Plasma Catecholamine Responses to Change of Posture in Alcoholics during Withdrawal and after Continued Abstinence from Alcohol

Abstract

Plasma catecholamine, blood pressure and heart rate responses to standing were measured in 10 alcoholics during withdrawal, 10 alcoholics after 2-7 wk of abstinence from alcohol, 6 abstinent alcoholics with orthostatic hypotension and 10 normal control subjects. Withdrawing alcoholics had supine and standing heart rates and plasma noradrenaline [norepinephrine, NE] and adrenaline [epinephrine, E] concentrations that were higher than in abstinent alcoholics or control subjects. Supine blood pressures were also higher in withdrawing alcoholics than in abstinent alcoholics or control subjects, but on standing blood pressures in withdrawing alcoholics fell, 4 patients having a fall of > 30/5 mm Hg. Abstinent alcoholics without orthostatic hypotension had higher basal and standing concentrations of NE than control subjects but normal heart rates and E concentrations. Abstinent alcoholics with orthostatic hypotension showed a wide range of basal plasma NE concentrations and were found to have variable plasma NE responses to standing, 3 subjects having normal responses and 3 subjects having little or no increase in plasma NE on standing. Alcohol withdrawal evidently is associated with increased sympathetic nervous activity, as reflected by raised supine and standing plasma concentrations of catecholamines. Even after 2-7 wk of abstinence from alcohol, plasma NE concentrations may be higher than in control subjects. Despite increased sympathetic nervous responses to standing, alcoholics during withdrawal have impaired blood pressure control and some may exhibit orthostatic hypotension. Orthostatic hypotension may also be observed in alcoholics during continuing abstinence from alcohol; in some of these patients failure of reflex NE release in response to standing may contribute to orthostatic hypotension.