Local passive heat for the treatment of hypertension in autonomic failure

Luis E. Okamoto, Jorge E. Celedonio, Emily C. Smith, Alfredo Gamboa, Cyndya A. Shibao, André Diedrich, Sachin Y. Paranjape, Bonnie K. Black, James A.S. Muldowney, Amanda C. Peltier, Ralf Habermann, Craig G. Crandall, Italo Biaggioni

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


BACKGROUND: Supine hypertension affects a majority of patients with autonomic failure; it is associated with end-organ damage and can worsen daytime orthostatic hypotension by inducing pressure diuresis and volume loss during the night. Because sympathetic activation prevents blood pressure (BP) from falling in healthy subjects exposed to heat, we hypothesized that passive heat had a BP-lowering effect in patients with autonomic failure and could be used to treat their supine hypertension. METHODS AND RESULTS: In Protocol 1 (n=22), the acute effects of local heat (40–42°C applied with a heating pad placed over the abdomen for 2 hours) versus sham control were assessed in a randomized crossover fashion. Heat acutely decreased systolic BP by −19±4 mm Hg (versus 3±4 with sham, P<0.001) owing to decreases in stroke volume (−18±5% versus −4±4%, P=0.013) and cardiac output (−15±5% versus −2±4%, P=0.013). In Protocol 2 (proof-of-concept overnight study; n=12), we compared the effects of local heat (38°C applied with a water-perfused heating pad placed under the torso from 10 pm to 6 am) versus placebo pill. Heat decreased nighttime systolic BP (maximal change −28±6 versus −2±6 mm Hg, P<0.001). BP returned to baseline by 8 am. The nocturnal systolic BP decrease correlated with a decrease in urinary volume (r=0.57, P=0.072) and an improvement in the morning upright systolic BP (r=−0.76, P=0.007). CONCLUSIONS: Local heat therapy effectively lowered overnight BP in patients with autonomic failure and supine hypertension and offers a novel approach to treat this condition. Future studies are needed to assess the long-term safety and efficacy in improving nighttime fluid loss and daytime orthostatic hypotension.

Original languageEnglish (US)
Article numbere018979
JournalJournal of the American Heart Association
Issue number7
StatePublished - Apr 6 2021
Externally publishedYes


  • Autonomic failure
  • Heat
  • Orthostatic hypotension
  • Supine hypertension
  • Thermoregulation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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