1999 Volume 21 Issue 3 Pages 341-346
We report a patient with severe orthostatic hypotension, who was successfully treated with enalapril. A 78-year-old man with a history of hypertension and lacunar brain infarctions was admined to our clinic. He could hardly stand up since an upright posture resulted in severe dizziness. Physical examinations revealed orthostatic hypotension and peripheral sensory and motor neuropathy. His blood pressure dropped from 180/ 92 mmHg to 102/66 mmHg on standing, with no change in heart rate. Deposion of AA amyloid was confirmed by duodenal biopsy. The cerebral hemodynamic changes were studied during passive tilting up of the body. The followìng parameters were recorded : mean blood pressure (MBP), heart rate (HR), end tidal CO2, and mean blood flow velocity (MFV) of the middle cerebral artery trunk as measured by transcranial Doppler sonography. The lower limit of cerebral blood flow autoregulation shifted from 95 mmHg to 80 mmHg in terms of MBP, after a 14-day course of treatment with enalapril (0.625 mg/day, p. o.). Use of elastic stockings increased the upright MBP from 78 mmHg to 83 mmHg. The upright MBP thus became higher than the lower limit of cerebral blood flow autoregulation, and the orthostatic dizziness improved. ACE inhibitor may be useful for the treatment of hypertensive patients with orthostatic hypotension, by improving abnormal shifts in the lower limit of cerebral blood flow autoregulation.
