Renal Impairment of Pure Autonomic Failure
- 1 November 2009
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Hypertension
- Vol. 54 (5), 1057-1061
- https://doi.org/10.1161/hypertensionaha.109.136853
Abstract
Supine hypertension is difficult to manage in patients with pure autonomic failure (PAF), because treatment can worsen orthostatic hypotension. Supine hypertension in PAF has been associated with left ventricular hypertrophy, but end organ damage in the kidney has not been assessed. We reviewed hemodynamic and laboratory data of 64 male patients with PAF who were 69±11 (mean±SD) years old. Systolic blood pressure fell by 67±40 mm Hg within 10 minutes of standing, with an inappropriately low 13±11-bpm increase in heart rate. Plasma norepinephrine levels were below normal (0.62±0.32 nmol/L supine and 1.28±1.25 nmol/L standing). A control data set of 75 men (67±12 years) was obtained from a deidentified version of the Vanderbilt University Medical Center electronic medical chart database. Compared with controls, PAF patients had lower hemoglobin (8.3±0.9 versus 9.3±0.8 mmol/L; P P 12 versus 5.0±0.5×10 12 cells/L; P P =0.021) and estimated glomerular filtration rate was lower (57±22 versus 70±20 mL/min per 1.73 m 2 ; P =0.022) compared with patients who did not have supine hypertension. These findings may indicate that renal function is diminished in PAF in association with supine hypertension.Keywords
This publication has 32 references indexed in Scilit:
- Tracking Hypotension and Dynamic Changes in Arterial Blood Pressure with Brachial Cuff MeasurementsAnesthesia & Analgesia, 2009
- Nocturnal Blood Pressure Dipping in the Hypertension of Autonomic FailureHypertension, 2009
- The Sympathetic Nervous System and Blood Volume Regulation: Lessons from Autonomic Failure PatientsThe American Journal of the Medical Sciences, 2007
- Prevalence and Severity of Renal Disease in Familial DysautonomiaAmerican Journal of Kidney Diseases, 2006
- The effects of water ingestion on orthostatic hypotension in two groups of chronic autonomic failure: multiple system atrophy and pure autonomic failureJournal of Neurology, Neurosurgery & Psychiatry, 2004
- Characteristics of 100 Consecutive Patients Presenting With Orthostatic HypotensionMayo Clinic Proceedings, 2004
- Water Potentiates the Pressor Effect of Ephedra AlkaloidsCirculation, 2004
- CONGENITAL DOPAMINE-BETA-HYDROXYLASE DEFICIENCY: A Novel Orthostatic SyndromeThe Lancet, 1987
- Isolated Failure of Autonomic Noradrenergic NeurotransmissionNew England Journal of Medicine, 1986
- Postural hypotension: A report of three casesAmerican Heart Journal, 1925