Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine (L.E.O., J.E.C., E.C.S., S.Y.P., B.K.B., A.W., J.-W.P., C.A.S., A.D., I.B.), Vanderbilt University Medical Center, Nashville, TN.
Department of Biomedical Engineering, Vanderbilt University, Nashville, TN (A.D.).
Hypertension. 2023 Mar;80(3):650-658. doi: 10.1161/HYPERTENSIONAHA.122.20081. Epub 2023 Jan 5.
Supine hypertension affects most patients with orthostatic hypotension (OH) due to autonomic failure, but it is often untreated for fear of worsening OH. We hypothesized that increasing intrathoracic pressure with continuous positive airway pressure (CPAP) had a Valsalva-like blood-pressure-lowering effect that could be used to treat nocturnal supine hypertension in these patients, while reducing nocturnal pressure diuresis and improving daytime OH.
In Protocol 1, we determined the acute hemodynamic effects of increasing levels of CPAP (0, 4, 8, 12, and 16 cm HO, 3 minutes each) in 26 patients with autonomic failure and supine hypertension studied while awake and supine. In Protocol 2 (n=11), we compared the effects of overnight therapy with CPAP (8-12 cm HO for 8 hours) versus placebo on nocturnal supine hypertension, nocturnal diuresis and daytime OH in a 2-night crossover study.
In Protocol 1, acute CPAP (4-16 cm HO) decreased systolic blood pressure in a dose-dependent manner (maximal drop 22±4 mmHg with CPAP 16) due to reductions in stroke volume (-16+3%) and cardiac output (-14±3%). Systemic vascular resistance and heart rate remained unchanged. In Protocol 2, overnight CPAP lowered nighttime systolic blood pressure (maximal change -23±5 versus placebo -1±7 mmHg; =0.023) and was associated with lower nighttime diuresis (609±84 versus placebo 1004±160 mL; =0.004) and improved morning orthostatic tolerance (AUC 642±121 versus placebo 410±109 mmHg*min; =0.014).
CPAP is a novel nonpharmacologic approach to treat the supine hypertension of autonomic failure while improving nocturia and daytime OH.
URL: https://www.
gov; Unique identifier: NCT03312556.
由于自主神经衰竭，仰卧位高血压影响大多数体位性低血压（OH）患者，但由于担心加重 OH，通常未予治疗。我们假设使用持续气道正压通气（CPAP）增加胸腔内压力具有类似瓦尔萨尔瓦的降压作用，可用于治疗这些患者的夜间仰卧位高血压，同时减少夜间压力利尿并改善白天 OH。
在方案 1 中，我们在 26 例自主神经衰竭和仰卧位高血压患者清醒并仰卧位时，确定增加 CPAP 水平（0、4、8、12 和 16 cmHO，每 3 分钟 1 次）的急性血液动力学效应。在方案 2（n=11）中，我们比较了在 2 晚交叉研究中，CPAP（8-12 cmHO 持续 8 小时）与安慰剂对夜间仰卧位高血压、夜间利尿和白天 OH 的影响。
在方案 1 中，急性 CPAP（4-16 cmHO）呈剂量依赖性降低收缩压（CPAP 16 时最大下降 22±4 mmHg），原因是每搏量减少（-16+3%）和心输出量减少（-14±3%）。全身血管阻力和心率保持不变。在方案 2 中，夜间 CPAP 降低夜间收缩压（最大变化-23±5 与安慰剂-1±7 mmHg；=0.023），并与夜间利尿减少（609±84 与安慰剂 1004±160 mL；=0.004）和改善早晨直立耐受力（AUC 642±121 与安慰剂 410±109 mmHg*min；=0.014）相关。
CPAP 是一种治疗自主神经衰竭仰卧位高血压的新型非药物方法，同时改善夜尿症和白天 OH。
gov；独特标识符：NCT03312556。
