Carbonated Water for Orthostatic Hypotension

Overseen By Vera-Ellen M Lucci, PhD

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: Simon Fraser University

Disqualifiers: Pregnancy, Cardiovascular, Neurological, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

Duration: 1 week

25 Participants Needed

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. ^{1 2 3 4 5}

Is 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. ^{4 5 6 7 8}

How 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. ^{2 3 4 5 7}

Research Team

Victoria E Claydon, PhD

Principal Investigator

Professor, Biomedical Physiology and Kinesiology

Eligibility 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

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

Treatment Details

Interventions

• Water Carbonation

Trial Overview 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.

Participant Groups

Group I: 50mL still water first, then 500mL still water, then 500 mL carbonated water Experimental Treatment 3 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 water Experimental Treatment 3 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 water Experimental Treatment 3 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 water Experimental Treatment 3 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 water Experimental Treatment 3 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 water Experimental Treatment 3 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.

Who Is Running the Clinical Trial?

Simon Fraser University

Lead Sponsor

Trials

59

Recruited

12,500+

Findings from Research

Both nonpharmacologic and pharmacologic treatments can effectively reduce symptoms of orthostatic hypotension, with new strategies emerging based on recent insights into the condition's underlying mechanisms.

Patients with severe autonomic failure may benefit significantly from simple interventions like drinking water, which can trigger a strong blood pressure response, highlighting the importance of personalized treatment approaches.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

New trends in the treatment of orthostatic hypotension. Jordan, J.[2019]

Drinking water can significantly help patients with autonomic failure by increasing blood pressure and reducing symptoms of severe orthostatic hypotension, making it a simple and effective treatment option.

In patients with orthostatic intolerance, water drinking reduces heart rate increases but has a limited effect on blood pressure, suggesting that the cardiovascular response involves sympathetic activation, although the exact mechanism remains unclear.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acute effect of water on blood pressure. What do we know? Jordan, J.[2007]

Drinking 480 mL of water significantly increased blood pressure in patients with severe orthostatic hypotension due to autonomic failure, demonstrating a rapid pressor response that can be beneficial for treatment.

In patients with idiopathic orthostatic intolerance, water drinking not only helped raise blood pressure but also reduced heart rate during episodes of orthostatic tachycardia, suggesting it could be a useful adjunctive therapy for managing these conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Water drinking as a treatment for orthostatic syndromes. Shannon, JR., Diedrich, A., Biaggioni, I., et al.[2019]

In a study involving 13 healthy subjects, drinking 500 mL of water significantly improved orthostatic tolerance by an average of 5 minutes, indicating that hydration can enhance the body's ability to handle changes in posture.

The improvement in orthostatic tolerance was linked to increased blood pressure and better regulation of cerebral blood flow, suggesting that water drinking elicits beneficial hemodynamic changes in healthy individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Water drinking acutely improves orthostatic tolerance in healthy subjects. Schroeder, C., Bush, VE., Norcliffe, LJ., et al.[2019]

Drinking cold or cold carbonated water significantly increases blood pressure more than room temperature water in both younger (average age 19.9) and older adults (average age 71.4), with the effect being stronger in older adults.

The pressor response from drinking cold and carbonated water is not only immediate but also persists during the recovery period, suggesting it could be an effective first aid method for managing acute hypotension.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Pressor Response to the Drinking of Cold Water and Cold Carbonated Water in Healthy Younger and Older Adults. Kubota, S., Endo, Y., Kubota, M., et al.[2022]

In a study involving 19 healthy young women, drinking carbonated water (CW) significantly increased feelings of fullness compared to regular water (W), suggesting a short-term satiating effect.

The consumption of CW also resulted in a higher heart rate, indicating that the satiating effect may be linked to increased sympathetic nervous system activity, which could enhance gastric and cardiac responses.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of carbonated water upon gastric and cardiac activities and fullness in healthy young women. Wakisaka, S., Nagai, H., Mura, E., et al.[2019]

In a study of 9 patients with orthostatic hypotension, drinking plain water significantly increased systolic blood pressure (SBP) more than drinking salt water, suggesting that water alone is more effective for managing blood pressure in these patients.

The addition of salt to water actually reduced the blood pressure response, indicating that gastrointestinal osmolality may play a crucial role in activating the sympathetic nervous system and enhancing the gastropressor response.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sodium paradoxically reduces the gastropressor response in patients with orthostatic hypotension. Raj, SR., Biaggioni, I., Black, BK., et al.[2016]

A study involving 8,894 high-school blood donations found that providing a 473-mL water drink significantly reduced the rate of vasovagal reactions during donations, with a 21% decrease in reactions compared to those who did not receive water.

The most notable benefits were observed in Caucasian, first-time donors, and the water drink did not interfere with the donation process, making it an easy and effective intervention for improving donor safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of a 473-mL (16-oz) water drink on vasovagal donor reaction rates in high-school students. Newman, B., Tommolino, E., Andreozzi, C., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

New trends in the treatment of orthostatic hypotension. [2019]

2. Germany pubmed.ncbi.nlm.nih.gov

Acute effect of water on blood pressure. What do we know? [2007]

3. United States pubmed.ncbi.nlm.nih.gov

Water drinking as a treatment for orthostatic syndromes. [2019]

4. United States pubmed.ncbi.nlm.nih.gov

Water drinking acutely improves orthostatic tolerance in healthy subjects. [2019]

5. Switzerland pubmed.ncbi.nlm.nih.gov

The Pressor Response to the Drinking of Cold Water and Cold Carbonated Water in Healthy Younger and Older Adults. [2022]

6. Japan pubmed.ncbi.nlm.nih.gov

The effects of carbonated water upon gastric and cardiac activities and fullness in healthy young women. [2019]

7. United States pubmed.ncbi.nlm.nih.gov

Sodium paradoxically reduces the gastropressor response in patients with orthostatic hypotension. [2016]

8. United States pubmed.ncbi.nlm.nih.gov

The effect of a 473-mL (16-oz) water drink on vasovagal donor reaction rates in high-school students. [2022]