Onrot J, Goldberg M R, Biaggioni I, Hollister A S, Kingaid D, Robertson D
N Engl J Med. 1985 Aug 29;313(9):549-54. doi: 10.1056/NEJM198508293130905.
We examined the effects of caffeine and meals on blood pressure and heart rate in 12 patients with autonomic failure. The influence of caffeine on plasma norepinephrine, epinephrine, and renin activity was also studied. Caffeine 250 mg, raised blood pressure by 12/6 mm Hg, from 129 +/- 25/78 +/- 12 (mean +/- S.D.) to a maximum of 141 +/- 30/84 +/- 16 mm Hg at 45 minutes (P less than 0.01), but did not change heart rate, levels of norepinephrine, or epinephrine, or plasma renin activity. Blood pressure fell by 28/18 mm Hg after a standardized meal, from 133 +/- 32/80 +/- 15 to a minimum of 105 +/- 21/62 +/- 12 mm Hg at 60 minutes (P less than 0.01). After pretreatment with 250 mg of caffeine, the standardized meal induced a fall of only 11/10 mm Hg, from 140 +/- 33/79 +/- 7 to 129 +/- 31/69 +/- 13 mm Hg at 60 minutes (P less than 0.05 vs. values after the control per day for seven days) in five patients, postprandial blood pressures remained higher after caffeine than after placebo (P less than 0.05). We conclude that caffeine is a pressor agent and attenuates postprandial hypotension in autonomic failure, and that this effect is not primarily due to elevations in sympathoadrenal activity or activation of the renin-angiotensin system. Caffeine may be useful in the treatment of orthostatic hypotension due to autonomic failure, especially in the postprandial state.
我们研究了咖啡因和进餐对12例自主神经功能衰竭患者血压和心率的影响。同时还研究了咖啡因对血浆去甲肾上腺素、肾上腺素和肾素活性的影响。250毫克咖啡因使血压升高12/6毫米汞柱，从129±25/78±12（平均值±标准差）升至45分钟时最高的141±30/84±16毫米汞柱（P<0.01），但未改变心率、去甲肾上腺素或肾上腺素水平以及血浆肾素活性。一顿标准化餐后，血压下降28/18毫米汞柱，从133±32/80±15降至60分钟时最低的105±21/62±12毫米汞柱（P<0.01）。在5例患者中，用250毫克咖啡因预处理后，标准化餐仅使血压下降11/10毫米汞柱，从140±33/79±7降至60分钟时的129±31/69±13毫米汞柱（与对照餐后的值相比，P<0.05）。在每天服用咖啡因七天后，五名患者的餐后血压仍高于服用安慰剂后（P<0.05）。我们得出结论，咖啡因是一种升压剂，可减轻自主神经功能衰竭患者的餐后低血压，且这种作用并非主要由于交感肾上腺活动增强或肾素-血管紧张素系统激活所致。咖啡因可能有助于治疗因自主神经功能衰竭引起的体位性低血压，尤其是在餐后状态。
