Autonomic neuroscience : basic & clinical · 2026
Elevating blood pressure in neurogenic orthostatic hypotension: Investigating the efficacy and tolerability of rebreathing therapy.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
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Baker Jacquie R, Ranada Shaun I, Incognito Anthony V, Sheldon Robert S, Morillo Carlos A, Wilson Richard J A, Phillips Aaron A, Raj Satish R
Аннотация
PURPOSE: Neurogenic orthostatic hypotension (nOH) causes profound drops in blood pressure (≥20/10 mmHg). We previously showed that carbon dioxide (CO2) inhalation powerfully elevates standing blood pressure in patients. Rebreathe devices elevate CO2 and lower O2 and may offer a simple, cost-effective way to raise standing blood pressure. We tested the acute efficacy of high CO2 + low O2 (i.e., simulated rebreathing) to raise standing blood pressure. Additionally, we compared simulated rebreathing to high CO2 (+CO2) alone.
METHODS: In this exploratory sub-study, ten patients with nOH (F = 3; 69 ± 9 years) performed two sit-to-stand tests while breathing either room air or simulated rebreathing. Continuous blood pressure, heart rate, respiration, stroke volume, cardiac output, and systemic vascular resistance were recorded. Hemodynamics were averaged over the final minute of stand for each condition. Tolerability was defined as completing the full 5-minute stand without aborting due to breathing discomfort.
RESULTS: Compared to room air, simulated rebreathing increased standing systolic blood pressure (p = 0.02), stroke volume (p = 0.03), cardiac output (p = 0.02), and reduced hypotensive time (p = 0.02). Hemodynamic responses and hypotensive time during simulated rebreathing did not differ from +CO₂ alone (all p > 0.1). Tolerability was lower with only 2/10 patients completing the simulated rebreathing protocol, primarily due to shortness of breath, whereas 9/10 completed +CO₂ alone (p = 0.014).
CONCLUSIONS: Simulated rebreathing improves standing blood pressure in nOH but is poorly tolerated. High CO₂ alone appears equally effective and better tolerated. CO₂ delivery systems that elevate CO₂ while maintaining oxygen may offer a more feasible therapeutic strategy.
CLINICAL TRIAL NO: NCT05295810 https://clinicaltrials.gov/study/NCT05295810.
METHODS: In this exploratory sub-study, ten patients with nOH (F = 3; 69 ± 9 years) performed two sit-to-stand tests while breathing either room air or simulated rebreathing. Continuous blood pressure, heart rate, respiration, stroke volume, cardiac output, and systemic vascular resistance were recorded. Hemodynamics were averaged over the final minute of stand for each condition. Tolerability was defined as completing the full 5-minute stand without aborting due to breathing discomfort.
RESULTS: Compared to room air, simulated rebreathing increased standing systolic blood pressure (p = 0.02), stroke volume (p = 0.03), cardiac output (p = 0.02), and reduced hypotensive time (p = 0.02). Hemodynamic responses and hypotensive time during simulated rebreathing did not differ from +CO₂ alone (all p > 0.1). Tolerability was lower with only 2/10 patients completing the simulated rebreathing protocol, primarily due to shortness of breath, whereas 9/10 completed +CO₂ alone (p = 0.014).
CONCLUSIONS: Simulated rebreathing improves standing blood pressure in nOH but is poorly tolerated. High CO₂ alone appears equally effective and better tolerated. CO₂ delivery systems that elevate CO₂ while maintaining oxygen may offer a more feasible therapeutic strategy.
CLINICAL TRIAL NO: NCT05295810 https://clinicaltrials.gov/study/NCT05295810.