deamino-arginine-vasopressin and Hypotension--Orthostatic

Topics: Adrenergic beta-Antagonists; Cyclooxygenase Inhibitors; Deamino Arginine Vasopressin; Dihydroergotamine; Fludrocortisone; Humans; Hypotension, Orthostatic; Metoprolol; Mineralocorticoids; Nitroglycerin; Pacemaker, Artificial; Posture; Renal Agents; Sleep; Sympathomimetics; Vasoconstrictor Agents; Vasodilator Agents

Topics: Deamino Arginine Vasopressin; Diet Therapy; Exercise; Fludrocortisone; Hormones; Humans; Hypoglycemic Agents; Hypotension, Orthostatic; Octreotide; Risk Factors; Valsalva Maneuver

The group of primary autonomic failure (AF) syndromes comprises pure AF (PAF), in which there are no central neurological signs, and multiple system atrophy (MSA) in which AF is accompanied by the overlapping degenerative disorders, striatonigral degeneration and olivopontocerebellar atrophy. Patients with these syndromes deteriorate progressively but, based on an understanding of the precise sites of the lesions, there are several ways of alleviating their deterioration, in particular the most disabling symptom, postural hypotension. The principles can be used in the treatment of AF in other general medical disorders, such as diabetes.

Topics: Autonomic Nervous System; Autonomic Nervous System Diseases; Combined Modality Therapy; Deamino Arginine Vasopressin; Fludrocortisone; Humans; Hypotension, Orthostatic; Pacemaker, Artificial; Posture

Day and night urine volume, morning and evening body weight, and supine and sitting blood pressure were measured in five patients with chronic autonomic failure who were not receiving treatment with drugs. All had nocturnal polyuria, overnight weight loss, and a pronounced postural fall in blood pressure, with lowest levels in the morning. Desmopressin (2-4 micrograms given intramuscularly at 8 pm) reduced nocturnal polyuria, diminished overnight weight loss, raised supine blood pressure, and reduced the postural fall, especially in the morning, when patients were often at their worst. Desmopressin may be a useful alternative to, or may supplement, other forms of treatment in some patients with autonomic failure.

Topics: Aged; Autonomic Nervous System Diseases; Body Weight; Deamino Arginine Vasopressin; Female; Humans; Hypotension, Orthostatic; Male; Middle Aged; Polyuria; Potassium; Sodium

Central diabetes insipidus (DI) is a rare disease characterized by the excretion of excessive volumes of dilute urine due to reduced levels of the antidiuretic hormone arginine vasopressin (AVP), caused by an acquired or genetic defect in the neurohypophysis. The aim of this study was to identify any autonomic dysfunction (AD) in patients with DI as a possible cofactor responsible for their reportedly higher mortality.. The study involved 12 patients (6 females) with central idiopathic DI and a well-controlled electrolyte balance, and 12 controls matched for age, sex and cardiovascular risk factors, who were assessed using the tilt, lying-to-standing, hand grip, deep breath, Valsalva maneuver and Stroop tests.. The tilt test showed a significantly more pronounced decrease in both systolic (- 20.67 ± 18 vs. - 1.92 ± 6.99 mmHg, p = 0.0009) and diastolic blood pressure (- 10.5 ± 14.29 vs. - 1.5 ± 5 mmHg, p = 0.012) in patients than in controls. Three patients with DI had to suspend the test due to the onset of syncope. The lying-to-standing test also revealed a marked reduction in blood pressure in patients with DI (1.05 ± 0.13 vs. 1.53 ± 0.14, p = 0.0001). Similar results emerged for the Valsalva maneuver (Valsalva ratio, 1.24 ± 0.19 vs. 1.79 ± 0.11, p < 0.0001) and deep breath test (1.08 ± 0.11 vs. 1.33 ± 0.08, p < 0.0001).. All the principal autonomic tests performed in the study were concordant in indicating that patients with central DI have an impaired autonomic nervous system function despite a normal hydroelectrolytic balance under desmopressin therapy. This impairment may reflect damage to the autonomic system per se and/or the absence of any vasoactive effect of AVP on vascular smooth muscle. In our opinion, patients with central DI should be educated on how to prevent orthostatic hypotension, and pharmacological treatment should be considered for patients with a more marked impairment.

Topics: Adult; Antidiuretic Agents; Autonomic Nervous System; Cardiovascular System; Case-Control Studies; Cross-Sectional Studies; Deamino Arginine Vasopressin; Death, Sudden, Cardiac; Diabetes Insipidus, Neurogenic; Female; Hemodynamics; Humans; Hypotension, Orthostatic; Male; Middle Aged; Stroop Test; Tilt-Table Test; Valsalva Maneuver

Topics: Cerebrovascular Circulation; Clonidine; Deamino Arginine Vasopressin; Dihydroergotamine; Dopamine; Epinephrine; Humans; Hypotension, Orthostatic; Metoclopramide; Octreotide; Patient Education as Topic; Pindolol; Yohimbine

Shuttle astronauts currently drink approximately a quart of water with eight salt tablets before reentry to restore lost body fluid and thereby reduce the likelihood of cardiovascular instability and syncope during reentry and after landing. However, the saline loading countermeasure is not entirely effective in restoring orthostatic tolerance to preflight levels. We tested the hypothesis that the effectiveness of this countermeasure could be improved with the use of a vasopressin analog, 1-deamino-8-D-arginine vasopressin (dDAVP). The rationale for this approach is that reducing urine formation with exogenous vasopressin should increase the magnitude and duration of the vascular volume expansion produced by the saline load, and in so doing improve orthostatic tolerance during reentry and postflight.

Topics: Adult; Bed Rest; Deamino Arginine Vasopressin; Fluid Therapy; Head-Down Tilt; Humans; Hypotension, Orthostatic; Lower Body Negative Pressure; Plasma Volume; Renal Agents; Sodium Chloride; Urine; Weightlessness Countermeasures