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Renal Impairment of Pure Autonomic Failure
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 hemo...
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| Published in: | Hypertension (Dallas, Tex. 1979) Tex. 1979), 2009-11, Vol.54 (5), p.1057-1061 |
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| container_end_page | 1061 |
| container_issue | 5 |
| container_start_page | 1057 |
| container_title | Hypertension (Dallas, Tex. 1979) |
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| creator | Garland, Emily M Gamboa, Alfredo Okamoto, Luis Raj, Satish R Black, Bonnie K Davis, Thomas L Biaggioni, Italo Robertson, David |
| description | 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 |
| doi_str_mv | 10.1161/HYPERTENSIONAHA.109.136853 |
| format | article |
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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<0.001), packed cell volume (0.40±0.04 versus 0.45±0.04; P<0.001), and red blood cell count (4.4±0.5×10 versus 5.0±0.5×10 cells/L; P<0.001). Serum creatinine and blood urea nitrogen levels were elevated in patients. Forty-eight percent of patients with PAF had supine hypertension (supine systolic blood pressure≥150 mm Hg). Serum creatinine was higher in patients with supine hypertension (133±44 versus 106±27 μmol/L; P=0.021) and estimated glomerular filtration rate was lower (57±22 versus 70±20 mL/min per 1.73 m; 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.</description><identifier>ISSN: 0194-911X</identifier><identifier>EISSN: 1524-4563</identifier><identifier>DOI: 10.1161/HYPERTENSIONAHA.109.136853</identifier><identifier>PMID: 19738158</identifier><identifier>CODEN: HPRTDN</identifier><language>eng</language><publisher>Hagerstown, MD: American Heart Association, Inc</publisher><subject>Age Distribution ; Aged ; Aged, 80 and over ; Arterial hypertension. Arterial hypotension ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Case-Control Studies ; Creatinine - blood ; Fundamental and applied biological sciences. Psychology ; Glomerular Filtration Rate ; Heart Rate - physiology ; Hemodynamics - physiology ; Humans ; Hypertension - complications ; Hypertension - diagnosis ; Hypotension, Orthostatic - complications ; Hypotension, Orthostatic - diagnosis ; Incidence ; Male ; Medical sciences ; Middle Aged ; Norepinephrine - blood ; Prognosis ; Pure Autonomic Failure - complications ; Pure Autonomic Failure - diagnosis ; Reference Values ; Renal Insufficiency - epidemiology ; Renal Insufficiency - etiology ; Renal Insufficiency - physiopathology ; Risk Assessment ; Severity of Illness Index ; Supine Position ; Vertebrates: urinary system</subject><ispartof>Hypertension (Dallas, Tex. 1979), 2009-11, Vol.54 (5), p.1057-1061</ispartof><rights>2009 American Heart Association, Inc.</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5413-d113921ea36830b11f90f5d456b88d338cc940a54742ba94a323828d5beacf193</citedby><cites>FETCH-LOGICAL-c5413-d113921ea36830b11f90f5d456b88d338cc940a54742ba94a323828d5beacf193</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22058064$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19738158$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Garland, Emily M</creatorcontrib><creatorcontrib>Gamboa, Alfredo</creatorcontrib><creatorcontrib>Okamoto, Luis</creatorcontrib><creatorcontrib>Raj, Satish R</creatorcontrib><creatorcontrib>Black, Bonnie K</creatorcontrib><creatorcontrib>Davis, Thomas L</creatorcontrib><creatorcontrib>Biaggioni, Italo</creatorcontrib><creatorcontrib>Robertson, David</creatorcontrib><title>Renal Impairment of Pure Autonomic Failure</title><title>Hypertension (Dallas, Tex. 1979)</title><addtitle>Hypertension</addtitle><description>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<0.001), packed cell volume (0.40±0.04 versus 0.45±0.04; P<0.001), and red blood cell count (4.4±0.5×10 versus 5.0±0.5×10 cells/L; P<0.001). Serum creatinine and blood urea nitrogen levels were elevated in patients. Forty-eight percent of patients with PAF had supine hypertension (supine systolic blood pressure≥150 mm Hg). Serum creatinine was higher in patients with supine hypertension (133±44 versus 106±27 μmol/L; P=0.021) and estimated glomerular filtration rate was lower (57±22 versus 70±20 mL/min per 1.73 m; 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.</description><subject>Age Distribution</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Arterial hypertension. Arterial hypotension</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>Case-Control Studies</subject><subject>Creatinine - blood</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Glomerular Filtration Rate</subject><subject>Heart Rate - physiology</subject><subject>Hemodynamics - physiology</subject><subject>Humans</subject><subject>Hypertension - complications</subject><subject>Hypertension - diagnosis</subject><subject>Hypotension, Orthostatic - complications</subject><subject>Hypotension, Orthostatic - diagnosis</subject><subject>Incidence</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Norepinephrine - blood</subject><subject>Prognosis</subject><subject>Pure Autonomic Failure - complications</subject><subject>Pure Autonomic Failure - diagnosis</subject><subject>Reference Values</subject><subject>Renal Insufficiency - epidemiology</subject><subject>Renal Insufficiency - etiology</subject><subject>Renal Insufficiency - physiopathology</subject><subject>Risk Assessment</subject><subject>Severity of Illness Index</subject><subject>Supine Position</subject><subject>Vertebrates: urinary system</subject><issn>0194-911X</issn><issn>1524-4563</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><recordid>eNpdkV1LHDEUhoO01K3tXyhDoV4UZs3Jx0zSC2GR1V0QFT_AXoVMJtOdNjNZkxnFf290F1sbCOGcPOfNyxuEvgKeAhRwsPh5Mb-8np9dLc_PZovZFLCcAi0EpztoApywnPGCvkMTDJLlEuB2F32M8TfGwBgrP6BdkCUVwMUEfb-0vXbZslvrNnS2HzLfZBdjsNlsHHzvu9Zkx7p1qfMJvW-0i_bz9txDN8fz66NFfnp-sjyaneaGM6B5DUAlAauTI4orgEbihtfJUiVETakwRjKsOSsZqbRkmhIqiKh5ZbVpQNI9dLjRXY9VZ2uTTAXt1Dq0nQ6PyutWvb3p25X65e8VKWUBwJPA_lYg-LvRxkF1bTTWOd1bP0ZVlIVk5Qv4YwOa4GMMtnl9BLB6jlr9F3XqS7WJOg1_-dfm39Fttgn4tgV0NNo1Qfemja8cIZgLXLDEsQ334N1gQ_zjxgcb1MpqN6wUTouRQuQE4_SVqcrTJpQ-AQ5YmBk</recordid><startdate>200911</startdate><enddate>200911</enddate><creator>Garland, Emily M</creator><creator>Gamboa, Alfredo</creator><creator>Okamoto, Luis</creator><creator>Raj, Satish R</creator><creator>Black, Bonnie K</creator><creator>Davis, Thomas L</creator><creator>Biaggioni, Italo</creator><creator>Robertson, David</creator><general>American Heart Association, Inc</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>200911</creationdate><title>Renal Impairment of Pure Autonomic Failure</title><author>Garland, Emily M ; Gamboa, Alfredo ; Okamoto, Luis ; Raj, Satish R ; Black, Bonnie K ; Davis, Thomas L ; Biaggioni, Italo ; Robertson, David</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5413-d113921ea36830b11f90f5d456b88d338cc940a54742ba94a323828d5beacf193</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Age Distribution</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Arterial hypertension. Arterial hypotension</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology. Vascular system</topic><topic>Case-Control Studies</topic><topic>Creatinine - blood</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Glomerular Filtration Rate</topic><topic>Heart Rate - physiology</topic><topic>Hemodynamics - physiology</topic><topic>Humans</topic><topic>Hypertension - complications</topic><topic>Hypertension - diagnosis</topic><topic>Hypotension, Orthostatic - complications</topic><topic>Hypotension, Orthostatic - diagnosis</topic><topic>Incidence</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Norepinephrine - blood</topic><topic>Prognosis</topic><topic>Pure Autonomic Failure - complications</topic><topic>Pure Autonomic Failure - diagnosis</topic><topic>Reference Values</topic><topic>Renal Insufficiency - epidemiology</topic><topic>Renal Insufficiency - etiology</topic><topic>Renal Insufficiency - physiopathology</topic><topic>Risk Assessment</topic><topic>Severity of Illness Index</topic><topic>Supine Position</topic><topic>Vertebrates: urinary system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Garland, Emily M</creatorcontrib><creatorcontrib>Gamboa, Alfredo</creatorcontrib><creatorcontrib>Okamoto, Luis</creatorcontrib><creatorcontrib>Raj, Satish R</creatorcontrib><creatorcontrib>Black, Bonnie K</creatorcontrib><creatorcontrib>Davis, Thomas L</creatorcontrib><creatorcontrib>Biaggioni, Italo</creatorcontrib><creatorcontrib>Robertson, David</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Hypertension (Dallas, Tex. 1979)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Garland, Emily M</au><au>Gamboa, Alfredo</au><au>Okamoto, Luis</au><au>Raj, Satish R</au><au>Black, Bonnie K</au><au>Davis, Thomas L</au><au>Biaggioni, Italo</au><au>Robertson, David</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Renal Impairment of Pure Autonomic Failure</atitle><jtitle>Hypertension (Dallas, Tex. 1979)</jtitle><addtitle>Hypertension</addtitle><date>2009-11</date><risdate>2009</risdate><volume>54</volume><issue>5</issue><spage>1057</spage><epage>1061</epage><pages>1057-1061</pages><issn>0194-911X</issn><eissn>1524-4563</eissn><coden>HPRTDN</coden><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<0.001), packed cell volume (0.40±0.04 versus 0.45±0.04; P<0.001), and red blood cell count (4.4±0.5×10 versus 5.0±0.5×10 cells/L; P<0.001). Serum creatinine and blood urea nitrogen levels were elevated in patients. Forty-eight percent of patients with PAF had supine hypertension (supine systolic blood pressure≥150 mm Hg). Serum creatinine was higher in patients with supine hypertension (133±44 versus 106±27 μmol/L; P=0.021) and estimated glomerular filtration rate was lower (57±22 versus 70±20 mL/min per 1.73 m; 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.</abstract><cop>Hagerstown, MD</cop><pub>American Heart Association, Inc</pub><pmid>19738158</pmid><doi>10.1161/HYPERTENSIONAHA.109.136853</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Age Distribution Aged Aged, 80 and over Arterial hypertension. Arterial hypotension Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Case-Control Studies Creatinine - blood Fundamental and applied biological sciences. Psychology Glomerular Filtration Rate Heart Rate - physiology Hemodynamics - physiology Humans Hypertension - complications Hypertension - diagnosis Hypotension, Orthostatic - complications Hypotension, Orthostatic - diagnosis Incidence Male Medical sciences Middle Aged Norepinephrine - blood Prognosis Pure Autonomic Failure - complications Pure Autonomic Failure - diagnosis Reference Values Renal Insufficiency - epidemiology Renal Insufficiency - etiology Renal Insufficiency - physiopathology Risk Assessment Severity of Illness Index Supine Position Vertebrates: urinary system |
| title | Renal Impairment of Pure Autonomic Failure |
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