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Therapy of Idiopathic Postural Hypotension

Therapy of Idiopathic Postural Hypotension Abstract The clinical response to a monamine oxidase inhibitor and a sympathomimetic amine or tyramine containing foodstuffs have been studied in four patients with idiopathic postural hypotension. Each was receiving fludrocortisone acetate therapy. One patient has had substantial clinical improvement for over 26 months on the combination and another improved symptomatically for nine months before further neurologic deterioration. One patient with additional chronic polymyositis had little change in symptoms. Another with milder manifestations of the syndrome had intolerable headaches with the therapy. Maintenance of blood volume was a necessary though not sufficient condition for symptomatic improvement with the regimen. References 1. Bradbury S, Eggleston C: Postural hypotension: A report of three cases. Amer Heart J 1:73-86,1925.Crossref 2. Stead EA Jr, Ebert RV: Postural hypotension: A disease of the sympathetic nervous system. Arch Intern Med 67:546-562, 1941.Crossref 3. Johnson RH, Lee G deJ, Oppenheimer DR, et al: Autonomic failure with orthostatic hypotension due to intermediolateral column degeneration. Quart J Med 35:276-292, 1966. 4. Bannister R, Ardill L, Fentem P: Defective autonomic control of blood vessels in idiopathic orthostatic hypotension. Brain 90:725-746, 1967.Crossref 5. Seller RH: Idiopathic orthostatic hypotension: Report of successful treatment with a new form of therapy. Amer J Cardiol 23:838-844, 1969.Crossref 6. Diamond MA, Murray RH, Schmid PG: Idiopathic postural hypotension physiologic observations and report of a new mode of therapy. J Clin Invest 49:1341-1348, 1970.Crossref 7. Blackwell B: Hypertensive crisis due to monoamine-oxidase inhibitors. Lancet 2:849-851, 1963.Crossref 8. Atkinson RM, Ditman KS: Tranylcypromine: A review. Clin Pharmacol Ther 6:631-655, 1965. 9. Horwitz D, Lovenberg W, Engelman K, et al: Monamine oxidase inhibitors, tyramine and cheese. JAMA 188:1108-1110, 1964.Crossref 10. Burns RJ, Downey JA, Frewin DB, et al: Autonomic dysfunction with orthostatic hypotension. Aust New Zeal J Med 1:15-21, 1971.Crossref 11. Rowland LP, Lovelace RE, Schotland DL, et al: The clinical diagnosis of McArdle's disease. Neurology 16:93-100, 1966.Crossref 12. MacLean K, Schurr PH: Reversible amyotrophy complicating treatment with fludrocortisone. Lancet 1:701-703, 1959.Crossref 13. Shy GM, Drager GA: A neurological syndrome associated with orthostatic hypotension. Arch Neurol 2:511-527, 1960.Crossref 14. Levin JM, Ravenna P, Weiss M: Idiopathic orthostatic hypotension: Treatment with a commercially available counterpressure suit. Arch Intern Med 114:145-148, 1964.Crossref 15. Hickler RB, Thompson GR, Fox LM, et al: Successful treatment of orthostatic hypotension with 9-alpha-fluorohydrocortisone. New Eng J Med 261:788-791, 1959.Crossref 16. Bannister R, Ardill L, Fentem P: An assessment of various methods of treatment of idiopathic orthostatic hypotension. Quart J Med 38:377-395, 1969. 17. Crost EA, Friedlander H: Orthostatic hypotension: Report of a case refractory to vasoconstrictor drugs: With observations on use of desoxycorticosterone, l-norepinephrine, ACTH and vasodepressor potentiating substances. Ann Intern Med 36:1343-1350, 1952.Crossref 18. Barnett AJ, Wagner GR: Severe orthostatic hypotension: Case report and description of response to sympatheticomimetic drugs. Amer Heart J 56: 412-424, 1958.Crossref 19. Owen C, Dodson WH, Hammack WJ: Medical grand rounds. Southern Med J 60:289-296, 1967.Crossref 20. Luft R, von Euler US: Two cases of postural hypotension showing a deficiency in release of norepinephrine and epinephrine. J Clin Invest 32:1065-1069, 1953.Crossref 21. Goodall M, Harlan WR Jr, Alton H: Noradrenaline release and metabolism in orthostatic (postural) hypotension. Circulation 36:489-496, 1967.Crossref 22. Thomas JE, Schirger A: Idiopathic orthostatic hypotension: A study of its natural history in 57 neurologically affected patients. Arch Neurol 22:289-293, 1970.Crossref 23. Blackwell B, Mabbitt LA: Tyramine in cheese related to hypertensive crises after monoamine-oxidase inhibition. Lancet 1:938-940, 1965.Crossref 24. Kaltreider NL, Meneely GR, Allen JR: The effect of epinephrine on the volume of the blood. J Clin Invest 21:339-345, 1942.Crossref 25. Finnerty FA Jr, Buccholz JH, Guillaudeu RL: The blood volumes and plasma protein during levarterenol induced hypertension. J Clin Invest 37:425-429, 1958.Crossref 26. Weil JV, Chidsey CA: Plasma volume expansion resulting from interference with adrenergic function in normal man. Circulation 37:54-61, 1968.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1972 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1972.00320060091011
Publisher site
See Article on Publisher Site

Abstract

Abstract The clinical response to a monamine oxidase inhibitor and a sympathomimetic amine or tyramine containing foodstuffs have been studied in four patients with idiopathic postural hypotension. Each was receiving fludrocortisone acetate therapy. One patient has had substantial clinical improvement for over 26 months on the combination and another improved symptomatically for nine months before further neurologic deterioration. One patient with additional chronic polymyositis had little change in symptoms. Another with milder manifestations of the syndrome had intolerable headaches with the therapy. Maintenance of blood volume was a necessary though not sufficient condition for symptomatic improvement with the regimen. References 1. Bradbury S, Eggleston C: Postural hypotension: A report of three cases. Amer Heart J 1:73-86,1925.Crossref 2. Stead EA Jr, Ebert RV: Postural hypotension: A disease of the sympathetic nervous system. Arch Intern Med 67:546-562, 1941.Crossref 3. Johnson RH, Lee G deJ, Oppenheimer DR, et al: Autonomic failure with orthostatic hypotension due to intermediolateral column degeneration. Quart J Med 35:276-292, 1966. 4. Bannister R, Ardill L, Fentem P: Defective autonomic control of blood vessels in idiopathic orthostatic hypotension. Brain 90:725-746, 1967.Crossref 5. Seller RH: Idiopathic orthostatic hypotension: Report of successful treatment with a new form of therapy. Amer J Cardiol 23:838-844, 1969.Crossref 6. Diamond MA, Murray RH, Schmid PG: Idiopathic postural hypotension physiologic observations and report of a new mode of therapy. J Clin Invest 49:1341-1348, 1970.Crossref 7. Blackwell B: Hypertensive crisis due to monoamine-oxidase inhibitors. Lancet 2:849-851, 1963.Crossref 8. Atkinson RM, Ditman KS: Tranylcypromine: A review. Clin Pharmacol Ther 6:631-655, 1965. 9. Horwitz D, Lovenberg W, Engelman K, et al: Monamine oxidase inhibitors, tyramine and cheese. JAMA 188:1108-1110, 1964.Crossref 10. Burns RJ, Downey JA, Frewin DB, et al: Autonomic dysfunction with orthostatic hypotension. Aust New Zeal J Med 1:15-21, 1971.Crossref 11. Rowland LP, Lovelace RE, Schotland DL, et al: The clinical diagnosis of McArdle's disease. Neurology 16:93-100, 1966.Crossref 12. MacLean K, Schurr PH: Reversible amyotrophy complicating treatment with fludrocortisone. Lancet 1:701-703, 1959.Crossref 13. Shy GM, Drager GA: A neurological syndrome associated with orthostatic hypotension. Arch Neurol 2:511-527, 1960.Crossref 14. Levin JM, Ravenna P, Weiss M: Idiopathic orthostatic hypotension: Treatment with a commercially available counterpressure suit. Arch Intern Med 114:145-148, 1964.Crossref 15. Hickler RB, Thompson GR, Fox LM, et al: Successful treatment of orthostatic hypotension with 9-alpha-fluorohydrocortisone. New Eng J Med 261:788-791, 1959.Crossref 16. Bannister R, Ardill L, Fentem P: An assessment of various methods of treatment of idiopathic orthostatic hypotension. Quart J Med 38:377-395, 1969. 17. Crost EA, Friedlander H: Orthostatic hypotension: Report of a case refractory to vasoconstrictor drugs: With observations on use of desoxycorticosterone, l-norepinephrine, ACTH and vasodepressor potentiating substances. Ann Intern Med 36:1343-1350, 1952.Crossref 18. Barnett AJ, Wagner GR: Severe orthostatic hypotension: Case report and description of response to sympatheticomimetic drugs. Amer Heart J 56: 412-424, 1958.Crossref 19. Owen C, Dodson WH, Hammack WJ: Medical grand rounds. Southern Med J 60:289-296, 1967.Crossref 20. Luft R, von Euler US: Two cases of postural hypotension showing a deficiency in release of norepinephrine and epinephrine. J Clin Invest 32:1065-1069, 1953.Crossref 21. Goodall M, Harlan WR Jr, Alton H: Noradrenaline release and metabolism in orthostatic (postural) hypotension. Circulation 36:489-496, 1967.Crossref 22. Thomas JE, Schirger A: Idiopathic orthostatic hypotension: A study of its natural history in 57 neurologically affected patients. Arch Neurol 22:289-293, 1970.Crossref 23. Blackwell B, Mabbitt LA: Tyramine in cheese related to hypertensive crises after monoamine-oxidase inhibition. Lancet 1:938-940, 1965.Crossref 24. Kaltreider NL, Meneely GR, Allen JR: The effect of epinephrine on the volume of the blood. J Clin Invest 21:339-345, 1942.Crossref 25. Finnerty FA Jr, Buccholz JH, Guillaudeu RL: The blood volumes and plasma protein during levarterenol induced hypertension. J Clin Invest 37:425-429, 1958.Crossref 26. Weil JV, Chidsey CA: Plasma volume expansion resulting from interference with adrenergic function in normal man. Circulation 37:54-61, 1968.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jun 1, 1972

References