title: Intrathecal Clonidine via Lumbar Puncture Decreases Blood Pressure in Patients With Poorly Controlled Hypertension.
abstract: OBJECTIVE
  Oral clonidine is used to treat hypertension but often produces sedation and severe dry mouth; intrathecal clonidine is used to treat chronic pain but may produce hypotension. This clinical feasibility study was conducted to determine if intrathecal clonidine decreases blood pressure in patients with poorly controlled hypertension.
  
  
  METHODS
  This prospective, single-arm, open-label study was conducted in ten subjects who were taking at least three antihypertensive medications including a diuretic and had an in-office systolic blood pressure between 140 and 190 mm Hg. On the day of treatment, blood pressure was measured before and after a single lumbar intrathecal dose (150 mcg) of clonidine using an automatic oscillometric device every 10-15 min for four hours. Student's paired t-test was used for statistical comparisons.
  
  
  RESULTS
  Maximal reductions in systolic and diastolic blood pressures averaging 63 ± 20/29 ± 13 mm Hg were observed approximately two hours after clonidine administration. Decreases in systolic pressure were strongly correlated with baseline systolic pressure. Clonidine produced a significant decrease in heart rate of 11 ± 7 beats/min. No subject required intravenous fluids or vasopressor rescue therapy, or reported spinal headache.
  
  
  CONCLUSIONS
  This is the first clinical study in subjects with hypertension that demonstrates significant and profound acute reductions in blood pressure after a single dose of intrathecal clonidine. Future placebo-controlled, dose-escalating studies are warranted to assess the long-term effects of intrathecal clonidine infusion via an implantable drug pump in patients with treatment-resistant hypertension at risk of stroke or myocardial infarction.
authors.affiliation: Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA.
authors.forename: Chris B
authors.initials: CB
authors.lastname: Komanski
authors.affiliation: Carolinas Pain Institute and Center for Clinical Research, Winston-Salem, NC, USA.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Rauck
authors.affiliation: Carolinas Pain Institute and Center for Clinical Research, Winston-Salem, NC, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: North
authors.affiliation: Carolinas Pain Institute and Center for Clinical Research, Winston-Salem, NC, USA.
authors.forename: Kyung S
authors.initials: KS
authors.lastname: Hong
authors.affiliation: Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: D'Angelo
authors.affiliation: Neuromodulation, Medtronic, Inc., Minneapolis, MN, USA.
authors.forename: Keith R
authors.initials: KR
authors.lastname: Hildebrand
mesh_terms: D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects*; D003000:Clonidine / Q000008:administration & dosage*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013129:Spinal Puncture / Q000379:methods*
chemical_list: D000959:Antihypertensive Agents; D003000:Clonidine
keywords: Blood pressure; clonidine; intrathecal; resistant hypertension; subarachnoid