Murray Gary L, Colombo Joseph
Cardiovascular Research, Heart-Vascular Institute, Germantown, Tennessee.
Autonomic Laboratory, Drexel University College of Medicine; Parasympathetic & Sympathetic Nervous System Consultant, Franklin Cardiovascular Associates, Pennsylvania.
Int J Angiol. 2019 Sep;28(3):188-193. doi: 10.1055/s-0038-1676957. Epub 2019 Feb 22.
Chronic orthostatic hypotension (OH), affecting 10 to 30% of the elderly, is associated with falls, and increased morbidity and mortality. Current pharmacologic therapy can cause or worsen hypertension and fluid retention. (r)α lipoic acid (ALA), a powerful natural antioxidant, avoids those complications and may assist management of chronic neurogenic orthostatic hypotension (NOH). The purpose of this study is to demonstrate improvement in the symptoms of orthostatic dysfunction with r-ALA, including improved sympathetic (S) and blood pressure (BP) responses to head-up postural change (standing). A cohort of 109 patients with low S tone upon standing was detected using the ANX -3.0, Autonomic Monitor, ANSAR Medical Technologies, Inc., Philadelphia, PA. From the cohort, 29 patients demonstrated NOH (change in (∆) standing BP ≥ -20/-10 mm Hg); 60 patients demonstrated orthostatic intolerance (OI, ∆ standing systolic BP between -6 and -19 mm Hg). These 89 were given ALA orally: either 590 to 788 mg (r)ALA or 867 to 1,500 mg of the less expensive 50 to 50% mixture (r)ALA and inactive (s)ALA. Changes in their S and parasympathetic (P) tone, and BPs, were compared with 20 control patients during mean follow-up of 2.28 years. Nineteen of 29 (66%) NOH patients responded with a ∆ standing BP from -28/-6 mm Hg to 0/+2 mm Hg. Forty of 60 (67%) of patients with OI responded with a ∆ standing BP of -9/+1 mm Hg to +6/+2 mm Hg. Although all patients treated with ALA increased S tone, the ∆ BP depended upon the pretreatment of S tone. Those with the lowest S tone responded the least well. The only treatment side effects were nausea, intolerable in only 5%. Nausea improved with routine gastrointestinal medications. Glucose levels improved in the 28% of patients who were diabetic. Also, resting hypertension improved. Control patients had no ∆ BP and no increase in S tone. (r)ALA improves S-, and BP, responses to head-up postural change, and thereby NOH/OI, in a majority of patients without causing harmful side effects.
慢性直立性低血压（OH）影响着10%至30%的老年人，与跌倒以及发病率和死亡率增加相关。目前的药物治疗可能会导致或加重高血压和液体潴留。（R）α硫辛酸（ALA）是一种强大的天然抗氧化剂，可避免这些并发症，并可能有助于慢性神经源性直立性低血压（NOH）的管理。本研究的目的是证明R-ALA可改善直立性功能障碍的症状，包括改善交感神经（S）和血压（BP）对抬头姿势变化（站立）的反应。使用位于宾夕法尼亚州费城的ANSAR Medical Technologies公司的ANX -3.0自主监测仪，检测了一组109名站立时交感神经张力较低的患者。在该队列中，29名患者表现为NOH（站立时血压变化（∆）≥ -20/-10 mmHg）；60名患者表现为直立不耐受（OI，站立时收缩压变化在-6至-19 mmHg之间）。这89名患者口服ALA：590至788毫克（R）ALA或867至1500毫克较便宜的50对50混合物（R）ALA和无活性（S）ALA。在平均2.28年的随访期间，将他们的交感神经和副交感神经（P）张力以及血压变化与20名对照患者进行了比较。29名NOH患者中有19名（66%）的站立血压变化从-28/-6 mmHg变为0/+2 mmHg。60名OI患者中有40名（67%）的站立血压变化从-9/+1 mmHg变为+6/+2 mmHg。尽管所有接受ALA治疗的患者交感神经张力均增加，但血压变化取决于交感神经张力的预处理情况。交感神经张力最低的患者反应最差。唯一的治疗副作用是恶心，只有5%的患者无法耐受。使用常规胃肠道药物后恶心症状有所改善。28%的糖尿病患者血糖水平有所改善。此外，静息高血压也有所改善。对照患者的血压无变化，交感神经张力也未增加。（R）ALA可改善大多数患者对抬头姿势变化的交感神经和血压反应，从而改善NOH/OI，且不会产生有害副作用。
