Human orthostatic reflexes after taking temazepam at night.

Patrick, J. M.; Dikshit, M B; Macdonald, I. A.; Fentem, P. H.

doi:10.1111/j.1365-2125.1987.tb03248.x

Cited by 7 publications

(11 citation statements)

References 17 publications

(24 reference statements)

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“…This effect is small but there is substantial inter-individual variation. Our results are consistent with a previous study in which young healthy volunteers subjected to lower body negative pressure after temazepam, at a dose of 20 mg, had a greater tachycardia and diminished forearm constriction, compared with placebo, but were able to maintain blood pressure (Patrick et al, 1987). The loss of the ability to maintain blood pressure in the elderly subjects of our study probably reflects ageassociated impairment of cardiovascular reflexes.…”

Section: Discussionsupporting

confidence: 92%

“…The mean of the two measurements of HR and BP in the hour before drug administration was taken as the baseline value for the calculation of each value. These data are shown in Figure 4 (Patrick et al, 1987). The loss of the ability to maintain blood pressure in the elderly subjects of our study probably reflects ageassociated impairment of cardiovascular reflexes.…”

Section: Resultsmentioning

confidence: 61%

“…Alterations in orthostatic reflexes have been demonstrated after the administration of 20 mg temazepam to young individuals subjected to lower body negative pressure (Patrick et al, 1987). Orthostatic hypotension is a common problem in the elderly which may lead to significant morbidity by causing falls (Johnson et al, 1965;Palmer, 1983).…”

Section: Introductionmentioning

confidence: 99%

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Effect of temazepam on blood pressure regulation in healthy elderly subjects.

Ford

Hoffman

Blaschke

1990

Brit J Clinical Pharma

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1. Blood pressure regulation was studied in 12 healthy elderly subjects after double‐blind randomised administration of placebo, 15 mg and 30 mg temazepam at 10.00 h and 22.00 h. 2. Supine and standing heart rate and blood pressure were measured after daytime administration and supine measurements were obtained during sleep. 3. Temazepam caused a fall in systolic blood pressure and an increase in heart rate after morning administration. These changes were greater in the standing position and were dose‐dependent; for standing blood pressure and heart rate 1 h after administration there was a 7 mm Hg fall and 6 beats min‐ 1 increase after 15 mg temazepam and a 10 mm Hg fall and 8 beats min‐1 increase after 30 mg temazepam. Temazepam magnified the fall in systolic blood pressure and increase in heart rate that occurred with standing. Temazepam enhanced the fall in systolic blood pressure that occurred during sleep (mean +/‐ s.d.; placebo: ‐23 +/‐ 10 mm Hg, 15 mg temazepam: ‐31 +/‐ 13 mm Hg, 30 mg temazepam: ‐36 +/‐ 14 mm Hg). 4. These changes in blood pressure regulation caused by temazepam may have clinical importance in some elderly individuals.

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Section: Discussionsupporting

confidence: 92%

Section: Resultsmentioning

confidence: 61%

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Effect of temazepam on blood pressure regulation in healthy elderly subjects.

Ford

Hoffman

Blaschke

1990

Brit J Clinical Pharma

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“…As against our observations, Hickler et al (8) found an incidence between 20%-25% in their otherwise normal Caucasian subjects exposed to HUT. In the same context, Indian O military men did not exhibit any abnormal response to 5 minutes of -50 mmHg LBNP (21) while some of our Caucasian subjects did have mild prodromal signs of syncope when exposed to the same degree of stress (28). Based on these observations, could it be too far fetched to deduce that Indians tolerate orthostatic stress better than Caucasians, possibly because Indians are known to be heat adapted, and hence their physiology for handling body fluid shifts functions more efficiently?…”

Section: Gender and Race Differences In Occurrence Of Syncopementioning

confidence: 74%

Current Concepts of Pathophysiology of Vasovagal Syncope and its Evaluation and Management: A Review

Dikshit

Jaju

2020

ANAMS

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Vasovagal syncope (VVS) with a sudden, temporary loss of consciousness (LoC) is a common phenomenon in the young and the elderly. Though generally described as innocuous, it may lead to serious consequences in special category of people (pilots), or in the elderly in whom LoC may lead to a fall and serious injury. The topic has been copiously researched upon and discussed in medical literature over the last few decades, but the exact mechanisms which lead to the disability have yet to be fully agreed upon. Changes in cardiovascular baroreceptor sensitivity, aberrations in the complex interaction amongst the nucleus of the tractus solitarius and the nuclei around it, inability of the peripheral circulation to respond to autonomic vasoconstrictors, or excess production of vasodilators such as nitric oxide produced locally have been considered in its pathophysiology. Various extraneous situations like dehydration, exposure to heat stress, medications, psychological factors may adversely stress regulatory physiological responses and promote occasional episodes of VVS. More complex dysautonomia could be a reason for the recurrent VVS. Differences between brain structure of VVS sufferers and normal subjects have been proposed. Head-up tilt table (HUT) test is the most widely applied investigation for evaluating VVS episodes. Lower body negative pressure (LBNP) has also been used. Enhancement of the orthostatic stress may be done by simultaneous use of both, or with peripheral vasodilators. As to whether such an enhancement is necessary is debatable. Management with increased salt and fluid intake, corticosteroids, beta adrenergic receptor blockers, alpha adrenergic receptor stimulants, selective serotonin reuptake inhibitors, and nitric oxide synthase inhibitors have been tried with variable success.

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“…The effect of benzodiazepines on heart rate and blood pressure in man has been investigated by several groups [5][6][7][8][9], but these studies were not designed to determine the role of GABA synapses in cardiac vagal pathways. Marty et al [5] examined the anaesthetic effects of diazepam and midazolam on baroreflex control of heart rate, showing that large doses of these drugs depress the sensitivity of the reflex.…”

Section: Introductionmentioning

confidence: 99%

A central γ-aminobutyric acid mechanism in cardiac vagal control in man revealed by studies with intravenous midazolam

et al. 1998

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1. Animal studies show that cardiac vagal tone can be modified by gamma-aminobutyric acid neurons acting at several sites in the central nervous system. The present study has attempted to determine whether similar control exists in humans by using midazolam, a benzodiazepine. Benzodiazepines exert their main actions on the central nervous system by interacting co-operatively at the gamma-aminobutyric acid receptor. 2. Twenty patients took part in the study before undergoing cardiac catheterization. After resting for 20 min in a semi-supine position on a couch, ECG, blood pressure and respiration were recorded for 5-min periods with either controlled (fixed) or free respiration. During this time a baroreceptor sensitivity test was conducted. 3. Doses of 1 mg and 5 mg of midazolam were administered intravenously. 4. Five-minute segments of data, before and after midazolam, were subjected to power spectral and time-domain analysis. 5. Midazolam caused a decrease in the high-frequency and an increase in the low-frequency components of the power spectral density plot, and in addition reduced the mean R-R interval and R-R variability expressed as the interquartile difference, and pNN50. There were no significant changes in the sensitivity of the baroreflex or in the systolic, diastolic and average blood pressures. 6. This decrease in variability of heart period, particularly at a controlled respiratory frequency, strongly suggests that cardiac vagal tone in man can be regulated by gamma-aminobutyric acid neurons.

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Human orthostatic reflexes after taking temazepam at night.

Cited by 7 publications

References 17 publications

Effect of temazepam on blood pressure regulation in healthy elderly subjects.

Effect of temazepam on blood pressure regulation in healthy elderly subjects.

Current Concepts of Pathophysiology of Vasovagal Syncope and its Evaluation and Management: A Review

A central γ-aminobutyric acid mechanism in cardiac vagal control in man revealed by studies with intravenous midazolam

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