Local Passive Heat for the Treatment of Hypertension in Autonomic Failure

Background Supine hypertension affects a majority of patients with autonomic failure; it is associated with end-organ damage and can worsen daytime orthostatic hypotension by inducing pressure diuresis and volume loss during the night. Because sympathetic activation prevents blood pressure (BP) from...

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Bibliographic Details
Published in:Journal of the American Heart Association 2021-04, Vol.10 (7), p.e018979
Main Authors: Okamoto, Luis E, Celedonio, Jorge E, Smith, Emily C, Gamboa, Alfredo, Shibao, Cyndya A, Diedrich, André, Paranjape, Sachin Y, Black, Bonnie K, Muldowney, 3rd, James A S, Peltier, Amanda C, Habermann, Ralf, Crandall, Craig G, Biaggioni, Italo
Format: Article
Language:English
Subjects:
Aged
autonomic failure
Autonomic Nervous System - physiopathology
Blood Pressure - physiology
Female
heat
Hot Temperature
Humans
Hypertension - complications
Hypertension - physiopathology
Hypertension - therapy
Hyperthermia, Induced - methods
Male
Original Research
orthostatic hypotension
Pure Autonomic Failure - complications
Pure Autonomic Failure - physiopathology
supine hypertension
thermoregulation
Treatment Outcome
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Summary:Background Supine hypertension affects a majority of patients with autonomic failure; it is associated with end-organ damage and can worsen daytime orthostatic hypotension by inducing pressure diuresis and volume loss during the night. Because sympathetic activation prevents blood pressure (BP) from falling in healthy subjects exposed to heat, we hypothesized that passive heat had a BP-lowering effect in patients with autonomic failure and could be used to treat their supine hypertension. Methods and Results In Protocol 1 (n=22), the acute effects of local heat (40-42°C applied with a heating pad placed over the abdomen for 2 hours) versus sham control were assessed in a randomized crossover fashion. Heat acutely decreased systolic BP by -19±4 mm Hg (versus 3±4 with sham,
ISSN:2047-9980
2047-9980
DOI:10.1161/JAHA.120.018979