We used a randomized crossover study to assess the cardiovascular responses to drinking 300 ml of ispaghula husk solution at either 6 or 37°C in nine healthy humans (age 24.08 ± 9.36 years) to establish the effect of gastric stretch with and without cooling. The effect of consuming peppermint oil capsules to activate cold thermoreceptors was also investigated. The ECG, respiratory movements and continuous blood pressure were recorded during a 5 min baseline period, followed by a 115 min post-drink period, during which 5 min epochs of data were recorded. Cardiac autonomic activity was assessed using time and frequency domain analyses of respiratory sinus arrhythmia to quantify parasympathetic autonomic activity, and corrected QT (QTc) interval analysis to quantify sympathetic autonomic activity. Gastric stretch only caused a significant reduction in QTc interval lasting up to 15 min, with a concomitant but non-significant increase in heart rate, indicating an increased sympathetic cardiac tone. The additional effect of gastric cold stimulation was significantly to reduce heart rate for up to 15 min, elevate indicators of cardiac parasympathetic tone and eliminate the reduction in QTc interval seen with gastric stretch only. Stimulation of gastric cold thermoreceptors with menthol also caused a significant reduction in heart rate and concomitant increase in the root mean square of successive differences. These findings indicate that gastric cold stimulation causes a shift in the sympathovagal balance of cardiac control towards a more parasympathetic dominant pattern.
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Affiliation(s)
- Lubobo-Claude Kazadi
- Department of Biomedical Science and Physiology, School of Sciences, Faculty of Science and Engineering, University of Wolverhampton, Wulfruna Street, Wolverhampton, UK
| | - Janine Fletcher
- Department of Biomedical Science and Physiology, School of Sciences, Faculty of Science and Engineering, University of Wolverhampton, Wulfruna Street, Wolverhampton, UK
| | - Paul A Barrow
- Department of Biomedical Science and Physiology, School of Sciences, Faculty of Science and Engineering, University of Wolverhampton, Wulfruna Street, Wolverhampton, UK
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Sharp R, Childs J, Bulmer AC, Esterman A. The effect of oral hydration and localised heat on peripheral vein diameter and depth: A randomised controlled trial. Appl Nurs Res 2018; 42:83-88. [DOI: 10.1016/j.apnr.2018.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 04/26/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
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Palma JA, Kaufmann H. Treatment of autonomic dysfunction in Parkinson disease and other synucleinopathies. Mov Disord 2018; 33:372-390. [PMID: 29508455 PMCID: PMC5844369 DOI: 10.1002/mds.27344] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/11/2018] [Accepted: 01/24/2018] [Indexed: 12/12/2022] Open
Abstract
Dysfunction of the autonomic nervous system afflicts most patients with Parkinson disease and other synucleinopathies such as dementia with Lewy bodies, multiple system atrophy, and pure autonomic failure, reducing quality of life and increasing mortality. For example, gastrointestinal dysfunction can lead to impaired drug pharmacodynamics causing a worsening in motor symptoms, and neurogenic orthostatic hypotension can cause syncope, falls, and fractures. When recognized, autonomic problems can be treated, sometimes successfully. Discontinuation of potentially causative/aggravating drugs, patient education, and nonpharmacological approaches are useful and should be tried first. Pathophysiology-based pharmacological treatments that have shown efficacy in controlled trials of patients with synucleinopathies have been approved in many countries and are key to an effective management. Here, we review the treatment of autonomic dysfunction in patients with Parkinson disease and other synucleinopathies, summarize the nonpharmacological and current pharmacological therapeutic strategies including recently approved drugs, and provide practical advice and management algorithms for clinicians, with focus on neurogenic orthostatic hypotension, supine hypertension, dysphagia, sialorrhea, gastroparesis, constipation, neurogenic overactive bladder, underactive bladder, and sexual dysfunction. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jose-Alberto Palma
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, New York, USA
| | - Horacio Kaufmann
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, New York, USA
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Kemper AR, Barnett ED, Walter EB, Hornik C, Pierre-Joseph N, Broder KR, Silverstein M, Harrington T. Drinking Water to Prevent Postvaccination Presyncope in Adolescents: A Randomized Trial. Pediatrics 2017; 140:peds.2017-0508. [PMID: 29061871 PMCID: PMC6075677 DOI: 10.1542/peds.2017-0508] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Postvaccination syncope can cause injury. Drinking water prephlebotomy increases peripheral vascular tone, decreasing risk of blood-donation presyncope and syncope. This study evaluated whether drinking water prevaccination reduces postvaccination presyncope, a potential syncope precursor. METHODS We conducted a randomized trial of subjects aged 11 to 21 years receiving ≥1 intramuscular vaccine in primary care clinics. Intervention subjects were encouraged to drink 500 mL of water, with vaccination recommended 10 to 60 minutes later. Control subjects received usual care. Presyncope symptoms were assessed with a 12-item survey during the 20-minutes postvaccination. Symptoms were classified with a primary cutoff sensitive for presyncope, and a secondary, more restrictive cutoff requiring greater symptoms. Results were adjusted for clustering by recruitment center. RESULTS There were 906 subjects randomly assigned to the control group and 901 subjects randomly assigned to the intervention group. None had syncope. Presyncope occurred in 36.2% of subjects by using the primary definition, and in 8.0% of subjects by using the restrictive definition. There were no significant differences in presyncope by intervention group for the primary (1-sided test, P = .24) or restrictive outcome (1-sided test, P = .17). Among intervention subjects vaccinated within 10 to 60 minutes after drinking all 500 mL of water (n = 519), no reduction in presyncope was observed for the primary or restrictive outcome (1-sided tests, P = .13, P = .17). In multivariable regression analysis, presyncope was associated with younger age, history of passing out or nearly passing out after a shot or blood draw, prevaccination anxiety, receiving >1 injected vaccine, and greater postvaccination pain. CONCLUSIONS Drinking water before vaccination did not prevent postvaccination presyncope. Predictors of postvaccination presyncope suggest opportunities for presyncope and syncope prevention interventions.
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Affiliation(s)
- Alex R. Kemper
- Division of Ambulatory Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Elizabeth D. Barnett
- Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
| | | | - Christoph Hornik
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - Natalie Pierre-Joseph
- Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
| | - Karen R. Broder
- Division of Healthcare Quality Promotion, Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael Silverstein
- Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
| | - Theresa Harrington
- Division of Healthcare Quality Promotion, Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
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Response of Blood Perfusion at ST 36 Acupoint after Drinking Cold Glucose or Saline Injection. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:4212534. [PMID: 28465703 PMCID: PMC5390596 DOI: 10.1155/2017/4212534] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/05/2017] [Indexed: 12/16/2022]
Abstract
Skin blood flux (SkBF) changes caused by drinking cold water are generally associated with vagal tone and osmotic factors in digestive system. According to acupuncture theory, change of SkBF at ST 36 might reflect the functional changes of digestive system. The aim of this study is to analyze the changes of SkBF after drinking 3°C 0.9% saline or 5% glucose injection by monitor blood flux at bilateral ST 36. The results indicated that, after drinking different cold water, the change ratio of SkBF at right side ST 36 has been different. Because all solutions have the same temperature (3°C) and both saline and glucose solution have the same osmolality, suggesting that the SkBF changes resulting from drinking cold water are not regulated just by the vagal tone and osmolality, there must have been other factors. These results have not been consistent with the frequency domain results of heart rate variability (HRV) analysis. Coherence analysis of blood flux signals at bilateral ST 36 indicated that there have been different coherence-frequency curves among different groups in special frequency bands, which suggested that coherence analysis might provide a potential tool to evaluate different status.
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Palma J, Kaufmann H. Epidemiology, Diagnosis, and Management of Neurogenic Orthostatic Hypotension. Mov Disord Clin Pract 2017; 4:298-308. [PMID: 28713844 PMCID: PMC5506688 DOI: 10.1002/mdc3.12478] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/13/2017] [Accepted: 01/23/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Orthostatic hypotension (OH) is a sustained fall in blood pressure on standing which can cause symptoms of organ hypoperfusion. OH is associated with increased morbidity and mortality and leads to a significant number of hospital admissions particularly in the elderly (233 per 100,000 patients over 75 years of age in the US). OH can be due to volume depletion, blood loss, large varicose veins, medications, or due to defective activation of sympathetic nerves and reduced norepinephrine release upon standing (i.e., neurogenic OH). METHODS AND FINDINGS Literature review. Neurogenic OH is a frequent and disabling problem in patients with synucleinopathies such as Parkinson disease, multiple system atrophy, and pure autonomic failure, and is commonly associated with supine hypertension. Several pharmacological and non-pharmacological therapeutic options are available. CONCLUSIONS Here we review the epidemiology, diagnosis, and management of neurogenic OH, and provide an algorithm for its treatment emphasizing the importance of removing aggravating factors, implementing non-pharmacologic measures, and selecting appropriate pharmacological treatments.
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Affiliation(s)
- Jose‐Alberto Palma
- Department of NeurologyDysautonomia CenterNew York University School of MedicineNew YorkNYUSA
| | - Horacio Kaufmann
- Department of NeurologyDysautonomia CenterNew York University School of MedicineNew YorkNYUSA
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Chu YH, Lu CC, Lin TC, Tsou MY, Hsu YJ, Ho ST, Tung CS, Tseng CJ, Li MH, Lee HS. The Osmopressor-Induced Angiopoietin-1 Secretion in Plasma and Subsequent Activation of the Tie-2/Akt/eNOS Signaling Pathway in Red Blood Cell. Am J Hypertens 2017; 30:295-303. [PMID: 28034894 DOI: 10.1093/ajh/hpw161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 11/28/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Water ingestion induces the osmopressor response, which typically presents as increased total peripheral vascular resistance in young healthy subjects. A previous study has suggested that the RBC membrane receptor is involved in osmopressor stress. Recent studies have indicated nitric oxide synthase phosphorylation in RBCs. However, the main process in signaling pathway activation to elicit such a response is unknown. Herein, we hypothesized that hypo-osmotic stress following water ingestion modulates the eNOS/NO pathway, thereby alternating vascular resistance. METHODS We included 24 young, healthy subjects. Physiological parameters and blood samples were collected at 5 minutes before and 25 and 50 minutes after 50 ml water, 500 ml water, or 500 ml normal saline ingestion. A human receptor tyrosine kinase (RTK) phosphorylation antibody array was used to simultaneously detect and monitor the biological activation pathways in RBCs. RESULTS Of the 71 RTKs assayed during the osmopressor response, several RTKs were significantly upregulated, including Tie-2 and Tie-1. Plasma angiopoietin-1 levels significantly increased at 25 minutes after 500 ml water ingestion compared to those at baseline. Simultaneous phosphorylation of Tie-2, Akt, and eNOS in RBCs occurred. RBCs in vitro were stimulated with angiopoietin-1, Tie-2, or 0.8% saline and showed significant increase in Tie-2, Akt, and eNOS phosphorylation upon angiopoietin-1 treatment and enhanced activation upon cotreatment of angiopoietin-1 and 0.8% saline. CONCLUSIONS The hypo-osmotic stimulus of water ingestion increases angiopoietin-1 secretion and subsequently activates the Tie-2/Akt/eNOS signaling pathway in RBCs, thereby revealing a novel biological mechanism simultaneously occurring with the osmopressor response.
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Affiliation(s)
- You-Hsiang Chu
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Cherng Lu
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- Institute of Aerospace Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tso-Chou Lin
- Department of Anesthesiology, Tri-Service General Hospital, Taipei, Taiwan
| | - Mei-Yung Tsou
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Juei Hsu
- Division of Nephrology and Department of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Nephrology of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Shung-Tai Ho
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Anesthesiology, National Defense Medical Center, Taipei, Taiwan
| | - Che-Se Tung
- Department of Physiology and Biophysics, National Defense Medical Center, Taipei, Taiwan
- Division of Medical Research and Education, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Ching-Jiunn Tseng
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Min-Hui Li
- Institute of Aerospace Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Herng-Sheng Lee
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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A Comparative Study of the Water Drinking Test in Eyes With Open-Angle Glaucoma and Prior Trabeculectomy or Tube Shunt. J Glaucoma 2017; 26:119-125. [DOI: 10.1097/ijg.0000000000000589] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gibbons CH, Schmidt P, Biaggioni I, Frazier-Mills C, Freeman R, Isaacson S, Karabin B, Kuritzky L, Lew M, Low P, Mehdirad A, Raj SR, Vernino S, Kaufmann H. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol 2017; 264:1567-1582. [PMID: 28050656 PMCID: PMC5533816 DOI: 10.1007/s00415-016-8375-x] [Citation(s) in RCA: 227] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/19/2016] [Accepted: 12/20/2016] [Indexed: 02/07/2023]
Abstract
Neurogenic orthostatic hypotension (nOH) is common in patients with neurodegenerative disorders such as Parkinson’s disease, multiple system atrophy, pure autonomic failure, dementia with Lewy bodies, and peripheral neuropathies including amyloid or diabetic neuropathy. Due to the frequency of nOH in the aging population, clinicians need to be well informed about its diagnosis and management. To date, studies of nOH have used different outcome measures and various methods of diagnosis, thereby preventing the generation of evidence-based guidelines to direct clinicians towards ‘best practices’ when treating patients with nOH and associated supine hypertension. To address these issues, the American Autonomic Society and the National Parkinson Foundation initiated a project to develop a statement of recommendations beginning with a consensus panel meeting in Boston on November 7, 2015, with continued communications and contributions to the recommendations through October of 2016. This paper summarizes the panel members’ discussions held during the initial meeting along with continued deliberations among the panel members and provides essential recommendations based upon best available evidence as well as expert opinion for the (1) screening, (2) diagnosis, (3) treatment of nOH, and (4) diagnosis and treatment of associated supine hypertension.
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Affiliation(s)
| | | | | | | | - Roy Freeman
- Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Stuart Isaacson
- Parkinson's Disease and Movement Disorders Center of Boca Raton, Boca Raton, FL, USA
| | | | - Louis Kuritzky
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Mark Lew
- Keck/USC School of Medicine, Los Angeles, CA, USA
| | | | - Ali Mehdirad
- Saint Louis University Hospital, St. Louis, MO, USA
| | | | - Steven Vernino
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Morand C, Coudurier N, Rolland C, Thoret S, Legrand D, Tiberghien P, Bosson JL. Prevention of syncopal-type reactions after whole blood donation: a cluster-randomized trial assessing hydration and muscle tension exercise. Transfusion 2016; 56:2412-2421. [DOI: 10.1111/trf.13716] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 05/26/2016] [Accepted: 05/26/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Sophie Thoret
- TIMC-IMAG Université Grenoble Alpes
- INSERM CIC-1406; Grenoble France
| | | | - Pierre Tiberghien
- UMR1098, INSERM, Etablissement Français du Sang, University of Franche-Comté; Besançon France
| | - Jean-Luc Bosson
- TIMC-IMAG Université Grenoble Alpes
- INSERM CIC-1406; Grenoble France
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Sexual dimorphism in the osmopressor response following water ingestion. Biosci Rep 2016; 36:BSR20150276. [PMID: 27129286 PMCID: PMC5293556 DOI: 10.1042/bsr20150276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 01/06/2016] [Indexed: 11/17/2022] Open
Abstract
Compared with men, women exhibit a greater magnitude of increase in resting blood pressure after drinking a single water bolus of 500 ml. Accordingly, our study provides direct evidence of sexual dimorphism in the haemodynamic response to water intake. There is conflicting evidence as to whether water drinking elicits a pressor response in healthy young adults. The inclusion of a variable number of women may have contributed to the discrepancies found in past research. Thus, we aimed at exploring whether the osmopressor response follows a sexually dimorphic pattern. In a randomized fashion, 31 healthy adults (16 men; 15 women, aged 18–40 years) ingested 50 and 500 ml of water before completing a resting protocol on two separate days. Arterial blood pressure, heart rate and spectral heart rate variability were measured in the seated position at pre- and post-25 min of water ingestion. Women responded to 500 ml of water with a greater proportion of change in diastolic and mean arterial pressure (MAP) (P<0.05). Conversely, the percent change in systolic blood pressure (SBP) and heart rate was not different between sexes after 500 ml of water. Overall, women demonstrated lower blood pressure, but higher resting heart rate compared with men (P<0.05). In contrast, heart rate variability was similar between sexes before and after ingesting either volume of water. There was a bradycardic effect of water and, irrespectively of sex; this was accompanied by increased high frequency power (HF) (P<0.05). We conclude that women display a greater magnitude of pressor response than men post-water ingestion. Accordingly, we provide direct evidence of sexual dimorphism in the haemodynamic response to water intake in young healthy adults.
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Rocha TC, Ramos PDS, Ricardo DR. INGESTÃO DE ÁGUA NO SISTEMA NERVOSO AUTÔNOMO: UMA REVISÃO SISTEMÁTICA E META-ANÁLISE. REV BRAS MED ESPORTE 2016. [DOI: 10.1590/1517-869220162201154165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Verificar, por meio de uma revisão sistemática, o efeito da ingestão de água (IA) no sistema nervoso autônomo (SNA) e variáveis hemodinâmicas em indivíduos adultos. Foram analisados estudos publicados entre 2000 e 2015, tendo como referência a base de dados Medline via Pubmed, sendo utilizado na construção da frase de pesquisa o MeSH. Foram estabelecidos os seguintes critérios de inclusão: ensaios clínicos controlados e randomizados (ECCR) realizados em humanos, na língua inglesa. Como critério de exclusão: intervenções pouco claras, mal descritas ou inadequadas e na forma de resumos. Utilizou-se as seguintes variáveis para a seleção dos estudos: frequência cardíaca (FC), pressão arterial (PA), componente de alta frequência (AF) e resistência vascular periférica (RVP). Foi usada a sistematização PRISMA para a elaboração desta revisão e a realização de uma meta-análise com o objetivo de evidenciar matematicamente os resultados da frequência cardíaca após a ingestão de água em sete estudos que avaliaram esta variável. Fizeram parte desta revisão 10 ECCR envolvendo 246 indivíduos com idade entre 19 a 64 anos, sendo que 34,55% do sexo masculino. A maioria dos ECCR analisados apresentou alterações após a IA. As alterações comumente observadas foram: diminuição da FC (estatisticamente significativa p < 0,001), aumento da AF e RVP. Contudo, em relação à PA, os resultados demonstraram-se conflitantes, com estudos que evidenciaram aumento e outros que não observaram diferença significativa. Esta revisão evidencia os efeitos da IA no SNA, em especial na FC, AF e RVP, não obstante em relação às alterações hemodinâmicas expressas pela PA permanece ainda um óbice em relação à comunidade científica.
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Loavenbruck A, Sandroni P. Neurogenic orthostatic hypotension: roles of norepinephrine deficiency in its causes, its treatment, and future research directions. Curr Med Res Opin 2015; 31:2095-104. [PMID: 26373628 DOI: 10.1185/03007995.2015.1087988] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although a diversity of neurotransmitters and hormones participate in controlling blood pressure, norepinephrine released from postganglionic sympathetic nerve terminals is an important mediator of the rapid regulation of cardiovascular function required for homeostasis of cerebral perfusion. Hence, neurogenic orthostatic hypotension (NOH) often represents a deficiency of noradrenergic responsiveness to postural change. RESEARCH DESIGN AND METHODS PubMed searches with 'orthostatic hypotension' and 'norepinephrine' as conjoint search terms and no restriction on language or date, so as to survey the pathophysiologic and clinical relevance of norepinephrine deficiency for current NOH interventions and for future directions in treatment and research. RESULTS Norepinephrine deficiency in NOH can arise peripherally, due to cardiovascular sympathetic denervation (as in pure autonomic failure, Parkinson's disease, and a variety of neuropathies), or centrally, due to a failure of viscerosensory signals to generate adequate sympathetic traffic to intact sympathetic nerve endings (as in multiple system atrophy). Nonpharmacologic countermeasures such as pre-emptive water intake may yield blood-pressure increases exceeding those achieved pharmacologically. For patients with symptomatic NOH unresponsive to such strategies, a variety of pharmacologic interventions have been administered off-label on the basis of drug mechanisms expected to increase blood pressure via blood-volume expansion or vasoconstriction. Two pressor agents have received FDA approval: the sympathomimetic midodrine and more recently the norepinephrine prodrug droxidopa. CONCLUSIONS Pressor agents are important for treating symptomatic NOH in patients unresponsive to lifestyle changes alone. However, the dysautonomia underlying NOH often permits blood-pressure excursions toward both hypotension and hypertension. Future research should aim to shed light on the resulting management issues, and should also explore the possibility of pharmacotherapy selectively targeting orthostatic blood-pressure decreases.
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Affiliation(s)
- Adam Loavenbruck
- a a Department of Neurology , University of Minnesota , Minneapolis , MN , USA
| | - Paola Sandroni
- b b Department of Neurology , Mayo Clinic , Rochester , MN , USA
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Abstract
The diagnostic process in patients with syncope is not always easy and includes a detailed clinical history, physical examination and baseline electrocardiogram; according to the results of these initial approaches, some additional tests must be performed. Using this strategy, the cause of syncope is diagnosed in 60% to 80% of patients; in the remaining patients, risk stratification can be established to identify those patients at risk of having cardiac events or death at midterm follow-up. This article reviews the treatment of patients with syncope according to the different causes.
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Affiliation(s)
- Angel Moya
- Arrhythmia Unit, Cardiology Department, Vall d'Hebron Hospital, Autonoma University Barcelona, P. Vall d'Hebrón 119 - 129, 08035 Barcelona, Spain.
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Abstract
Neurogenic orthostatic hypotension (nOH) is a fall in blood pressure (BP) on standing due to reduced norepinephrine release from sympathetic nerve terminals. nOH is a feature of several neurological disorders that affect the autonomic nervous system, most notably Parkinson disease (PD), multiple system atrophy (MSA), pure autonomic failure (PAF), and other autonomic neuropathies. Droxidopa, an orally active synthetic amino acid that is converted to norepinephrine by the enzyme aromatic L-amino acid decarboxylase (dopa-decarboxylase), was recently approved by the FDA for the short-term treatment of nOH. It is presumed to raise BP by acting at the neurovascular junction to increase vascular tone. This article summarizes the pharmacological properties of droxidopa, its mechanism of action, and the efficacy and safety results of clinical trials.
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Affiliation(s)
- Horacio Kaufmann
- Department of Neurology, New York University School of Medicine, New York, NY, USA
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Mendonca GV, Fernhall B. The influence of water ingestion on postexercise hypotension and standing haemodynamics. Clin Physiol Funct Imaging 2015; 36:447-456. [DOI: 10.1111/cpf.12249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 02/16/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Goncalo V. Mendonca
- Laboratory of Motor Behavior; Faculty of Human Kinetics; University of Lisbon; Lisbon Portugal
| | - Bo Fernhall
- College of Applied Health Sciences; University of Illinois at Chicago; Chicago IL USA
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Kuritzky L, Espay AJ, Gelblum J, Payne R, Dietrich E. Diagnosing and treating neurogenic orthostatic hypotension in primary care. Postgrad Med 2015; 127:702-15. [PMID: 26012731 DOI: 10.1080/00325481.2015.1050340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In response to a change in posture from supine or sitting to standing, autonomic reflexes normally maintain blood pressure (BP) by selective increases in arteriovenous resistance and by increased cardiac output, ensuring continued perfusion of the central nervous system. In neurogenic orthostatic hypotension (NOH), inadequate vasoconstriction and cardiac output cause BP to drop excessively, resulting in inadequate perfusion, with predictable symptoms such as dizziness, lightheadedness and falls. The condition may represent a central failure of baroreceptor signals to modulate cardiovascular function, a peripheral failure of norepinephrine release from cardiovascular sympathetic nerve endings, or both. Symptomatic patients may benefit from both non-pharmacologic and pharmacologic interventions. Among the latter, two pressor agents have been approved by the US Food and Drug Administration: the sympathomimetic prodrug midodrine, approved in 1996 for symptomatic orthostatic hypotension, and the norepinephrine prodrug droxidopa, approved in 2014, which is indicated for the treatment of symptomatic neurogenic orthostatic hypotension caused by primary autonomic failure (Parkinson's disease, multiple system atrophy and pure autonomic failure). A wide variety of off-label options also have been described (e.g. the synthetic mineralocorticoid fludrocortisone). Because pressor agents may promote supine hypertension, NOH management requires monitoring of supine BP and also lifestyle measures to minimize supine BP increases (e.g. head-of-bed elevation). However, NOH has been associated with cognitive impairment and increases a patient's risk of syncope and falls, with the potential for serious consequences. Hence, concerns about supine hypertension - for which the long-term prognosis in patients with NOH is yet to be established - must sometimes be balanced by the need to address a patient's immediate risks.
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Affiliation(s)
- Louis Kuritzky
- a 1 Department of Community Health and Family Medicine, University of Florida , Gainesville, FL, USA
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Lafontan M, Visscher TL, Farpour-Lambert N, Yumuk V. Opportunities for intervention strategies for weight management: global actions on fluid intake patterns. Obes Facts 2015; 8:54-76. [PMID: 25765164 PMCID: PMC5644897 DOI: 10.1159/000375103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/20/2014] [Indexed: 12/12/2022] Open
Abstract
Water is an essential nutrient for all physiological functions and particularly important for thermoregulation. About 60% of our body weight is made of water. Under standard conditions (18-20 °C and moderate activity), water balance is regulated within 0.2 % of body weight over a 24-hour period. Water requirement varies between individuals and according to environmental conditions. Concerning considerations related to obesity, the health impact of fluid intake is commonly overlooked. Fluid intake advices are missing in most of food pyramids offered to the public, and water requirements and hydration challenges remain often neglected. The purpose of this paper is to emphasize and discuss the role of water consumption in the context of other important public health measures for weight management. Attention will be focused on fluid intake patterns and hydration-related questions in the context of global interventions and/or physical activity programs settled in weight management protocols.
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Affiliation(s)
- Max Lafontan
- Inserm/University Paul Sabatier UMR 1048, Institute of Metabolic and Cardiovascular Diseases, Hôpital Rangueil, Toulouse cedex, France
- *Dr. Max Lafontan, D. Sc., Inserm/UPS UMR 1048, Institut des Maladies Métaboliques et Cardiovasculaires, Hôpital Rangueil, 1, Avenue Jean Poulhès — BP 84225, 31432 Toulouse cedex 4, France,
| | - Tommy L.S. Visscher
- Research Centre for the Prevention of Overweight, Windesheim University of Applied Sciences and VU University, Zwolle, the Netherlands
| | - Nathalie Farpour-Lambert
- Service of Therapeutic Education for Chronic Diseases, Department of Community Health, Primary Care and Emergency, University Hospital of Geneva and University of Geneva, Geneva, Switzerland
| | - Volkan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
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Schleifer JW, Shen W. Vasovagal syncope: an update on the latest pharmacological therapies. Expert Opin Pharmacother 2014; 16:501-13. [DOI: 10.1517/14656566.2015.996129] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Modulation of GPCRs by monovalent cations and anions. Naunyn Schmiedebergs Arch Pharmacol 2014; 388:363-80. [DOI: 10.1007/s00210-014-1073-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/17/2014] [Indexed: 10/24/2022]
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Newman BH. Management of young blood donors. ACTA ACUST UNITED AC 2014; 41:284-95. [PMID: 25254024 DOI: 10.1159/000364849] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 04/24/2014] [Indexed: 11/19/2022]
Abstract
The emphasis on high-school blood drives and acceptance of 16-year-old blood donors led to more research on physiologic and psychological ways to decrease vasovagal reaction rates in young blood donors and to increase donor retention. Research on how to accomplish this has been advantageous for the blood collection industry and blood donors. This review discussed the current situation and what can be done psychologically, physiologically, and via process improvements to decrease vasovagal reaction rates and increase donor retention. The donation process can be significantly improved. Future interventions may include more dietary salt, a shorter muscle tension program to make it more feasible, recommendations for post-donation muscle tension / squatting / laying down for lightheadedness, more donor education by the staff at the collection site, more staff attention to donors with fear or higher risk for a vasovagal reaction (e.g. estimated blood volume near 3.5 l, first-time donor), and a more focused donation process to ensure a pleasant and safer procedure.
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Affiliation(s)
- Bruce H Newman
- American Red Cross Blood Services, Southeastern Michigan Region, Detroit, MI, USA
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