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Insulin-induced hypotension and neurogenic orthostatic hypotension

Clinical Neuropharmacology Section, Medical Neurology Branch, National Institute of Neurological and Communicative Disorders and Stroke, Bethesda. MD.

Insulin-induced hypoglycemia induced a fall in blood pressure (BP) in patients with idiopathic orthostatic hypotension (IOH) and multiple system atrophy (MSA), but not in control subjects. Only in IOH was there a correlation between plasma norepinephrine (NE) levels and maintenance of BP during the test. The hypotension was not affected by pretreatment with propranol-ol. Hypotension during insulin-induced hypoglycemia is manifested in patients who lack an adequate NE response. The hypotension, however, may be due to a central action of insulin because not all MSA patients with impaired NE release become hypotensive.

Address correspondence and reprint requests to Dr. Brown, NIH. Building 10, Room 5N236. Bethesda. MD 20892.

Presented in part at the thirty-seventh annual meeting of the American Academy of Neurology, Dallas, TX, May 1985.

Accepted for publication February 25, 1986.

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