Impact of Decreased Venous Return on Supine Blood Pressure
Vanderbilt University Medical Center
Summary
Many persons with autonomic failure often have high blood pressure when lying down (supine hypertension). This study is exploring the impact of decreased venous return to the heart (achieved by raising the head of the bed) to lessen supine blood pressure. If decreased venous return to the heart is effective at lowering supine blood pressure, these approaches may be utilized to treat supine hypertension non-pharmacologically. Raising the head of the bed decreases the amount of blood returning to the heart due to the effects of gravity. In this case, the decreased blood return to the heart may decrease blood pressure.
Description
Autonomic failure (AF) is a severely disabling condition, which is characterized by orthostatic hypotension (severe drop in blood pressure upon standing), bladder and bowel dysfunction, and sexual dysfunction. Besides disabling orthostatic hypotension, however, half of these patients have supine hypertension (high blood pressure when lying). Sustained high blood pressure is a cardiac risk for heart disease, kidney disease, and stroke. Sustained supine hypertension during the night induces pressure natriuresis (increased urine production due to high blood pressure) and volume loss (due to frequ…
Eligibility
- Age range
- 18–85 years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * Patients with autonomic failure and with supine hypertension from all races * Males and females, between 18 to 85 years Exclusion Criteria: * All medical students * Pregnant women * High-risk patients (for example: heart failure, symptomatic coronary artery disease, liver impairment, history of stroke or myocardial infarction) * History of serious allergies or asthma.
Interventions
- OtherTilt
Tilt of the whole bed so that the head is elevated by 9 and/or 12 inches in an acute trial or overnight.
- OtherElevated trunk
Elevation of the trunk through raising just the head of the bed until the head is elevated by 9 and/or 12 inches in an acute trial or overnight.
- OtherTilt - In home
Tilt of the whole bed so that the head is elevated by 8 inches overnight.
- OtherElevated Trunk - In home
Elevation of the trunk through raising the head 8 inches on a wedge pillow overnight.
Location
- Vanderbilt University Medical CenterNashville, Tennessee