Osmosensitive mechanisms contribute to the water drinking-induced pressor response in humans

Lipp, Axel; Tank, Jens; Franke, G; Arnold, G.; Luft, Friedrich C.; Jordan, Jens

doi:10.1212/01.wnl.0000176060.90959.36

Cited by 46 publications

(60 citation statements)

References 21 publications

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“…Our data are concordant with and build on the recent report of Lipp et al 29 They studied 10 patients with multiple system atrophy and gave them 500 mL of water and 500 mL of normal saline (0.9%) through a nasogastric tube. After 20 minutes, the water increased the SBP in their patients by 8Ϯ9 mm Hg, whereas the normal saline did not alter the SBP (Ϫ1Ϯ11 mm Hg).…”

Section: Consistency Of Findingssupporting

confidence: 93%

“…The most likely explanation for the differences in the response to water is that their patients may have had a different degree of autonomic failure than did our patients. Another possibility for the larger pressor response in the current study is that deglutition or esophageal receptors, both of which Lipp et al 29 bypass with the use of a nasogastric tube, might contribute to activation of the pressor response to water. Crossover studies with oral ingestions versus nasogastric ingestion in the same patients will be required to tease out these differences.…”

Section: Consistency Of Findingsmentioning

confidence: 74%

“…Crossover studies with oral ingestions versus nasogastric ingestion in the same patients will be required to tease out these differences. Lipp et al 29 also used a stronger saline concentration than was used in this study. It is possible that if our patients had drunk normal saline (and tolerated it), they might have shown an absent pressor response (demonstrating a dose-response relationship).…”

Section: Consistency Of Findingsmentioning

confidence: 99%

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Sodium Paradoxically Reduces the Gastropressor Response in Patients With Orthostatic Hypotension

et al. 2006

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Abstract-Orthostatic hypotension (OH) can cause syncope that is difficult to treat. We have found that 473 mL (16 oz) of water can increase systolic blood pressure (SBP) by Ͼ30 mm Hg in many OH patients (the gastropressor response). OH patients are routinely advised to increase their sodium intake to augment their blood volume. We tested the hypothesis that the ingestion of salt with water would increase the magnitude of the acute pressor response compared with water alone in patients with OH. Key Words: blood pressure Ⅲ sympathetic nervous system Ⅲ sodium Ⅲ hypotension Ⅲ autonomic nervous system Ⅲ water-electrolyte balance O rthostatic hypotension (OH) can be a debilitating condition that is difficult to treat. 1-8 Oral water ingestion has been shown to effect a large pressor response in patients with neurogenic OH, 9 -13 with some patients experiencing increases of Ͼ40 mm Hg in their systolic blood pressure (SBP). 9 This gastropressor response takes place over minutes rather than seconds, with a peak effect between 20 and 40 minutes after the water ingestion. 9,10 The oral route is important, because the increase in SBP was only one-third as great with identical volumes of intravenous 5% dextrose in water (D5W) versus oral water. 10

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Section: Consistency Of Findingssupporting

confidence: 93%

Section: Consistency Of Findingsmentioning

confidence: 74%

Section: Consistency Of Findingsmentioning

confidence: 99%

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Sodium Paradoxically Reduces the Gastropressor Response in Patients With Orthostatic Hypotension

et al. 2006

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“…We thus identified a new population of sensory neurons that transduce ongoing changes in hepatic osmolality. The findings explained clinical observations made by our group showing that just by drinking cool tap water, blood pressure and basal metabolic rate increased perceptibly [2,3]. Since then, TRPV4 has become an "old friend".…”

supporting

confidence: 74%

Tripping out on TRPV4

Luft

2015

J Mol Med

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Transient receptor potential (TRP) ion channels are located on the plasma membrane of most animal cells. TRP channels were initially discovered in the trp-mutant strain of the fruit fly, Drosophila melanogaster. Subsequently, TRP channels were found in vertebrates where they are ubiquitously expressed in many cells and tissues. Almost 30 TRP channels have been described that share some structural similarity with each other and are subdivided into seven subfamilies by sequence similarity: TRPC for canonical, TRPV for vanilloid, TRPM for melastatin, TRPN (named for the first member of the Drosophila NOMPC protein/"no mechanoreceptor potentials") and TRPA (named for its ankyrin repeat domain), TRPP for polycystic, and TRPML for mucolipin. Many of these channels mediate sensations such as pain, temperature, different kinds of tastes, pressure, and vision. Molecules found in spices such as garlic (allicin), chili pepper (capsaicin), and wasabi (allyl isothiocyanate) activate some TRP channels. Others are activated by menthol, camphor, peppermint, and cooling agents. Molecules found in cannabis still activate others. Some TRP channels act as sensors of osmotic pressure, volume, stretch, and vibration. TRP channels are relatively nonselectively permeable to cations, including sodium, calcium, and magnesium. Most TRP channels are composed of six membrane-spanning helices with intracellular Nand C-termini (Fig. 1).TRPV4, initially named vanilloid receptor-related osmotically activated channel (VR-OAC), and OSM9-like transient receptor potential channel, member 4 (OTRPC4), is a Ca 2+ -permeable, nonselective cation channel that has been found involved in multiple physiologic functions, dysfunctions, and also diseases. It functions in the regulation of systemic osmotic pressure by the brain, in vascular function, in liver, intestinal, renal and bladder function, in skin barrier function and response of the skin to ultraviolet-B radiation, in growth and structural integrity of the skeleton, in function of joints, in airway and lung function, in retinal and inner ear function, and in pain. The channel is activated by osmotic, mechanical, and chemical cues. It also responds to thermal changes (warmth). Channel activation can be sensitized by inflammation and injury. Hereditary channelopathy mutations of TRPV4 lead to skeletal dysplasias, premature osteoarthritis, and neurological motor function disorders as a manifestation of a motor neuropathy or spinal muscular atrophy.My associates identified afferent neurons in the thoracic dorsal root ganglia of mice that innervate hepatic blood vessels and detect physiological hypo-osmotic shifts in blood osmolality [1]. I was able to play a modest role in this project. We found that hepatic sensory neurons are equipped with an inward current that faithfully transduces graded changes in osmolality within the physiological range (~15 mOsm). In mice lacking the osmotically activated ion channel, TRPV4, hepatic sensory neurons no longer exhibited osmosensitive inward currents and activatio...

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“…These changes were later identified in humans by Jordan and colleagues (1999), who observed profound haemodynamic changes after water consumption in adults with autonomic failure. This response is driven by the presence of hypo-osmotic fluids (i.e., water) in the stomach and/or portal vein (Lipp et al 2005) which provokes a powerful pressor stimulus, immediately increasing blood pressure. In patients with autonomic denervation, this response is established within 10-15 minutes, lasts approximately 90 minutes, and peaks at approximately 30 mm Hg (Jordan et al 2000;Jordan et al 1999).…”

Section: Why Consider Water?mentioning

confidence: 99%

Water consumption as a source of error in the measurement of heart rate variability

Heathers¹,

Quintana²,

Angus³

et al. 2018

Preprint

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Abstract.Heart rate variability (HRV) is a common measure of the autonomic modulation of the heart. To ensure accuracy, various external factors known to affect HRV such as medication use and concurrent illnesses are frequently controlled during measurement. While the influences of such confounds on accurate measurement of HRV are accepted, the influence of seemingly innocuous daily activities such as drinking and eating have received remarkably little attention. In fact, water consumption is known to provoke a powerful pressor stimulus that is buffered by changes in cardiovagal outflow yet it is sporadically controlled during experimentation. This paper examines the dose-dependent magnitude of the effect of water on HRV, the loss of HRV during a common attentional task after water consumption, and the typical scenario of water and mixed meal ingestion. Our findings show that water affects HRV in a dosedependent manner, and exaggerates attentionally-mediated HRV reduction. This effect is antagonised by simultaneous mixed meal consumption, which strongly increases cardiac sympathetic activity. Water consumption during or previous to HRV measurement should be carefully controlled, if possible.Considering the diverse nature of experimental protocols and populations, we suggest a hierarchy of methods to control for water consumption in HRV research.

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Osmosensitive mechanisms contribute to the water drinking-induced pressor response in humans

Cited by 46 publications

References 21 publications

Sodium Paradoxically Reduces the Gastropressor Response in Patients With Orthostatic Hypotension

Sodium Paradoxically Reduces the Gastropressor Response in Patients With Orthostatic Hypotension

Tripping out on TRPV4

Water consumption as a source of error in the measurement of heart rate variability

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