(r)Alpha Lipoic Assists With Control of Neurogenic Orthostatic Hypotension, Hypertension, and Reduces Sudden Cardiac Death in Geriatric Diabetics

Background: 10-30% of people have Orthostatic Hypotension (OH), 1/3rd of the world’s population has Hypertension (HTN), and Sudden Cardiac Death (SCD) is twice as common and the most frequent manner of death in Type 2 diabetes (DM II), all of which can involve oxidative stress. Objective: To study the effect of the potent, natural antioxidant (r)Alpha Lipoic Acid in (1) neurogenic OH (NOH), (2) HTN, and (3) DMII SCD. Methods:(1) A cohort of 109 patients with low sympathetic tone(S) upon standing was detected using the ANX-3.0, Autonomic Monitor Physio PS, Inc., Atlanta GA USA. From the cohort, 29 patients demonstrated neurogenic orthostatic hypotension (NOH) (change in (Δ) standing BP –20/–10 mmHg) and 60 patients demonstrated orthostatic intolerance (OI, Δ standing systolic BP between –6 and–19 mm Hg). These 89 were given ALA orally: either 590 to 788 mg (r) ALA or 867 to 1500 mg of the less expensive 50 to 50% mixture (r) ALA and inactive (s)ALA. Changes in their S and parasympathetic tone (P), and BPs, were compared with 20 control patients during mean follow-up of 2.28 years. (2) 46 uncontrolled HTN patients were randomized to P&S-assisted management, vs. JNC 8 therapy using the ANX 3.0 Autonomic Monitor and adding (r) Alpha Lipoic Acid (Group 1) vs. JNC 8 (Group 2). (3) 133 patients (mean age 66y/o) with diabetic autonomic neuropathy (DAN) or cardiac autonomic neuropathy (CAN) were offered (r) ALA:: 83 agreed (Group 1 ):50 refused (Group 2). S and P-were re-measured up to 3 times/yr. (mean f/u 6.31 yrs.); SCDs were recorded. Results: (1) Nineteen of 29 (66%) NOH patients responded with a Δ standing BP from –28/–6 mm Hg to 0/+2 mm Hg. Forty of 60 (67%) of patients with OI responded with a Δ standing BP of –9/+1 mm Hg to 6/+2 mm Hg. Although all patients treated with ALA increased S tone, the Δ BP depended upon the pretreatment of S tone. Those with the lowest S tone responded the least well. (2) The two Groups were similar in: (1) age (mean 66 vs. 70 y/o for Groups 1 and 2, respectively; (2) initial resting home Blood Pressure (BP, Group 1 mean=162/90 mmHg vs. Group 2 mean=166/87 mmHg), (3) initial resting office BP(BP, Group 1 mean=151/75 mmHg vs. Group 2 mean=155/73 mmHg), and (4) ethnicity. Upon follow-up (mean=8.35 mo.): (1) mean resting home BPs were 145/77 mmHg (Group 1, 74% of patients at JNC 8 goal) vs. 155/83.5 mmHg (Group 2, 30.4% at JNC 8 goal), and (2) mean resting office BPs were 138/71 mmHg (Group 1) vs. 146/65 mmHg (Group 2). At the study’s conclusion, Group 1 S tone was lower than Group 2 at rest, and Group 1 P tone higher than that for Group 2 both at rest and upon standing . (3) A 43% Relative Risk Reduction (RRR) in SCD occurred with (r) ALA (25% SCD Group 1 vs. 44% SCD Group 2, p=0.0076). Conclusions: ALA is useful in NOH, HTN, and reduces DMII SCD. Citation: Gary L Murray. (2020) (r)Alpha Lipoic Assists With Control of Neurogenic Orthostatic Hypotension, Hypertension, and Reduces Sudden Cardiac Death in Geriatric Diabetics. Int J Pharm Sci Clin Pharm 1(1): 32-52. https://doi.org/10.47890/IJPSCP/GaryLMurray/2020/24148305 *Corresponding author: Gary L Murray, Director of research, The Heart and Vascular Institute, Germantown, TN, USA. Email:drglmurray@hotmail.com. International Journal of Pharmaceutical Sciences and Clinical Pharmacy https://journalofpharma.com Helics Group 33