Contrasting effects of carbohydrate and water on blood pressure responses to postural maneuvers in patients with posturally related (vasovagal) syncope
Tóm tắt
Crouching then standing
induces large changes in arterial
blood pressure. Ingestion of carbohydrate
and water are known to
have contrasting effects on cardiovascular
control in patients with
various forms of autonomic dysfunction.
We tested the hypothesis
that, in patients with attacks of
posturally related (neurogenic or
vasovagal) syncope, postural maneuvers
would cause greater
changes in blood pressure than in
normal controls and that they
would be affected differently by
carbohydrate and water. We studied
7 patients with histories indicating
posturally related syncope and who
we had shown to have abnormal responses
to an orthostatic stress
test, and 7 healthy volunteers with
normal orthostatic responses. Responses
of blood pressure (Portapres® finger photoplethysmography)
were determined to crouching
and subsequent standing, before
and after ingestion of a high carbohydrate
”meal” (2.5MJ) and (on a
different day) water (500 ml). Before
the “meal” or water there were
no differences between groups in
baseline blood pressures or in the
responses to crouching and standing.
In controls, neither carbohydrate
nor water had any significant
effect on baseline blood pressure or
on the responses to the maneuvers.
In the patients, the standing pressures
were also unaffected by carbohydrate
but they did increase after
water. In the patients the
increases in pressure during the
crouch were larger after carbohydrate,
but smaller after water. These
results show that, in patients with
posturally related syncope, unlike
in control subjects, carbohydrate
ingestion and water result in opposite
effects on blood pressure during
postural maneuvers. These results
raise the possibility that these
patients might have a mild form of
autonomic dysfunction.
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