• Autonomic activity
• Baroreflex function
• Exercise
• Orthostatic hypotension
• Water intake

• Humans
• Female
• Male
• Cross-Over Studies
• Hemodynamics/physiology
• Drinking/physiology
• Young Adult
• Hypotension, Orthostatic/physiopathology
• Hypotension, Orthostatic/prevention & control
• Adult
• Baroreflex/physiology
• Blood Pressure/physiology
• Heart Rate/physiology
• Exercise/physiology
• Post-Exercise Hypotension/physiopathology
• Post-Exercise Hypotension/prevention & control

• Blood pressure
• Exercise
• Fluid
• Hydration
• Hypotension

• 2023-04492 NSERC

• NHANES
• metabolic dysfunction-associated steatotic liver disease
• mortality
• non-alcoholic fatty liver disease
• plain water

• Optical coherence tomography angiography
• Primary open-angle glaucoma
• Vessel density
• Water drinking test

• Humans
• Tomography, Optical Coherence/methods
• Male
• Female
• Prospective Studies
• Optic Disk/blood supply
• Optic Disk/diagnostic imaging
• Intraocular Pressure/physiology
• Middle Aged
• Retinal Vessels/diagnostic imaging
• Retinal Vessels/pathology
• Macula Lutea/blood supply
• Macula Lutea/diagnostic imaging
• Glaucoma, Open-Angle/physiopathology
• Glaucoma, Open-Angle/diagnosis
• Fluorescein Angiography/methods
• Adult
• Drinking/physiology
• Fundus Oculi
• Aged
• Retinal Ganglion Cells/pathology

• ADH
• Aquaporin 2
• arginin-vasopressin
• blood pressure
• hyaluronidase
• hypertension
• water load
• water metabolism

• Humans
• Male
• Hyaluronoglucosaminidase/urine
• Hyaluronoglucosaminidase/metabolism
• Hypertension/metabolism
• Hypertension/urine
• Blood Pressure
• Middle Aged
• Adult
• Aquaporin 2/urine
• Aquaporin 2/metabolism
• Arginine Vasopressin/metabolism
• Vasopressins/metabolism
• Glycopeptides

• diagnosis
• biomarkers

• Humans
• Intraocular Pressure/physiology
• Male
• Female
• Tonometry, Ocular
• Glaucoma, Open-Angle/physiopathology
• Prospective Studies
• Middle Aged
• Aged
• Circadian Rhythm/physiology
• Drinking/physiology
• Tomography, Optical Coherence/methods
• Blood Pressure/physiology
• Heart Rate/physiology

• Brain
• DRG neurons
• Energy balance
• Energy intake
• Glucose sensing
• Liver
• Liver disease
• Mental illness
• Osmosensing
• Spinal cord
• Vagus nerve

• Humans
• Interoception/physiology
• Animals
• Liver Diseases/physiopathology
• Liver Diseases/metabolism
• Liver/metabolism
• Brain/metabolism
• Brain/physiology

• R01 DK092587 NIDDK NIH HHS
• R01 DK105032 NIDDK NIH HHS
• R01 DK047348 NIDDK NIH HHS
• OT2 OD023864 NIH HHS
• R01 AT011683 NCCIH NIH HHS

• Parkinson’s disease
• autonomic failure
• autonomic nervous system
• hypotension
• orthostatic hypotension

• Hypotension, Orthostatic/therapy
• Hypotension, Orthostatic/etiology
• Hypotension, Orthostatic/physiopathology
• Humans
• Parkinson Disease/complications
• Parkinson Disease/therapy

• U01 NS113851 NINDS NIH HHS
• K23 NS123506 NINDS NIH HHS
• UL1 TR001422 NCATS NIH HHS

• Cardiovascular disease
• Chronic kidney disease
• Insulin resistance
• Organ protection
• Renal denervation

• Animals
• Humans
• Sympathectomy/methods
• Kidney
• Hypertension/surgery
• Sympathetic Nervous System/surgery
• Blood Pressure/physiology
• Denervation

• autonomic dysfunction
• orthostatic hypotension
• osmopressor response

• Humans
• Hypotension, Orthostatic
• Postural Orthostatic Tachycardia Syndrome
• Prospective Studies
• Hemodynamics
• Blood Pressure/physiology
• Water

• autonomic nervous system
• cardiovascular physiology
• dehydration
• electrolyte balance
• heart rate control
• water intake

• Humans
• Adolescent
• Blood Pressure
• Heart Rate
• Exercise/physiology
• Water/pharmacology
• Eating
• Randomized Controlled Trials as Topic

• concussion
• diagnosis
• heart rate correction
• heart rate variability
• management
• normative values
• sports-related concussion
• treatment biomarkers.

• Carbon dioxide
• Cardiovascular responses
• Perceptions
• TRP channels
• Thermoregulation

Bolus water drinking, at room temperature, has been shown to improve orthostatic tolerance (OT), probably via sympathetic activation; however, it is not clear whether the temperature of the water bolus modifies the effect on OT or the cardiovascular responses to orthostatic stress. The aim of this study was to assess whether differing water temperature of the water bolus would alter time to presyncope and/or cardiovascular parameters during incremental orthostatic stress.

Fourteen participants underwent three head-up tilt (HUT) tests with graded lower body negative pressure (LBNP) continued until presyncope. Fifteen minutes prior to each HUT, participants drank a 500 mL bolus of water which was randomised, in single-blind crossover fashion, to either room temperature water (20 °C) (ROOM), ice-cold water (0–3 °C) (COLD) or warm water (45 °C) (WARM). Cardiovascular parameters were monitored continuously.

There was no significant difference in OT in the COLD (33 ± 3 min; p = 0.3321) and WARM (32 ± 3 min; p = 0.6764) conditions in comparison to the ROOM condition (31 ± 3 min). During the HUT tests, heart rate and cardiac output were significantly reduced (p < 0.0073), with significantly increased systolic blood pressure, stroke volume, cerebral blood flow velocity and total peripheral resistance (p < 0.0054), in the COLD compared to ROOM conditions.

In healthy controls, bolus cold water drinking results in favourable orthostatic cardiovascular responses during HUT/LBNP without significantly altering OT. Using a cold water bolus may result in additional benefits in patients with orthostatic intolerance above those conferred by bolus water at room temperature (by ameliorating orthostatic tachycardia and enhancing vascular resistance responses). Further research in patients with orthostatic intolerance is warranted.

To identify specific behavioural change techniques to promote uptake and adherence with non-pharmacologic interventions for older adults with OH.

Specific behaviour change strategies, derived from older people with orthostatic hypotension, include biofeedback, rehearsal, embedding into daily routine and patient education.

Evidence-based behaviour change strategies may be used to improve uptake and adherence to non-drug therapies for older people with orthostatic hypotension.

Non-pharmacologic therapies are a safe and effective treatment for orthostatic hypotension (OH) in older adults. However, adherence to non-drug therapies is challenging and may require specific behaviour change approaches to promote uptake and adherence. The study aim is to identify specific behavioural change techniques to promote uptake and adherence with non-pharmacologic interventions for older adults with OH.

Forty semi-structured, qualitative interviews were performed in 25 older adults with OH. Each participant experienced bolus-water drinking, physical counter-manoeuvres and compression garments during two efficacy studies. Emergent themes were identified through framework analysis, based on The Behaviour Change Technique Taxonomy.

Several themes to encourage uptake and adherence arose. Motivation to adhere with an intervention may be improved by demonstrating its effectiveness, either through symptom monitoring or biofeedback. Practising or rehearsing how to use an intervention may improve self-efficacy and promote habit formation. Embedding therapies into daily life so that they become second nature was felt to be a useful strategy. Educating older adults about why they are being asked to use a therapy and demonstrating how to use it is important. More specific barriers may be overcome by encouraging a personal problem-solving approach.

These specific behaviour change techniques, derived by older people with OH and based on evidence-based approaches, provide useful strategies to improve the uptake and adherence of non-drug therapies in the treatment of OH.

ISRCTN15084870.

• Behaviour and behaviour mechanisms
• Conservative treatment
• Orthostatic hypotension
• Postural hypotension
• Treatment adherence and compliance

• cardiovascular diseases
• heart failure
• hypertension
• orthostatic hypotension
• patient care

• Cardiovascular Diseases/complications
• Cognitive Dysfunction/complications
• Humans
• Hypertension/complications
• Hypotension, Orthostatic/diagnosis
• Hypotension, Orthostatic/etiology
• Hypotension, Orthostatic/therapy
• Syncope

• K08 AG058483 NIA NIH HHS

Purpose: Water drinking has been proposed for the treatment of orthostatic hypotension because it can increase blood pressure in patients. This study aimed to investigate whether drinking water with a cold or carbonation stimulus would cause a more effective pressor response, and whether it would be greater in older than in younger adults.

Methods: We assessed blood pressure and heart rate from non-invasive arterial pressure (a volume-clamp method) and type II electrocardiography in 13 healthy young adults (6 females, 7 males; mean age, 19.9 ± 1.1 years) and nine healthy older adults (all females; mean age, 71.4 ± 4.2 years) who drank 200 mL of cold, cold carbonated, and room temperature water.

Results: The pressor response to the drinking of cold and cold carbonated water was greater than that to room temperature water in both younger and older participants (p < 0.05; changes in systolic blood pressure of room temperature water, cold water and cold carbonated water in young: 15.31 ± 9.66, 22.56 ± 11.51 and 32.6 ± 17.98 mmHg, respectively; changes in systolic blood pressure of room temperature water, cold water and cold carbonated water in elderly: 21.84 ± 14.31, 41.53 ± 19.82 and 48.16 ± 16.77 mmHg, respectively). In addition, the pressor response to cold and cold carbonated water was persistent during the recovery period by about 5–10 mmHg (p < 0.05). Furthermore, the pressor response during the drinking and recovery periods was greater in the older than in the younger participants (p < 0.05).

Conclusion: Our data suggest that even smaller amounts of water are able to elicit a sustained pressor response, in particular if the water is cold and carbonated. We speculate that the pressor effect may render cold and carbonated water an appropriate first aid method against certain forms of acute hypotension.

• age
• cold carbonated water
• cold water
• drink
• pressor response

• Fludrocortisone
• Hospitalized Patient
• Midodrine
• Orthostatic Hypotension
• Supine Hypertension

• Aging
• Diagnosis
• Elderly
• Prognosis
• Syncope
• Treatment

Cardiovascular autonomic dysfunctions (CAD) are prevalent in Parkinson’s disease (PD). It contributes to the development of cognitive dysfunction, falls and even mortality. Significant progress has been achieved in the last decade. However, the underlying mechanisms and effective treatments for CAD have not been established yet. This review aims to help clinicians to better understand the pathogenesis and therapeutic strategies. The literatures about CAD in patients with PD were reviewed. References for this review were identified by searches of PubMed between 1972 and March 2021, with the search term “cardiovascular autonomic dysfunctions, postural hypotension, orthostatic hypotension (OH), supine hypertension (SH), postprandial hypotension, and nondipping”. The pathogenesis, including the neurogenic and non-neurogenic mechanisms, and the current pharmaceutical and non-pharmaceutical treatment for CAD, were analyzed. CAD mainly includes four aspects, which are OH, SH, postprandial hypotension and nondipping, among them, OH is the main component. Both non-neurogenic and neurogenic mechanisms are involved in CAD. Failure of the baroreflex circulate, which includes the lesions at the afferent, efferent or central components, is an important pathogenesis of CAD. Both non-pharmacological and pharmacological treatment alleviate CAD-related symptoms by acting on the baroreflex reflex circulate. However, pharmacological strategy has the limitation of failing to enhance baroreflex sensitivity and life quality. Novel OH treatment drugs, such as pyridostigmine and atomoxetine, can effectively improve OH-related symptoms via enhancing residual sympathetic tone, without adverse reactions of supine hypertension. Baroreflex impairment is a crucial pathological mechanism associated with CAD in PD. Currently, non-pharmacological strategy was the preferred option for its advantage of enhancing baroreflex sensitivity. Pharmacological treatment is a second-line option. Therefore, to find drugs that can enhance baroreflex sensitivity, especially via acting on its central components, is urgently needed in the scientific research and clinical practice.

• Parkinson’s disease
• cardiovascular autonomic dysfunction
• orthostatic hypotension
• postprandial hypotension
• supine hypertension

Although fingerstick is often favorably compared to venipuncture as a less invasive method of drawing blood for clinical labs, there is little empirical research that compares physical and psychological stress responses to fingerstick vs. venipuncture (blood draw using a needle in the arm) within the same person.

We assessed changes in cortisol (a stress hormone), heart rate variability (a marker of autonomic stress), and psychological stress in 40 healthy women who completed both venipuncture and fingerstick. Contrary to our predictions, there was a significant decline in cortisol across conditions, with greater decline from pre- to post-draw in response to venipuncture than fingerstick. There were similar patterns of rise and fall in heart rate variability in both types of blood draw, suggestive of mild vasovagal responses. Psychological measures of stress (such as negative emotion and perceived stress) were generally stronger predictors of participant’s reported pain and blood draw preferences than physical stress measures.

These findings challenge the characterization of fingerstick as necessarily “less invasive” than venipuncture, as participant’s stress responses to fingerstick were equivalent to (and for some measures greater than) their response to venipuncture. Heart rate variability response to fingerstick significantly predicted that individual’s vasovagal-like responses to venipuncture, suggesting that measuring heart rate variability during pre-donation hemoglobin testing may identify donors at risk for adverse events during venipuncture.

• Autonomic Nervous System/physiopathology
• Biomarkers/metabolism
• Blood Specimen Collection/psychology
• Endocrine System/physiopathology
• Heart Rate/physiology
• Humans
• Hydrocortisone/metabolism
• Nonlinear Dynamics
• Pain/psychology
• Phlebotomy
• Probability
• Saliva/metabolism
• Self Report
• Stress, Physiological
• Stress, Psychological/etiology
• Young Adult

• University of Nebraska-Lincoln
• Nebraska Tobacco Settlement Biomedical Research Development Fund

• autonomic dysfunction
• dyspnea
• postural orthostatic tachycardia syndrome
• preload failure
• preload insufficiency

• adverse event
• barrier
• critical illness
• early mobilization
• mechanical ventilation
• post-intensive care syndrome
• rehabilitation
• risk factor
• safety
• tracheally intubated patient

• older
• orthostasis
• orthostatic hypotension
• postural hypotension
• supine hypertension

• Heat
• Internal cooling
• Post-exercise hypotension
• Recovery

To characterize laser speckle flowgraphy (LSFG) pulse waveform parameters for ocular circulation evaluation, a multicenter, prospective, cross-sectional study was conducted in 111 eyes of 86 healthy Japanese individuals. Optic nerve head (ONH) tissue-area, vessel-area mean blur rate (MT and MV, respectively), and MT and MV pulse waveform parameters were obtained using LSFG and ONH structural parameters using planimetry. Multivariate linear mixed-effects modeled regression analysis identified factors contributing to MT- or MV-waveforms using age, gender, smoking history, body mass index, systolic and diastolic blood pressure, heart rate, intraocular pressure, axial length, disc, rim, and β-peripapillary atrophy areas, MT or MV, central retinal artery, and vein equivalents (CRAE and CRVE) as explanatory variables. MT- and MV-waveforms significantly correlated with one or more systemic factors, consistent with previous studies. Following confounding factor adjustment, MT-Skew significantly negatively correlated with β-PPA area (P = 0.026); MT- and MV-flow acceleration index positively correlated with CRAE, MT, and MV (P = 0.041–< 0.001), compatible with these parameters’ observed correlations to systemic factors. Significantly negative correlations of the blowout score and acceleration time index to CRAE partly conflicted with their correlations to systemic factors, and other waveform parameters showed little correlation to ocular factors. Thus, Skew and flow acceleration index assisted the in vivo ocular circulation characterization.

• Gatorade
• heart rate variability
• parasympathetic
• parasympathique
• vagal
• variabilité de la fréquence cardiaque

• Chinese
• Parkinson's disease
• body mass index
• de novo
• sex differences
• underweight

• Blood pressure
• Therapeutics

• Blood Pressure/drug effects
• Drug-Related Side Effects and Adverse Reactions/complications
• Humans
• Hypertension/drug therapy
• Hypertension/physiopathology
• Hypotension, Orthostatic/diagnosis
• Hypotension, Orthostatic/etiology
• Hypotension, Orthostatic/therapy
• Life Style
• Practice Guidelines as Topic
• Supine Position/physiology

• Body mass index
• Chinese
• Newly diagnosed
• Parkinson’s disease
• Risk factors
• Underweight

• Focal adhesion kinase
• glucose
• osmopressor
• red blood cells

[Purpose] The aim of this case study is to reconsider the method for preventing orthostatic hypotension in multiple system atrophy. [Participant and Methods] The case was that of a 70-year-old female with multiple system atrophy who experienced frequent falls and orthostatic hypotension. An orthostatic test was performed, and the effect of cold oral stimulation before standing was compared with no stimulation. Outcome measures were blood pressure, heart rate variability and autonomic variables. [Results] In the control test, blood pressure decreased from 150/72 mmHg in the supine position to 98/58 mmHg in the standing position. Heart rate increased from 71 bpm to 82 bpm, high frequency declined from 16.48 msec² to 14.07 msec², and low/high frequency increased from 2.56 to 5.13. Cold stimulation in the standing position induced changes in blood pressure from 168/82 mmHg to 104/72 mmHg, heart rate from 73 bpm to 83 bpm, high frequency from 61.29 msec² to 24.56 msec², and low/high frequency from 1.45 to 6.33 msec². [Conclusion] Standing after cold stimulation affected autonomic variables, but did not affect the heart rate or blood pressure, possibly because of damaged peripheral blood vessels. Further research is required to demonstrate the effect of cold stimulation on orthostatic hypotension.

• Cold stimulation
• Multiple system atrophy
• Orthostatic hypotension

• Autonomic failure
• Autonomic nervous system
• Heart failure
• Neurogenic orthostatic hypotension

There is a lack of studies exploring the effects of Zamzam water on human physiology. The present study determined the effects of Zamzam water on blood pressure and heart rate variability (HRV).

This comparative interventional study was conducted at the Department of Physiology, of our university in March 2018. A total number of 97 female subjects drank 500 ml of either Zamzam water or mineral water in one minute. Finometer Pro and PowerLab (ADInstruments^R) with ECG electrodes through bioamplifier and attached finger pulse transducer were used to collect data at the baseline (for five minutes), during (for one minute) and after the drink (for five minutes). Paired and uunpaired student’s t-test, one-way ANCOVA and one-way repeated measure ANOVA were used for analysis. Blood pressure parameters were followed minute by minute and HRV parameters were compared as a 5-minute of baseline segment to 5-minute post drink segment.

Within-the-group comparison exhibited significant increases in blood pressure parameters (systolic, diastolic, pulse and mean arterial pressure), over a 5-minute post-drinking period in both groups. Zamzam water caused a significant increase in SDRR (an indication of overall HRV) and RMSSD (an indication of vagal activity) as compared to baseline.

Both drinks cause a significant increase in systolic, diastolic, pulse and mean arterial pressure within five minutes post-drinking period. Zamzam water produce a significant increase in cardiac vagal tone but has no effect on cardiac sympathetic activity. Mineral water has no significant effect on both, cardiac vagal and sympathetic activity.

• Heart rate
• Heart rate variability
• Mineral water
• RMSSD
• SDRR
• Zamzam water

• beetroot juice
• blood pressure
• nitrate
• nitric oxide
• pregnancy

• Blood pressure variability
• TRPV4
• cold stress
• heart rate variability
• portal vein denervation
• water ingestion

orthostatic hypotension (OH) is highly prevalent in older populations and is associated with reduced quality of life and increased mortality. Although non-pharmacologic therapies are recommended first-line, evidence for their use is lacking.

determine the efficacy of combination non-pharmacologic therapy for OH in older people.

a total of 111 orthostatic BP responses were evaluated in this prospective phase 2 efficacy study in 37 older people (≥60 years) with OH. Primary outcome was the proportion of participants whose systolic BP drop improved by ≥10 mmHg. Secondary outcomes include standing BP and symptoms. Comparison is made to the response rate of the most efficacious single therapy (bolus water drinking 56%). Therapeutic combinations were composed of interventions with known efficacy and tolerability: Therapy A- Bolus water drinking + physical counter-manoeuvres (PCM); Therapy B- Bolus water drinking + PCM + abdominal compression.

the response rate to therapy A was 38% (95% confidence interval – CI 24, 63), with standing systolic BP increasing by 13 mmHg (95% CI 4, 22). Therapy B was efficacious in 46% (95% CI 31, 62), increasing standing systolic BP by 20 mmHg (95% CI 12, 29). Neither therapy had a significant effect on symptoms. There were no adverse events.

in comparison to single therapy, there is little additional benefit to be gained from combination non-pharmacologic therapy. Focussing on single, efficacious therapies, such as bolus water drinking or PCM, should become standard first-line therapy.

• clinical trial
• conservative treatment
• older people
• orthostatic hypotension
• phase 2