Effect of perturbations and a meal on superior mesenteric artery flow in patients with orthostatic hypotension

Jiro Fujimura, Michael Camilleri, Phillip Anson Low, Vera Novak, Peter Novak, Tonette L. Opfer-Gehrking

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Our aims were to evaluate to role of superior mesenteric blood flow in the pathophysiology of orthostatic hypotension in patients with generalized autonomic failure, Methods: Twelve patients with symptomatic neurogenic orthostatic hypotension and 12 healthy controls underwent superior mesenteric artery flow measurements using Doppler ultrasonography during head-up tilt and tilt plus meal ingestion. Autonomic failure was assessed using standard tests of the function of the sympathetic adrenergic, cardiovagal and postganglionic sympathetic sudomotor function. Results: Superior mesenteric flow volume and time-averaged velocity were similar in patients and controls at supine rest; however, responses to cold pressor test and upright tilt were attenuated (p < 0.05) in patients compared to controls. Head-up tilt after the meal evoked a profound fall of blood pressure and mesenteric blood flow in the patients; the reduction of mesenteric blood flow correlated (r = 0.89) with the fall of blood pressure in these patients, providing another manifestation of failed baroreflexes. We make the novel finding that the severity of postprandial orthostatic hypotension regressed negatively with the postprandial increase in mesenteric flow in patients with orthostatic hypotension. Conclusion: Mesenteric flow is under baroreflex control, which when defective, results in, or worsens orthostatic hypotension. Its large size and baroreflexivity renders it quantitatively important in the maintenance of postural normotension. The effects of orthostatic stress can be significantly attenuated by reducing the splanchnic-mesenteric volume increase in response to food. Evaluation of mesenteric flow in response to eating and head-up tilt provide important information on intra-abdominal sympathetic adrenergic function, and the ability of the patient to cope with orthostatic stress.

Original languageEnglish (US)
Pages (from-to)15-23
Number of pages9
JournalJournal of the Autonomic Nervous System
Volume67
Issue number1-2
DOIs
StatePublished - Dec 3 1997

Fingerprint

Orthostatic Hypotension
Superior Mesenteric Artery
Meals
Baroreflex
Head
Adrenergic Agents
Eating
Blood Pressure
Doppler Ultrasonography
Viscera
Maintenance
Food

Keywords

  • Adrenergic
  • Autonomic
  • Doppler
  • Mesenteric flow
  • Sympathetic
  • Ultrasound

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Neuroscience(all)

Cite this

Effect of perturbations and a meal on superior mesenteric artery flow in patients with orthostatic hypotension. / Fujimura, Jiro; Camilleri, Michael; Low, Phillip Anson; Novak, Vera; Novak, Peter; Opfer-Gehrking, Tonette L.

In: Journal of the Autonomic Nervous System, Vol. 67, No. 1-2, 03.12.1997, p. 15-23.

Research output: Contribution to journalArticle

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