Effect of the somatostatin analogue SMS-201-995 on the adrenergic response to glucose ingestion in patients with postprandial hypotension.
OBJECTIVE
The somatostatin analogue SMS-201-995 has recently been introduced as a new therapy for postprandial hypotension in patients with autonomic neuropathy. The present study was performed to determine the effect of SMS-201-995 on the adrenergic response to glucose ingestion in patients with this disorder.


METHODS
Eleven patients with postprandial hypotension were studied: six with central autonomic dysfunction (multiple system atrophy) and five with peripheral sympathetic dysfunction (progressive autonomic failure). Patients received either a subcutaneous injection of SMS-201-995 or a placebo injection, immediately before administration of a 50-g glucose drink. Each treatment was given on separate, consecutive days in a randomized fashion.


RESULTS
Glucose ingestion caused a decrease in blood pressure (from 82 +/- 6 mm Hg to 66 +/- 7 mm Hg, p less than 0.01) and an increase in plasma norepinephrine level (165 +/- 20 pg/mL to 305 +/- 85 pg/mL, p less than 0.01) in five patients with progressive autonomic failure. Administration of SMS-201-995 prevented both the decline in blood pressure and the increase in norepinephrine. By contrast, glucose ingestion elicited no increase in plasma norepinephrine levels despite profound hypotension (average postprandial mean blood pressure, 55 +/- 3 mm Hg) in six patients with multiple system atrophy. Administration of SMS-201-995 prevented postprandial hypotension in these patients, but had no effect on plasma norepinephrine.


CONCLUSIONS
Our data indicate that the pressor effect of SMS-201-995 is independent of the sympathetic nervous system in patients with multiple system atrophy, but may suppress the adrenergic response to glucose ingestion in patients with progressive autonomic failure.
Hoeldtke
R D
RD
Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania.
Dworkin
G E
GE
Gaspar
S R
SR
Israel
B C
BC
Boden
G
G
D001342:Autonomic Nervous System Diseases / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology; D001794:Blood Pressure / Q000187:drug effects; D002986:Clinical Trials as Topic; D005247:Feeding Behavior / Q000187:drug effects* / Q000502:physiology; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D007022:Hypotension / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D007024:Hypotension, Orthostatic / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology; D009638:Norepinephrine / Q000097:blood; D015282:Octreotide / Q000009:adverse effects / Q000627:therapeutic use*; D011941:Receptors, Adrenergic / Q000187:drug effects* / Q000502:physiology; D013564:Sympathetic Nervous System / Q000187:drug effects
D011941:Receptors, Adrenergic; D005947:Glucose; D015282:Octreotide; D009638:Norepinephrine