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Orthostatic responses to nitric oxide synthase inhibition in persons with tetraplegia.

AbstractOBJECTIVES:
To determine the effects of 1.0 mg/kg nitro-L-arginine methyl ester (L-NAME) on orthostatic mean arterial pressure (MAP), serum aldosterone, and plasma renin concentrations in persons with chronic tetraplegia compared with nonspinal cord-injured controls.
DESIGN:
Prospective placebo-controlled intervention study.
SETTING:
James J. Peters Veterans Affairs Medical Center.
PARTICIPANTS:
Patients (n=5) with tetraplegia and controls (n=7) participated. The groups were matched for age, height, and weight; the average duration of injury in the tetraplegia group was 22+/-14 years.
INTERVENTION:
Subjects with tetraplegia visited the laboratory twice, receiving placebo on day 1 and L-NAME (1.0 mg/kg) on day 2. The agents were infused via an intravenous catheter over 60 minutes with the patient in the supine position. Data were collected during the infusion and then during head-up tilt to 45 degrees for 30 minutes. Control subjects visited the laboratory once for placebo infusion and the head-up tilt maneuver.
MAIN OUTCOME MEASURE:
Orthostatic MAP.
RESULTS:
Orthostatic MAP was reduced after placebo infusion in subjects with tetraplegia compared with controls (69+/-11 vs 89+/-9 mmHg, respectively; P<.01) and compared with L-NAME infusion (90+/-16 mmHg; P<.01). Orthostatic MAP did not differ when comparing the tetraplegia group with controls after L-NAME infusion. Orthostatic aldosterone levels were increased after placebo compared with L-NAME infusion in persons with tetraplegia; plasma renin levels did not differ among the groups.
CONCLUSIONS:
These data suggest that nitric oxide synthase inhibition may have clinical potential for treatment of orthostatic hypotension in persons with chronic tetraplegia.
AuthorsJill M Wecht, Miroslav Radulovic, Michael F Lafountaine, Dwindally Rosado-Rivera, Run-Lin Zhang, William A Bauman
JournalArchives of physical medicine and rehabilitation (Arch Phys Med Rehabil) Vol. 90 Issue 8 Pg. 1428-34 (Aug 2009) ISSN: 1532-821X [Electronic] United States
PMID19651280 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)
Chemical References
  • Placebos
  • Nitric Oxide Synthase
  • NG-Nitroarginine Methyl Ester
Topics
  • Adult
  • Analysis of Variance
  • Blood Pressure (drug effects)
  • Case-Control Studies
  • Female
  • Heart Rate (drug effects)
  • Humans
  • Hypotension, Orthostatic (drug therapy)
  • Male
  • Middle Aged
  • NG-Nitroarginine Methyl Ester (pharmacology)
  • Nitric Oxide Synthase (antagonists & inhibitors)
  • Placebos
  • Prospective Studies
  • Quadriplegia (enzymology)
  • Spinal Cord Injuries (drug therapy)
  • Tilt-Table Test

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