Comparative effects of clonidine and dihydroergotamine on venomotor tone and orthostatic tolerance in patients with severe hypoadrenergic orthostatic hypotension

The American Journal of Medicine
Ronald G Victor, W T Talman

Abstract

Clonidine, an alpha(2)-adrenergic agonist, raises blood pressure in patients with autonomic failure, in whom failure of reflex neurogenic venoconstriction leads to severe orthostatic hypotension. Because animal studies suggest that postjunctional alpha(2)-adrenoreceptors are located mainly on venous capacitance rather than arterial resistance vessels, we tested the hypothesis that venoconstriction is the main mechanism by which clonidine raises blood pressure in patients with autonomic failure. We measured forearm venous and arterial tone using plethysmography in 4 patients with autonomic failure before and after acute administration of clonidine (0.4 mg orally) or dihydroergotamine (0.15 mg intravenously), a known venoconstrictor agent. We also recorded supine intraarterial pressure at rest and during graded orthostatic stress with lower body negative pressure. Clonidine and dihydroergotamine caused similar increases in supine (mean +/- SD) arterial pressure (+23 +/- 11 mm Hg vs. and +27 +/- 5 mm Hg) and forearm vascular resistance (+36% +/- 13% vs. +28% +/- 9%). However, the drugs had different effects on forearm venous tone, which increased by 38% +/- 9% with dihydroergotamine (P = 0.01 vs. control) but was unaffected by clo...Continue Reading

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Citations

Oct 22, 2008·Phytomedicine : International Journal of Phytotherapy and Phytopharmacology·Rainer Schandry, Stefan Duschek
Aug 26, 2006·European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies·H LahrmannM Tassinari
Apr 1, 2004·Veterinary Anaesthesia and Analgesia·Deborah V WilsonDavid R Mullineaux
May 28, 2015·Postgraduate Medicine·Louis KuritzkyEric Dietrich
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Aug 9, 2006·Expert Review of Neurotherapeutics·Atul Pathak, Jean-Michel Senard

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