THE TREATMENT OF POSTPRANDIAL HYPOTENSION IN AUTONOMIC FAILURE WITH 3,4-DL-THREO-DIHYDROXYPHENYLSERINE

Postprandial hypotension occurs commonly in patients with autonomic fa ilure and may be due to attenuation of the normal sympathetic nervous system activation in response to meal ingestion. In a randomized, doub le-blind, placebo-controlled study, we investigated the therapeutic ef fect of the norepinephrine precursor 3,4-DL-threodihydroxyphenylserine (DL-DOPS) on this condition. We measured blood pressure, heart rate, forearm vascular resistance, and plasma DL-DOPS and norepinephrine in 11 patients with autonomic failure. DL-DOPS attenuated the postprandia l fall in blood pressure. This was associated with an increase in plas ma norepinephrine and forearm vascular resistance. DL-DOPS therapy did not change the postprandial increase in heart rate. There was a trend toward increased supine hypertension associated with DL-DOPS treatmen t. This study shows that DL-DOPS is a promising treatment for postpran dial hypotension and provides support for the hypothesis that postpran dial hypotension is, at least in part, due to decreased activation of the sympathetic nervous system.