Carbonated Water for Orthostatic Hypotension
Recruiting in Palo Alto (17 mi)
Overseen byVictoria E Claydon, PhD
Age: 18 - 65
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Simon Fraser University
Disqualifiers: Pregnancy, Cardiovascular, Neurological, others
No Placebo Group
Trial Summary
What is the purpose of this trial?The primary purpose of this investigation is to determine whether water carbonation can improve orthostatic tolerance in healthy control volunteers. Orthostatic tolerance refers to the ability to maintain an adequate blood pressure when standing. In some individuals blood pressure can fall when standing, predisposing to dizzy spells or fainting episodes. Drinking water can boost blood pressure and making fainting episodes less likely. However, it is not clear whether the carbonation of the water has any further impact on the blood pressure response. This is important because it may be that carbonated water expands the stomach (gastric distension), provoking an increase in sympathetic activity. The increase in sympathetic nervous system activity boosts blood pressure. Resolving this question would have important implications for patients with syncope. This study will test whether carbonated water will have any further impact on blood pressure than the already known effect of non-carbonated water.
Do I need to stop my current medications for the trial?
The trial protocol does not specify whether you need to stop taking your current medications.
What data supports the effectiveness of carbonated water as a treatment for orthostatic hypotension?
Research shows that drinking cold carbonated water can increase blood pressure more effectively than room temperature water, especially in older adults. This suggests that carbonated water might help manage orthostatic hypotension by providing a quick boost in blood pressure.
12345Is carbonated water safe for humans?
Research shows that drinking carbonated water is generally safe for healthy adults, as it can increase blood pressure and heart rate temporarily without any reported harmful effects.
45678How does carbonated water as a treatment for orthostatic hypotension differ from other treatments?
Carbonated water is unique because it can increase blood pressure more effectively than room temperature water, especially when cold, making it a simple and non-invasive option for managing orthostatic hypotension. Unlike treatments that involve medication or increased salt intake, carbonated water leverages the body's natural response to cold and carbonation to improve blood pressure.
23457Eligibility Criteria
This trial is for healthy, English-speaking individuals without a history of cardiovascular or neurological diseases, not pregnant, and who haven't fainted more than once in the past six months. It's designed to see if carbonated water helps people maintain blood pressure when standing up.Inclusion Criteria
English-speaking
This criterion means that the participant should be in good health with no major medical conditions.
Exclusion Criteria
I have a history of heart disease.
I have a history of a neurological condition.
Pregnancy or suspected pregnancy
+1 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
1-2 weeks
Treatment
Participants undergo a tilt test on three separate days, drinking different types of water to assess orthostatic tolerance.
1 week
3 visits (in-person)
Follow-up
Participants are monitored for safety and effectiveness after treatment
1-2 weeks
Participant Groups
The study tests whether drinking 500mL of carbonated water improves orthostatic tolerance—the ability to keep blood pressure stable when standing—compared to the same amount of still water. A smaller volume (50mL) of still water serves as an additional control.
6Treatment groups
Experimental Treatment
Group I: 50mL still water first, then 500mL still water, then 500 mL carbonated waterExperimental Treatment3 Interventions
Participants will undergo this test on three separate days. On each day participants will be asked to drink a glass of water: either a 50mL drink of still water (control condition), a 500mL drink of still (non-carbonated) water, or a 500mL drink of carbonated water. In this arm of the study, participants will receive 50mL still water on the first test day, 500mL carbonated water on the second test day, then 500mL carbonated water on the third day.
Group II: 50mL still water first, then 500mL carbonated water, then 500 mL still waterExperimental Treatment3 Interventions
Participants will undergo this test on three separate days. On each day participants will be asked to drink a glass of water: either a 50mL drink of still water (control condition), a 500mL drink of still (non-carbonated) water, or a 500mL drink of carbonated water. In this arm of the study, participants will receive 50mL still water on the first test day, 500mL still water on the second test day, then 500mL still water on the third day.
Group III: 500mL still water first, then 50mL still water, then 500 mL carbonated waterExperimental Treatment3 Interventions
Participants will undergo this test on three separate days. On each day participants will be asked to drink a glass of water: either a 50mL drink of still water (control condition), a 500mL drink of still (non-carbonated) water, or a 500mL drink of carbonated water. In this arm of the study, participants will receive 500mL still water on the first test day, 50mL still water on the second test day, then 500mL carbonated water on the third day.
Group IV: 500mL still water first, then 500 mL carbonated water, then 50mL still waterExperimental Treatment3 Interventions
Participants will undergo this test on three separate days. On each day participants will be asked to drink a glass of water: either a 50mL drink of still water (control condition), a 500mL drink of still (non-carbonated) water, or a 500mL drink of carbonated water. In this arm of the study, participants will receive 500mL still water on the first test day, 500mL carbonated water on the second test day, then 50mL still water on the third day.
Group V: 500mL carbonated water first, then 50mL of still water, then 500mL of still waterExperimental Treatment3 Interventions
Participants will undergo this test on three separate days. On each day participants will be asked to drink a glass of water: either a 50mL drink of still water (control condition), a 500mL drink of still (non-carbonated) water, or a 500mL drink of carbonated water. In this arm of the study, participants will receive 500mL carbonated water on the first test day, 50mL still water on the second test day, then 500mL still water on the third day.
Group VI: 500mL carbonated water first, then 500mL of still water, then 50mL of still waterExperimental Treatment3 Interventions
Participants will undergo this test on three separate days. On each day participants will be asked to drink a glass of water: either a 50mL drink of still water (control condition), a 500mL drink of still (non-carbonated) water, or a 500mL drink of carbonated water. In this arm of the study, participants will receive 500mL carbonated water on the first test day, 500mL still water on the second test day, then 50mL still water on the third day.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Simon Fraser UniversityBurnaby, Canada
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Who Is Running the Clinical Trial?
Simon Fraser UniversityLead Sponsor
References
New trends in the treatment of orthostatic hypotension. [2019]Nonpharmacologic and pharmacologic treatment can significantly attenuate the symptoms of orthostatic hypotension. Some of the interventions that are used to treat orthostatic hypotension have been known for decades. However, several new treatment strategies have been developed in recent years. New knowledge about the pathophysiology of orthostatic syndromes has been gathered that will strongly influence the way treatments are tailored to individual patients. For example, patients with and without residual autonomic function exhibit differential responses to certain treatments. A large subgroup of patients with severe autonomic failure show a profound pressor response to water drinking. This simple effect can be exploited to treat orthostatic and postprandial hypotension in some patients. New bioengineering technologies that attempt to replicate normal baroreflex mechanisms may become available for selected patients with central autonomic dysfunction.
Acute effect of water on blood pressure. What do we know? [2007]Water drinking elicits a large, acute, pressor response in patients with autonomic failure who experience severe orthostatic hypotension. This essentially cost-free intervention has been successfully employed therapeutically in these patients to attenuate orthostatic and postprandial hypotension. In orthostatic intolerance patients, water drinking blunts the orthostatic tachycardia but has only a modest effect on blood pressure. Water drinking also has effects on blood pressure and heart rate in normal subjects, although the actions are more subtle. The cardiovascular effects seem to be in part mediated through sympathetic activation. The exact mechanism that causes the sympathetic activation is not known.
Water drinking as a treatment for orthostatic syndromes. [2019]Water drinking increases blood pressure in a substantial proportion of patients who have severe orthostatic hypotension due to autonomic failure. We tested the hypothesis that water drinking can be used as a practical treatment for patients with orthostatic and postprandial hypotension, as well as those with orthostatic tachycardia.
Water drinking acutely improves orthostatic tolerance in healthy subjects. [2019]Orthostatic symptoms and syncope are common, even in apparently healthy subjects. In patients with severe autonomic dysfunction, water drinking elicits an acute pressor response and improves orthostatic hypotension. We tested the hypothesis that water drinking also improves orthostatic tolerance in healthy subjects.
The Pressor Response to the Drinking of Cold Water and Cold Carbonated Water in Healthy Younger and Older Adults. [2022]Purpose: Water drinking has been proposed for the treatment of orthostatic hypotension because it can increase blood pressure in patients. This study aimed to investigate whether drinking water with a cold or carbonation stimulus would cause a more effective pressor response, and whether it would be greater in older than in younger adults. Methods: We assessed blood pressure and heart rate from non-invasive arterial pressure (a volume-clamp method) and type II electrocardiography in 13 healthy young adults (6 females, 7 males; mean age, 19.9 ± 1.1 years) and nine healthy older adults (all females; mean age, 71.4 ± 4.2 years) who drank 200 mL of cold, cold carbonated, and room temperature water. Results: The pressor response to the drinking of cold and cold carbonated water was greater than that to room temperature water in both younger and older participants (p < 0.05; changes in systolic blood pressure of room temperature water, cold water and cold carbonated water in young: 15.31 ± 9.66, 22.56 ± 11.51 and 32.6 ± 17.98 mmHg, respectively; changes in systolic blood pressure of room temperature water, cold water and cold carbonated water in elderly: 21.84 ± 14.31, 41.53 ± 19.82 and 48.16 ± 16.77 mmHg, respectively). In addition, the pressor response to cold and cold carbonated water was persistent during the recovery period by about 5-10 mmHg (p < 0.05). Furthermore, the pressor response during the drinking and recovery periods was greater in the older than in the younger participants (p < 0.05). Conclusion: Our data suggest that even smaller amounts of water are able to elicit a sustained pressor response, in particular if the water is cold and carbonated. We speculate that the pressor effect may render cold and carbonated water an appropriate first aid method against certain forms of acute hypotension.
The effects of carbonated water upon gastric and cardiac activities and fullness in healthy young women. [2019]Although previous reports suggested that carbonated water drinking was effective against gastrointestinal symptoms, there is little information about the effects of carbonated water on gastric and appetite sensation. We therefore investigated the effect of carbonated water on short-term fullness with respect to gastric and cardiac responses in 19 healthy young women. Each subject was tested on three separate days at approximately 9 a.m. after an overnight fast. Gastric motility, evaluated by electrogastrography (EGG) and heart rate (HR), was measured for 20 min in the fasting state and 40 min after ingestion of water. Preloads consisted of an equivalent amount (250 mL) of water (W) or carbonated water (CW) and no drinking (blank). Fullness scores were measured using visual analog scales. To determine gastric motility, we assessed the component of bradygastria (1-2 cycles/min [cpm]), normogastria (2-4 cpm), tachygastria (4-9 cpm), and dominant frequency of the EGG power spectrum. After ingestion of CW, significant increases in fullness scores were observed compared with W. All postprandial EGG powers were significantly greater than preprandial, but no group difference was found. However, a dominant frequency tended to shift toward a lower band after ingestion of W. A significantly higher HR was found following consumption of CW as opposed to W. Multiple regression analysis revealed that increased HR was a significant variable contributing to the variances in fullness after ingestion of CW at 40 min. Our data suggest that CW may induce a short-term, but significant, satiating effect through enhanced postprandial gastric and cardiac activities due possibly to the increased sympathetic activity and/or withdrawal of parasympathetic activity.
Sodium paradoxically reduces the gastropressor response in patients with orthostatic hypotension. [2016]Orthostatic hypotension (OH) can cause syncope that is difficult to treat. We have found that 473 mL (16 oz) of water can increase systolic blood pressure (SBP) by > 30 mm Hg in many OH patients (the gastropressor response). OH patients are routinely advised to increase their sodium intake to augment their blood volume. We tested the hypothesis that the ingestion of salt with water would increase the magnitude of the acute pressor response compared with water alone in patients with OH. Patients with OH (n = 9; female = 5; 65+/-3 years) underwent a randomized crossover trial of drinking water (H2O) and salt water (NaCl-H2O). Noninvasive heart rate and BP were measured with the patient seated for > or = 60 minutes after ingestion. The area under the curve for SBP was greater with H2O than NaCl-H2O for the 30 minutes (714+/-388 mm Hg x min versus 364+/-369 mm Hg x min; P = 0.002) and 60 minutes (1454+/-827 mm Hg x min versus 812+/-734 mm Hg x min; P = 0.048) after ingestion. The increase in SBP with H2O was greater than with NaCl-H2O at 30 minutes (37+/-6 versus 18+/-5 mm Hg; P = 0.006) but not at 60 minutes (17+/-6 versus 10+/-6 mm Hg; P = 0.4). Norepinephrine increased after H2O (P = 0.018) but not after NaCl-H2O (P = 0.195). Both oral water and salt water increase BP in patients with OH. Instead of augmenting the gastropressor response, the additional salt paradoxically attenuates the pressor response to water. These data suggest a potentially important role for gastrointestinal osmolality in the activation of the sympathetic nervous system leading to cardiovascular reflexes responsible for the gastropressor response.
The effect of a 473-mL (16-oz) water drink on vasovagal donor reaction rates in high-school students. [2022]Recent clinical studies found that a water drink prevented orthostatic hypotension in healthy subjects subjected to a tilt-table test. A water drink was tested as a method to decrease vasovagal donor reactions in high-school students.