DOI QR코드

DOI QR Code

Effect of fludrocortisone in cervical spinal cord injury patients with orthostatic hypotension - randomized controlled trial

경수부 척수손상 환자의 기립성 저혈압에서 플루드로코티손의 효과 - 무작위 대조군 연구

  • Lee, Do-Hee (Department of Rehabilitation Medicine, Wonkwang University School of Medicine) ;
  • Joo, Min-Cheol (Department of Rehabilitation Medicine, Wonkwang University School of Medicine)
  • 이도희 (원광대학교 의과대학 재활의학과) ;
  • 주민철 (원광대학교 의과대학 재활의학과)
  • Received : 2021.03.08
  • Accepted : 2021.06.04
  • Published : 2021.06.30

Abstract

The purpose of this study was to investigate the therapeutic effect of fludrocortisone in patients suffering from cervical spinal cord injury (SCI) with orthostatic hypotension (OH). Twenty-six patients with cervical SCI diagnosed with OH through a head-up tilt test were randomly assigned, and they were given either conservative treatment or additional fludrocortisone treatment. Fludrocortisone was administered for 2 weeks, increasing from 0.1 mg to 0.2 mg week . Blood pressure (BP), heart rate (HR), and blood parameters were measured at the beginning and after 2 weeks. After 2 weeks of treatment, there was a significant increase in the baseline BP of the treatment groups (p<.05). When analyzing the drop ratio, there was a tendency for a lower orthostatic BP drop in the treatment groups. Mild adverse events were reported in 7.69% of the treatment groups. Fludrocortisone exhibited therapeutic effects such as preventing cardiovascular complications and continuing rehabilitation through increased baseline BP and reduced OH, and can therefore be considered as a treatment option for OH in patients with SCI.

본 연구는 기립성 저혈압이 동반된 경수부 척수손상 환자에서 플루드로코티손의 치료 효과에 대해 알아보고자 하였다. 기립경사도 검사를 통해 기립성 저혈압으로 진단된 경수부 척수손상 환자 26명을 무작위로 배정하였고, 보존적 치료 혹은 추가로 플루드로코티손 치료 중 한가지를 시행하였다. 플루드로코티손은 주마다 0.1mg에서 0.2mg로 증량하여 총 2주간 투약하였고, 초기 및 2주 후의 혈압 및 심박수, 혈액학적 검사 수치의 변화를 평가하였다. 치료 2주 후에 치료군에서 기저 혈압의 유의미한 상승이 나타났다(p<.05). 기립성 혈압 감소의 비율 분석에서 치료군의 기립성 혈압 감소가 덜 나타나는 경향성을 보였다. 플루드로코티손 치료군의 7.69%에서 경증의 이상 반응을 보고하였다. 이를 통해 플루드로코티손이 기저 혈압의 상승 및 기립성 저혈압 감소를 통해 심혈관계 합병증 방지 및 재활치료 지속 등의 치료 효과를 나타내었음을 알 수 있으며, 척수손상 환자의 기립성 저혈압에서 하나의 치료 방안으로 고려해볼 수 있다고 생각된다.

Keywords

References

  1. C. Y. L Chao, G. L. Y Cheing, "Orthostatic hypotension for people with spinal cord injuries", Hong Kong Physiotherapy Journal, Vol.26, No.1, pp.51-58, 2008. DOI : https://doi.org/10.1016/S1013-7025(09)70008-9
  2. V. E. Claydon, J. D. Steeves, A. Krassioukov, "Orthostatic hypotension following spinal cord injury: understanding clinical pathophysiology", Spinal cord, Vol.44, No.6, pp.341-351, 2006. DOI : https://doi.org/10.1038/sj.sc.3101855
  3. H. Kaufmann, "Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy", Neurology, Vol.46, No.5, p.1470, 1996. DOI : https://doi.org/10.1212/WNL.46.5.1470
  4. E. V. Sidorov, A. F. Townson, M. F. Dvorak, B. K. Kwon, J. Steeves, "Orthostatic hypotension in the first month following acute spinal cord injury", Spinal Cord, Vol.46, No.1, pp.65-69, 2008. DOI : https://doi.org/10.1038/sj.sc.3102064
  5. S. L. Groah, D. Weitzenkamp, P. Sett, B. Soni, G. Savic, "The relationship between neurological level of injury and symptomatic cardiovascular disease risk in the aging spinal injured", Spinal Cord, Vol.39, No.6, pp.310-317, 2001. DOI : https://doi.org/10.1038/sj.sc.3101162
  6. R. Banerjea, U. Sambamoorthi, F. Weaver, M. Maney, L. M. Pogach LM, "Risk of stroke, heart attack, and diabetes complications among veterans with spinal cord injury", Archives of physical medicine and rehabilitation, Vol.89, No.8, pp.1448-1453, 2008. DOI : https://doi.org/10.1016/j.apmr.2007.12.047
  7. J. Blackmer, "Orthostatic hypotension in spinal cord injured patients", The Journal of Spinal Cord Medicine, Vol.20, No.2, pp.212-217, 1997. DOI : https://doi.org/10.1080/10790268.1997.11719471
  8. A. Krassioukov, J. J. Eng, D. E. Warburton, R. Teasell, "A systematic review of the management of orthostatic hypotension after spinal cord injury", Archives of physical medicine and rehabilitation, Vol.90, No.5, pp.876-885, 2009. DOI : https://doi.org/10.1016/j.apmr.2009.01.009
  9. D. Robertson, R. M. Robertson, Chapter 133 - Fludrocortisone, Primer on the autonomic nervous system, 2012, pp.635-637. DOI : https://doi.org/10.1016/B978-0-12-386525-0.00133-5
  10. T. E. Groomes, Chi-Tsou Huang, "Orthostatic hypotension after spinal cord injury: treatment with fludrocortisone and ergotamine", Archives of physical medicine and rehabilitation, Vol72, No.1, pp.56-58, 1991. DOI : https://doi.org/10.5555/uri:pii:0003999391900803
  11. D. B. Barber, S. J. Rogers, "Midodrine hydrochloride and the treatment of orthostatic hypotension in tetraplegia: two cases and a review of the literature", Spinal Cord, Vol.38, No.2, pp.109-111, 2000. DOI : https://doi.org/10.1038/sj.sc.3100959
  12. J. H. Frisbie, David J. R. Steele, "Postural hypotension and abnormalities of salt and water metabolism in myelopathy patients", Spinal Cord Vol.35, No.5, pp.303-307, 1997. DOI : https://doi.org/10.1038/sj.sc.3100436
  13. W. O. McKinley, A. B. Jackson, D. D. Cardenas, "Long-term medical complications after traumatic spinal cord injury: a regional model systems analysis", Archives of physical medicine and rehabilitation, Vol.80, No.11, pp.1402-1410, 1999. DOI : https://doi.org/10.1016/S0003-9993(99)90251-4
  14. I. W. Campbell, D. J. Ewing, B. F. Clarke, "9-Alpha-fluorohydrocortisone in the treatment of postural hypotension in diabetic autonomic neuropathy", Diabetes, Vol.24, No.4, pp.381-384, 1975. DOI : https://doi.org/10.2337/diab.24.4.381
  15. S. R. Schreglmann, F. Buchele, M. Sommerauer, L. Epprecht, "Pyridostigmine bromide versus fludrocortisone in the treatment of orthostatic hypotension in Parkinson's disease-a randomized controlled trial", European journal of neurology, Vol.24, No.4, pp.545-551, 2017. DOI : https://doi.org/10.1111/ene.13260
  16. J. M. Senard, A. Arias, M. Berlan, M. A. Tran, "Pharmacological evidence of alpha 1-and alpha 2-adrenergic supersensitivity in orthostatic hypotension due to spinal cord injury: a case report", European journal of clinical pharmacology, Vol.41, No.6, pp.593-596, 1991. DOI : https://doi.org/10.1007/BF00314991
  17. R. W. Teasell, J. M. O. Arnold, A. Krassioukov, "Cardiovascular consequences of loss of supraspinal control of the sympathetic nervous system after spinal cord injury", Archives of physical medicine and rehabilitation, Vol.81, No.4, pp.506-516, 2000. DOI : https://doi.org/10.1053/mr.2000.3848
  18. A. A. Phillips, V. A. Krassioukov, "Contemporary cardiovascular concerns after spinal cord injury: mechanisms, maladaptations, and management", Journal of neurotrauma, Vol.32, No.24, pp.1927-1942, 2015. DOI : https://doi.org/10.1089/neu.2015.3903
  19. S. Duschek, N. Weisz, R. Schandry, "Reduced cognitive performance and prolonged reaction time accompany moderate hypotension", Clinical Autonomic Research, Vol.13, No.6, pp.427-432, 2003. DOI : https://doi.org/10.1007/s10286-003-0124-4
  20. A. B. Jegede, D. Rosado-Rivera, W. A. Bauman, "Cognitive performance in hypotensive persons with spinal cord injury," Clinical Autonomic Research, Vol.20, No.1, pp.3-9, 2010. DOI : https://doi.org/10.1007/s10286-009-0036-z
  21. M. L. Eigenbrodt, K. M. Rose, D. J. Couper, "Orthostatic hypotension as a risk factor for stroke: the atherosclerosis risk in communities (ARIC) study, 1987-1996", Stroke, Vol.31, No.10, pp.2307-2313, 2000. DOI : https://doi.org/10.1161/01.STR.31.10.2307
  22. K. M. Rose, H. A. Tyroler, C. J. Nardo, "Orthostatic hypotension and the incidence of coronary heart disease: the Atherosclerosis Risk in Communities study", American journal of hypertension, Vol.13, No.6, pp.571-578, 2000. DOI : https://doi.org/10.1016/S0895-7061(99)00257-5
  23. K. H. Masaki, I. J. Schatz, C. M. Burchfiel, "Orthostatic hypotension predicts mortality in elderly men: the Honolulu Heart Program", Circulation, Vol.98, No.21, pp.2290-2295, 1998. DOI : https://doi.org/10.1161/01.CIR.98.21.2290
  24. A. V. Chobanian, L. Volicer, C. P. Tifft, H. Gavras, "Mineralocorticoid-induced hypertension in patients with orthostatic hypotension", New England Journal of Medicine, Vol.301, No.2, pp.68-73, 1979. DOI : https://doi.org/10.1056/NEJM197907123010202
  25. C. C. Grijalva, I. Biaggioni, M. R. Griffin, C. A. Shibao, " fludrocortisone is associated with a higher risk of all-cause hospitalizations compared with midodrine in patients with orthostatic hypotension", Journal of the American Heart Association, Vol.6, No.10, e006848, 2017. DOI : https://doi.org/10.1161/JAHA.117.006848
  26. H. Lahrmann, P. Cortelli, M. Hilz, C. J. Mathias, "EFNS guidelines on the diagnosis and management of orthostatic hypotension", European journal of neurology, Vol.13, No.9, pp.930-936, 2006. DOI : https://doi.org/10.1111/j.1468-1331.2006.01512.x
  27. P. B. Mills, C. K. Fung, A. Krassioukov, "Nonpharmacologic management of orthostatic hypotension: a systematic review", Archives of physical medicine and rehabilitation, Vol.96, No.2, pp.366-375, 2015. DOI : https://doi.org/10.1016/j.apmr.2014.09.028