NN-Nicotinic Blockade as an Acute Human Model of Autonomic Failure by Jens Jordan, John R. Shannon, Bonnie K. Black, Robert H. Lance, Mark D. Squillante, Fernando Costa, and David Robertson Hypertension Volume 31(5):1178-1184 May 1, 1998 Copyright © American Heart Association, Inc. All rights reserved.

Changes in HR and BP with trimethaphan infusion at 6 mg/min. Changes in HR and BP with trimethaphan infusion at 6 mg/min. The arrowhead indicates the start of the infusion. There is a marked decrease in SBP and DBP, narrowing of the pulse pressure, and an increase in HR with trimethaphan. BP and HR changes reached a plateau after ≈5 minutes of continuous infusion. Jens Jordan et al. Hypertension. 1998;31:1178-1184 Copyright © American Heart Association, Inc. All rights reserved.

Changes in skin temperature with trimethaphan infusion compared with baseline. Changes in skin temperature with trimethaphan infusion compared with baseline. Temperature increased less proximally (forehead, upper arm, thigh) than distally (forearm, finger, calf, toe). Jens Jordan et al. Hypertension. 1998;31:1178-1184 Copyright © American Heart Association, Inc. All rights reserved.

BP and HR with controlled breathing (12 breaths per minute) before (Pre) and during (Post) trimethaphan. BP and HR with controlled breathing (12 breaths per minute) before (Pre) and during (Post) trimethaphan. Respiration (Resp) was monitored by respiratory bellows. Sinus arrhythmia is almost completely eliminated with trimethaphan. Jens Jordan et al. Hypertension. 1998;31:1178-1184 Copyright © American Heart Association, Inc. All rights reserved.

Valsalva test before (Pre) and during (Post) trimethaphan. Valsalva test before (Pre) and during (Post) trimethaphan. The solid bar indicates duration of the maneuver. With ganglionic blockade, there is a continuous decrease in BP in phase II, and the BP overshoot in phase IV is absent. Compensatory changes in HR are abolished with trimethaphan, and there is a delayed increase in SBP by more than 10 mm Hg after the Valsalva maneuver. The delayed increase in BP was sustained for several minutes (not shown). Jens Jordan et al. Hypertension. 1998;31:1178-1184 Copyright © American Heart Association, Inc. All rights reserved.

Top, Tilt testing before trimethaphan. Top, Tilt testing before trimethaphan. There is a continuous increase in HR with increasing tilt angles. SBP decreases slightly and DBP remains stable. Bottom, Tilt testing with trimethaphan. There is a decrease in BP with increasing tilt angle and no compensatory HR changes. Only one subject tolerated a tilt angle of >20°. Jens Jordan et al. Hypertension. 1998;31:1178-1184 Copyright © American Heart Association, Inc. All rights reserved.

Saliva production (grams per 10 minutes) and tear production (millimeters on Schirmer paper) before (pre) and during (post) trimethaphan. Saliva production (grams per 10 minutes) and tear production (millimeters on Schirmer paper) before (pre) and during (post) trimethaphan. There was a dramatic decrease in saliva and tear production with trimethaphan. Jens Jordan et al. Hypertension. 1998;31:1178-1184 Copyright © American Heart Association, Inc. All rights reserved.

Time course of the decrease in plasma norepinephrine level with trimethaphan infusion at 6 mg/min. Time course of the decrease in plasma norepinephrine level with trimethaphan infusion at 6 mg/min. The infusion was begun at 0 minutes. Jens Jordan et al. Hypertension. 1998;31:1178-1184 Copyright © American Heart Association, Inc. All rights reserved.

Supine (sup) and upright (up) norepinephrine and epinephrine levels before and approximately 40 minutes after trimethaphan infusion was begun. Supine (sup) and upright (up) norepinephrine and epinephrine levels before and approximately 40 minutes after trimethaphan infusion was begun. There is a profound decrease in plasma norepinephrine with trimethaphan and relative sparing of plasma epinephrine levels. Jens Jordan et al. Hypertension. 1998;31:1178-1184 Copyright © American Heart Association, Inc. All rights reserved.

Plasma vasopressin (on log scale) and PRA before (pre) and during (post) trimethaphan (horizontal bar indicates mean value). Plasma vasopressin (on log scale) and PRA before (pre) and during (post) trimethaphan (horizontal bar indicates mean value). There was a dramatic increase in plasma vasopressin and no change in PRA. Jens Jordan et al. Hypertension. 1998;31:1178-1184 Copyright © American Heart Association, Inc. All rights reserved.