Water Drinking to Prevent Orthostatic Hypotension and Neurally Mediated Syncope: Mechanisms and Benefits

  • C. J. Mathias
  • T. M. Young
Conference paper


Water drinking is now recognized as having pressor effects even in normal subjects. In young subjects there is no change in blood pressure after water drinking, but in older subjects there is a rise in systolic blood pressure [1]. An even greater rise-in some cases over 30 mmHg-occurs in patients with orthostatic hypotension due to chronic autonomic failure (Fig. 1) [2]. Water alone, therefore, has appreciable cardiovascular effects in both normal and diseased man. The mechanisms of the pressor response remain unclear. Recognition of these effects of water is of importance in studies of cardiovascular and autonomic function. This review relates to the physiology and pathophysiology of water drinking, its ability to reduce orthostatic hypotension in autonomie failure, and its potential benefit when intermittent autonomie dysfunction causes orthostatic intolerance or syncope.


Pressor Response Multiple System Atrophy Muscle Sympathetic Nerve Activity Autonomic Failure Lower Body Negative Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Jordan J, Shannon JR, Grogan E, Biaggioni I, Robertson D (1999) A potent pressor response elicited by drinking water. Lancet 353:723PubMedCrossRefGoogle Scholar
  2. 2.
    Cariga P, Mathias CJ (2001) Human sympathetic denervation due to autonomic failure. Clin Sci 101:313–319PubMedCrossRefGoogle Scholar
  3. 3.
    Jordan J, Shannon JR, Black BK et al (2000) The pressor response to water drinking in humans: a sympathetic reflex? Circulation 101:504–509PubMedCrossRefGoogle Scholar
  4. 4.
    Scott EM, Greenwood JP, Gilbey SG, Stoker JB, Mary DA (2001) Water ingestion increases sympathetic vasoconstrictor discharge in normal human subjects. Clin Sci (Colch) 100:335–342CrossRefGoogle Scholar
  5. 5.
    Endo Y, Yamauchi K, Tsutsui Y et al (2002) Changes in blood pressure and muscle sympathetic nerve activity during water drinking in humans. Jap J Physiol 52:421–427CrossRefGoogle Scholar
  6. 6.
    Mathias CJ (2000) Disorders of the autonomie nervous system. In: WG Bradley, RB Daroff, GM Fenichel, CD Marsden (eds) Neurology in clinical practice, 3rd edn. Butterworth-Heinemann, Boston, USA, pp 2131–2165Google Scholar
  7. 7.
    Young TM, Mathias CJ (2003) Water ingestion and haemodynamic responses while seated and standing in subjects with chronic autonomie failure. Clin Autonom Res 13:122–123 (abs)Google Scholar
  8. 8.
    Rossi P, Andriesse GI, Oey PL et al (1998) Stomach distension increases efferent muscle sympathetic nerve activity and blood pressure in healthy humans. J Neurol Sci 161:148–155PubMedCrossRefGoogle Scholar
  9. 9.
    Mathias CJ, Frankel H (2002) Autonomie disturbances in spinal cord lesions. In: Mathias CJ, Bannister R (eds) Autonomie failure: a textbook of clinical disorders of the autonomie nervous system, 4th edn. Oxford University Press, Oxford, pp 494–513Google Scholar
  10. 10.
    Mathias CJ, Christensen NJ, Corbett JL, Frankel HL, Spalding JMK (1976) Plasma catecholamines during paroxysmal neurogenic hypertension in quadriplegic man. Circ Res 39:204–208PubMedCrossRefGoogle Scholar
  11. 11.
    Mathias CJ, Frankel HL, Christensen NJ, Spalding JMK (1976) Enhanced pressor response to noradrenaline in patients with cervical spinal cord transection. Brain 99:757–770PubMedCrossRefGoogle Scholar
  12. 12.
    DiBona GF, Wilcox CS (2002) The kidney and the sympathetic nervous system. In: Mathias CJ, Bannister R (eds) autonomie failure: a textbook of clinical disorders of the autonomie nervous system, 4th edn. Oxford University Press, Oxford, pp 143–150Google Scholar
  13. 13.
    Schalekamp MADH, Man in’t Veld AJ, Wenning GJ (1985) The second Sir George Pickering Memorial Lecture: What regulates whole body autoregulation? Clinical observations. J Hypertens 3:97–107PubMedCrossRefGoogle Scholar
  14. 14.
    Kooner JS, da Costa DF, Edge W, Frankel HL, Bannister R, Peart WS, Mathias CJ (1987) Recumbency induces hypertension, diuresis and natriuresis in autonomic failure but diuresis alone in tetraplegia. J Hypertens 5[Suppl 5]:327–329CrossRefGoogle Scholar
  15. 15.
    Mathias CJ, Fosbraey P da Costa DF, Thornley A, Bannister R (1986). The effect of desmopressin on nocturnal polyuria, overnight weight loss and morning postural hypotension in patients with autonomic failure. Br Med J 293:353–354Google Scholar
  16. 16.
    Mathias CJ, Young TM (2003) Plugging the leak-benefits of the vasopressin-2 agonist, desmopressin in autonomie failure. Clin Autonom Res 13:85–87CrossRefGoogle Scholar
  17. 17.
    Mathias CJ, da Costa DF, McIntosh CM et al (1989) Differential blood pressure and hormonal effects following glucose and xylose ingestion in chronic autonomie failure. Clin Sci 77:85–92PubMedGoogle Scholar
  18. 18.
    Mathias CJ (2000) A 21st century water cure. Lancet 356:1046–1048PubMedCrossRefGoogle Scholar
  19. 19.
    Shannon JR, Diedrich A, Biaggioni I et al (2002) Water drinking as a treatment for orthostatic syndromes. Am J Med 112:355–360PubMedCrossRefGoogle Scholar
  20. 20.
    Mathias CJ (2002) To stand on one’s own legs. Clin Med 2:237–245PubMedGoogle Scholar
  21. 21.
    Younoszai AK, Franklin WH, Chan DP, Cassidy SC, Allen HD (1998) Oral fluid therapy. A promising treatment for vasodepressor syncope. Arch Pediatr Adolesc Med 152:163–168Google Scholar
  22. 22.
    Schroeder C, Bush VE, Norcliffe LJ et al (2002) Water drinking acutely improves orthostatic tolerance in healthy subjects. Circulation 106:2806–2811PubMedCrossRefGoogle Scholar
  23. 23.
    Mathias CJ, Deguchi K, Schatz I (2001) Observations on recurrent syncope and pre-syncope in 641 patients. Lancet 357:348–353PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2004

Authors and Affiliations

  • C. J. Mathias
    • 1
    • 2
    • 3
  • T. M. Young
    • 1
    • 2
    • 3
  1. 1.Neurovascular Medicine UnitImperial College London at St Mary’s HospitalLondonUK
  2. 2.Autonomic UnitNational Hospital for Neurology and NeurosurgeryLondonUK
  3. 3.Institute of NeurologyUniversity College LondonLondonUK

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