{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T17:16:47Z","timestamp":1781198207609,"version":"3.54.1"},"reference-count":45,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,4,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Supine hypertension affects a majority of patients with autonomic failure; it is associated with end\u2010organ 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\u2010lowering effect in patients with autonomic failure and could be used to treat their supine hypertension.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              In Protocol 1 (n=22), the acute effects of local heat (40\u201342\u00b0C applied with a heating pad placed over the abdomen for 2\u00a0hours) versus sham control were assessed in a randomized crossover fashion. Heat acutely decreased systolic BP by \u221219\u00b14\u00a0mm\u00a0Hg (versus 3\u00b14 with sham,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) owing to decreases in stroke volume (\u221218\u00b15% versus \u22124\u00b14%,\n              <jats:italic>P<\/jats:italic>\n              =0.013 ) and cardiac output (\u221215\u00b15% versus \u22122\u00b14%,\n              <jats:italic>P<\/jats:italic>\n              =0.013). In Protocol 2 (proof\u2010of\u2010concept overnight study; n=12), we compared the effects of local heat (38\u00b0C applied with a water\u2010perfused heating pad placed under the torso from 10\u00a0\n              <jats:sc>pm<\/jats:sc>\n              to 6\u00a0\n              <jats:sc>am<\/jats:sc>\n              ) versus placebo pill. Heat decreased nighttime systolic BP (maximal change \u221228\u00b16 versus \u22122\u00b16\u00a0mm\u00a0Hg,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). BP returned to baseline by 8\u00a0\n              <jats:sc>am<\/jats:sc>\n              . The nocturnal systolic BP decrease correlated with a decrease in urinary volume (\n              <jats:italic>r<\/jats:italic>\n              =0.57,\n              <jats:italic>P<\/jats:italic>\n              =0.072) and an improvement in the morning upright systolic BP (\n              <jats:italic>r<\/jats:italic>\n              =\u22120.76,\n              <jats:italic>P<\/jats:italic>\n              =0.007).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">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\u2010term safety and efficacy in improving nighttime fluid loss and daytime orthostatic hypotension.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Registration<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifiers: NCT02417415 and NCT03042988.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.018979","type":"journal-article","created":{"date-parts":[[2021,3,19]],"date-time":"2021-03-19T10:23:22Z","timestamp":1616149402000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":35,"title":["Local Passive Heat for the Treatment of Hypertension in Autonomic Failure"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6914-7287","authenticated-orcid":false,"given":"Luis E.","family":"Okamoto","sequence":"first","affiliation":[{"name":"Vanderbilt Autonomic Dysfunction Center Vanderbilt University Medical Center Nashville TN"},{"name":"Division of Clinical Pharmacology Vanderbilt University Medical Center Nashville TN"},{"name":"Department of Medicine Vanderbilt University Medical Center Nashville TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge E.","family":"Celedonio","sequence":"additional","affiliation":[{"name":"Vanderbilt Autonomic Dysfunction Center Vanderbilt University Medical Center Nashville TN"},{"name":"Division of Clinical Pharmacology Vanderbilt University Medical Center Nashville TN"},{"name":"Department of Medicine Vanderbilt University Medical Center Nashville TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5078-6748","authenticated-orcid":false,"given":"Emily C.","family":"Smith","sequence":"additional","affiliation":[{"name":"Vanderbilt Autonomic Dysfunction Center Vanderbilt University Medical Center Nashville TN"},{"name":"Division of Clinical Pharmacology Vanderbilt University Medical Center Nashville TN"},{"name":"Department of Medicine Vanderbilt University Medical Center Nashville TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8676-687X","authenticated-orcid":false,"given":"Alfredo","family":"Gamboa","sequence":"additional","affiliation":[{"name":"Vanderbilt Autonomic Dysfunction Center Vanderbilt University Medical Center Nashville TN"},{"name":"Division of Clinical Pharmacology Vanderbilt University Medical Center Nashville TN"},{"name":"Department of Medicine Vanderbilt University Medical Center Nashville TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4518-6801","authenticated-orcid":false,"given":"Cyndya A.","family":"Shibao","sequence":"additional","affiliation":[{"name":"Vanderbilt Autonomic Dysfunction Center Vanderbilt University Medical Center Nashville TN"},{"name":"Division of Clinical Pharmacology Vanderbilt University Medical Center Nashville TN"},{"name":"Department of Medicine Vanderbilt University Medical Center Nashville TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9","family":"Diedrich","sequence":"additional","affiliation":[{"name":"Vanderbilt Autonomic Dysfunction Center Vanderbilt University Medical Center Nashville TN"},{"name":"Division of Clinical Pharmacology Vanderbilt University Medical Center Nashville TN"},{"name":"Department of Medicine Vanderbilt University Medical Center Nashville TN"},{"name":"Department of Biomedical Engineering Vanderbilt University Medical Center Nashville TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sachin Y.","family":"Paranjape","sequence":"additional","affiliation":[{"name":"Vanderbilt Autonomic Dysfunction Center Vanderbilt University Medical Center Nashville TN"},{"name":"Division of Clinical Pharmacology Vanderbilt University Medical Center Nashville TN"},{"name":"Department of Medicine Vanderbilt University Medical Center Nashville TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bonnie K.","family":"Black","sequence":"additional","affiliation":[{"name":"Vanderbilt Autonomic Dysfunction Center Vanderbilt University Medical Center Nashville TN"},{"name":"Division of Clinical Pharmacology Vanderbilt University Medical Center Nashville TN"},{"name":"Department of Medicine Vanderbilt University Medical Center Nashville TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"James A. 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