Journal articles on the topic 'Orthostatic hypotension (OH)'
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1
Listratov, A. I., O. D. Ostroumova, E. V. Aleshkovich, and M. S. Chernyaeva. "Drug-induced orthostatic hypotension." Medical alphabet, no. 3 (April 15, 2022): 14–22. http://dx.doi.org/10.33667/2078-5631-2022-3-14-22.
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Orthostatic hypotension (OH) is one of the most significant symptoms in clinical practice. The development of OH in the short term is associated with such consequences as falls, decreased adherence to treatment, in the long term, OH is associated with dementia and an increase in overall mortality. One of the leading factors in the development of OH is drugs in this case, the term ‘drug-induced’ (DI) OH is used. The leading drugs that induce this symptom include antihypertensive drugs, vasodilators, as well as alpha-blockers and antidepressants. The risk factors for DI OH are old age, concomitant diseases, in particular arterial hypertension (AH). The question of OH in patients with AH is difficult. Оn the one hand, AH is a risk factor for OH, in addition, antihypertensive drugs are inducers of OH and an increase in the amount of antihypertensive drugs can lead to an increase in the risk of developing OH. On the other hand, optimal therapy for AH on the contrary, leads to a decrease in the severity of OH. The basis of the treatment of DI OH is the correction of therapy with the drug withdrawal or replacement. The leading methods of prevention and treatment are non-pharmacological, requiring the active participation of the patient – a certain algorithm for accepting an upright position, changing eating behavior and counter maneuvers. Pharmacological therapies play a minor role. Informing doctors, as well as the patients themselves, about the problem of DI OH plays an important role in the prevention of its consequences.
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Aksenova, A. V., Sh B. Gorieva, A. N. Rogoza, O. A. Sivakova, T. E. Esaulova, and I. E. Chazova. "State of the art for diagnosis and treatment of orthostatic hypotension." Systemic Hypertension 15, no. 2 (June 15, 2018): 32–42. http://dx.doi.org/10.26442/2075-082x_2018.2.32-42.
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This paper presents state of the art of the problem of diagnosis and treatment of orthostatic hypotension (OH). It focuses on the developed algorithms for diagnostics of classical orthostatic hypotension (COH), initial orthostatic hypotension (IOH) and delayed orthostatic hypotension (DOH). It describes the necessary methods for the differential diagnosis of the OH causes. Comparative analysis of the European Society of Cardiology and American College of Cardiology/American Heart Association/Society of Cardiac Rhythm was performed. The treatment options for different groups of patients with orthostatic hypotension are described.
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Hiorth, Ylva Hivand, Kenn Freddy Pedersen, Ingvild Dalen, Ole-Bjørn Tysnes, and Guido Alves. "Orthostatic hypotension in Parkinson disease." Neurology 93, no. 16 (September 16, 2019): e1526-e1534. http://dx.doi.org/10.1212/wnl.0000000000008314.
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ObjectiveTo determine the frequency, evolution, and associated features of orthostatic hypotension (OH) over 7 years of prospective follow-up in a population-based, initially drug-naive Parkinson disease (PD) cohort.MethodsWe performed repeated lying and standing blood pressure measurements in 185 patients with newly diagnosed PD and 172 matched normal controls to determine the occurrence of (1) OH using consensus-based criteria and (2) clinically significant OH (mean arterial pressure in standing position ≤75 mm Hg). We applied generalized estimating equations models for correlated data to investigate associated features of these 2 outcomes in patients with PD.ResultsOH was more common in patients with PD than controls at all visits, with the relative risk increasing from 3.0 (95% confidence interval [CI] 1.6–5.8; p < 0.001) at baseline to 4.9 (95% CI 2.4–10.1; p < 0.001) after 7 years. Despite a high cumulative prevalence of OH (65.4%) and clinically significant OH (29.2%), use of antihypotensive drugs was very rare (0.5%). OH was independently associated with older age (odds ratio [OR] 1.06 per year; 95% CI 1.03–1.10), lower Mini-Mental State Examination score (OR 0.91 [0.85–0.97] per unit), and longer follow-up time (OR 1.12 [1.03–1.23] per year). Clinically significant OH was associated with the same characteristics, in addition to higher levodopa equivalent dosage (OR 1.16 [1.07–1.25] per 100 mg).ConclusionsIn this population-based study, we found OH to be a very frequent but undertreated complication in early PD, with associations to both disease-specific symptoms and drug treatment. Our findings suggest that clinicians should more actively assess and manage OH abnormalities in PD.
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Schell, Kathleen, Denise Lyons, and Barry Bodt. "Orthostatic Hypotension and Falls in Hospitalized Older Adults." Clinical Nursing Research 30, no. 5 (January 10, 2021): 699–706. http://dx.doi.org/10.1177/1054773820986682.
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The aim of this retrospective study was to determine the prevalence of orthostatic hypotension (OH) among a convenience sample of older adults on two Acute Care of the Elderly (ACE) units of the ChristianaCare™ in Delaware. Another aim was to determine if subjects with documented OH experienced falls. Retrospective de-identified data was obtained from electronic medical records for the years 2015 to 2018. Among all patients who had valid first orthostatic vital sign (OVS) readings ( n = 7,745), 39.2% had orthostatic hypotension on the first reading. Among the patients, 42.8% were found to be hypotensive during OVS. Thirty-one (0.9%) of those with OH fell at some point during their stay. The odds ratio for falls in the presence of OH was 1.34 with a 95% confidence interval (0.82, 2.21), but a chi-square test failed to find significance ( p = .2494). The results could not determine if OVS should be mandatory in fall prevention protocols.
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Mar, Philip L., Cyndya A. Shibao, Emily M. Garland, Bonnie K. Black, Italo Biaggioni, André Diedrich, Sachin Y. Paranjape, David Robertson, and Satish R. Raj. "Neurogenic hyperadrenergic orthostatic hypotension: a newly recognized variant of orthostatic hypotension in older adults with elevated norepinephrine (noradrenaline)." Clinical Science 129, no. 2 (April 24, 2015): 107–16. http://dx.doi.org/10.1042/cs20140766.
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Neurogenic hyperadrenergic orthostatic hypotension (hyperOH) is neurogenic orthostatic hypotension (OH) that is associated with paradoxically elevated levels of norepinephrine (NE) (noradrenaline). This condition has not been extensively studied. Our study finds this population has less severe adrenergic dysfunction compared with classic OH populations.
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Shibao, Cyndya A., and Italo Biaggioni. "Management of Orthostatic Hypotension, Postprandial Hypotension, and Supine Hypertension." Seminars in Neurology 40, no. 05 (October 2020): 515–22. http://dx.doi.org/10.1055/s-0040-1713886.
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AbstractThis review provides recommendations for the treatment of neurogenic orthostatic hypotension (nOH), postprandial hypotension, and supine hypertension. It focuses on novel treatment strategies and new insights into the mechanism underlying these conditions. Our goal is to provide practical advice for clinicians on how to screen, diagnose, and treat these conditions with nonpharmacological and pharmacological approaches. For each disorder, we offered a stepwise recommendation on how to apply these new concepts to successfully ameliorate the symptoms associated with OH to prevent syncope and falls. The management of OH in patients who also have supine hypertension requires special considerations and pharmacotherapy. It is noteworthy that there are few therapeutic options for OH and only two Food and Drug Administration–approved drugs for the treatment of OH and nOH based on randomized clinical trials. We will use these studies to develop evidence-based guidelines for OH. The research is limited for postprandial hypotension and supine hypertension, and therefore the recommendations will be based on small studies, clinical expertise, and, above all, an understanding of the underlying pathophysiology.
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O'Brien, Michelle, Jennifer Britton, Miriam Clarke, and Orla Collins. "226 Staff Knowledge of Orthostatic Hypotension." Age and Ageing 48, Supplement_3 (September 2019): iii17—iii65. http://dx.doi.org/10.1093/ageing/afz103.136.
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Abstract Background The prevalence of orthostatic hypotension increases with age(1). The aim of this audit was to assess healthcare provider’s knowledge of identifying and measuring orthostatic hypotension (OH) in the acute setting. Early identification and management of OH is an important step to prevent adverse outcomes and improve patient’s overall functional performance. Methods Fifty-one questionnaires were distributed to a random selection of non-consultant doctors and nurses in our hospital. The questionnaires included questions regarding basic knowledge of OH and its measurement. Questions were based on international guidelines on the appropriate measurement and assessment of OH(1). An education session was then offered to junior doctors and nurses, and subsequently carried out by a senior nurse. Staff were educated on OH and how to correctly assess it. Doctors and nurses were subsequently reassessed using the same questionnaire. Results Initial results showed that many of the respondents were interns (37%) and nurses (35%). 94% of respondents had never received formal training in the evaluation of OH. 51% knew that a patient should lie supine for 5 minutes prior to initial BP assessment. 61% knew to take the BP at 1-minute post standing, and 45% knew that the BP should again be taken at 3 minutes. 71% knew to take the pulse alongside the BP checks. The education sessions and repeat audit are ongoing. Conclusion Many of the hospital staff who assess for OH have not received specific training on how to evaluate and diagnose OH. It is our aim to educate front line staff as to the importance of looking for OH and how to diagnose it.
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Park, Kee Hong. "Diagnosis of orthostatic hypotension in older people." Journal of Geriatric Neurology 1, no. 2 (September 15, 2022): 45–52. http://dx.doi.org/10.53991/jgn.2022.00094.
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Orthostatic hypotension (OH) can be classified to classic OH, delayed OH, initial OH, and delayed blood pressure recovery. It causes various symptoms such as lightheadedness, dizziness, visual blurring, and fall. Furthermore, the importance of OH is emphasized because it increases morbidity and mortality, especially in the elderly. Because neurogenic and non-neurologic components cause OH, an appropriate diagnosis is required to differentiate it.
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Fanciulli, Alessandra, Fabian Leys, Cristian Falup-Pecurariu, Roland Thijs, and Gregor K. Wenning. "Management of Orthostatic Hypotension in Parkinson’s Disease." Journal of Parkinson's Disease 10, s1 (September 1, 2020): S57—S64. http://dx.doi.org/10.3233/jpd-202036.
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Orthostatic hypotension (OH) is a common non-motor feature of Parkinson’s disease that may cause unexplained falls, syncope, lightheadedness, cognitive impairment, dyspnea, fatigue, blurred vision, shoulder, neck, or low-back pain upon standing. Blood pressure (BP) measurements supine and after 3 minutes upon standing screen for OH at bedside. The medical history and cardiovascular autonomic function tests ultimately distinguish neurogenic OH, which is due to impaired sympathetic nerve activity, from non-neurogenic causes of OH, such as hypovolemia and BP lowering drugs. The correction of non-neurogenic causes and exacerbating factors, lifestyle changes and non-pharmacological measures are the cornerstone of OH treatment. If these measures fail, pharmacological interventions (sympathomimetic agents and/or fludrocortisone) should be introduced stepwise depending on the severity of symptoms. About 50% of patients with neurogenic OH also suffer from supine and nocturnal hypertension, which should be monitored for with in-office, home and 24 h-ambulatory BP measurements. Behavioral measures help prevent supine hypertension, which is eventually treated with non-pharmacological measures and bedtime administration of short-acting anti-hypertensive drugs in severe cases. If left untreated, OH impacts on activity of daily living and increases the risk of syncope and falls. Supine hypertension is asymptomatic, but often limits an effective treatment of OH, increases the risk of hypertensive emergencies and, combined with OH, facilitates end-organ damage. A timely management of both OH and supine hypertension ameliorates quality of life and prevents short and long-term complications in patients with Parkinson’s disease.
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Soysal, Pinar, Suleyman Emre Kocyigit, Ozge Dokuzlar, Esra Ates Bulut, Lee Smith, and Ahmet Turan Isik. "Relationship between sarcopenia and orthostatic hypotension." Age and Ageing 49, no. 6 (July 2, 2020): 959–65. http://dx.doi.org/10.1093/ageing/afaa077.
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Abstract Background The relationship between sarcopenia and orthostatic hypotension (OH) is unclear. Objectives The aim of the present study was to investigate associations between sarcopenia/sarcopenia severity and OH. Design A total of 511 patients attending a geriatric outpatient clinic were included. OH was defined as a decrease in systolic and/or diastolic blood pressure of ≥ 20 mmHg and/or ≥ 10 mmHg, respectively, when one transitions from the supine to an upright position. OH was measured by the Head-up Tilt Table test at 1, 3 and 5 min (OH1, OH3 and OH5, respectively). Sarcopenia and its severity were defined according to the revised European consensus on definition and diagnosis. Results The mean age of the sample was 75.40 ± 7.35 years, and 69.9% were female. The prevalence of probable sarcopenia, sarcopenia and severe sarcopenia was 42.2%, 6.06% and 11.1%, respectively. After adjustment for all covariates, systolic OH1, OH1 and systolic OH5 were statistically significantly different between severe sarcopenia and the robust group (odds ratio [OR]: 3.26, confidence interval [CI] 0.98–10.84; P = 0.05 for systolic OH1; OR 4.31, CI 1.31–14.15; P = 0.016 for OH1; OR 4.09, CI 1.01–16.55; P = 0.048 for systolic OH5). Only systolic OH1 was statistically different between the sarcopenia and severe sarcopenia groups (OR 2.64, CI 1.87–8.73; P = 0.012). OH1 and OH5 were statistically significant different between severe sarcopenia and probable sarcopenia groups (P < 0.05); there was no relationship between the robust group and probable sarcopenia (P > 0.05). Conclusions There is a close relationship between sarcopenia and severe sarcopenia and OH in older adults. Therefore, when a healthcare practitioner is evaluating an older patient with sarcopenia, OH should also be evaluated, and vice versa.
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Antropova, O. N., I. V. Osipova, and G. G. Efremushkin. "Orthostatic hypotension and atrial fibrillation: is there a relationship?" "Arterial’naya Gipertenziya" ("Arterial Hypertension") 27, no. 4 (October 20, 2021): 409–14. http://dx.doi.org/10.18705/1607-419x-2021-27-4-409-414.
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Orthostatic hypotension (OH), a possible marker of autonomic dysfunction, reflects the inability of reflex cardiovascular mechanisms to compensate for the fall in venous return in the upright position. This is a manifestation of structural and functional abnormalities of the cardiovascular system. Significance of the orthostatic hypotension is underestimated, while it is associated with all-cause mortality and cardiovascular disease. The article reviews the relationship between atrial fibrillation (AF) and OH. The pathogenetic mechanisms of OH are considered, including various subgroups, e. g. elderly patients. The article also discusses the relationship between OH, AF and cerebrovascular complications. Available evidence suggests that impaired orthostatic hemodynamic response should be considered as a new risk factor for AF. Further research is needed for better understanding of the association between AF and OH, as well as their management.
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Tasic, Danijela, Nebojsa Tasic, Dalibor Dragisic, and Miroslav Mitrovic. "Orthostatic Hypotension and Therapy with an Ace Inhibitor in Hypertensive Patients." Serbian Journal of Experimental and Clinical Research 18, s1 (September 26, 2017): 61–66. http://dx.doi.org/10.1515/sjecr-2017-0035.
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Abstract Orthostatic hypotension (OH) is defined as a drop in the systolic blood pressure greater than 20 mmHg and that of the diastolic blood pressure greater than 10 mmHg within 3 minutes from the change of the body’s position from lying or sitting down to standing up. The objective of this study is to analyse the incidence and severity of orthostatic hypertension when taking one of the generic representatives of the ACE inhibitor group (trandolapril) as a monotherapy in patients with essential hypertension. Th e study involved 314 patients (medium age of 54±4 years; 52.5% men) with poorly regulated hypertension for whom trandolapril was introduced as monotherapy. Th e incidence rates of patients with and without orthostatic hypotension between the first and second examination were not statistically significantly different. At the second control examination, 7 patients (2,3%) still had orthostatic hypotension, as was the case at the first examination. Between the third and fourth controls, a statistically significant decrease in the number of patients with orthostatic hypotension was recorded. No statistically significant difference in the incidence of orthostatic hypotension between patients with normal body mass and those who were overweight was observed. Our study has shown that certain ACE inhibitors, such as Trandolapril, do not have a pronounced adverse effect with regard to orthostatic hypotension and that in long-term application, they can have a positive role in the prevention of hypotensive episodes and improving patient compliance.
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Juraschek, Stephen P., Addison A. Taylor, Jackson T. Wright, Gregory W. Evans, Edgar R. Miller, Timothy B. Plante, William C. Cushman, et al. "Orthostatic Hypotension, Cardiovascular Outcomes, and Adverse Events." Hypertension 75, no. 3 (March 2020): 660–67. http://dx.doi.org/10.1161/hypertensionaha.119.14309.
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Orthostatic hypotension (OH) is frequently observed with hypertension treatment, but its contribution to adverse outcomes is unknown. The SPRINT (Systolic Blood Pressure Intervention Trial) was a randomized trial of adults, age ≥50 years at high risk for cardiovascular disease with a seated systolic blood pressure (BP) of 130 to 180 mm Hg and a standing systolic BP ≥110 mm Hg. Participants were randomized to a systolic BP treatment goal of either <120 or <140 mm Hg. OH was defined as a drop in systolic BP ≥20 or diastolic BP ≥10 mm Hg 1 minute after standing from a seated position. We used Cox models to examine the association of OH with cardiovascular disease or adverse study events by randomized BP goal. During the follow-up period (median 3years), there were 1170 (5.7%) instances of OH among those assigned a standard BP goal and 1057 (5.0%) among those assigned the intensive BP goal. OH was not associated with higher risk of cardiovascular disease events (primary outcome: hazard ratio 1.06 [95% CI, 0.78–1.44]). Moreover, OH was not associated with syncope, electrolyte abnormalities, injurious falls, or acute renal failure. OH was associated with hypotension-related hospitalizations or emergency department visits (hazard ratio, 1.77 [95% CI, 1.11–2.82]) and bradycardia (hazard ratio, 1.94 [95% CI, 1.19–3.15]), but these associations did not differ by BP treatment goal. OH was not associated with a higher risk of cardiovascular disease events, and BP treatment goal had no effect on OH’s association with hypotension and bradycardia. Symptomless OH during hypertension treatment should not be viewed as a reason to down-titrate therapy even in the setting of a lower BP goal. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT01206062.
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Hale, Genevieve M., Jose Valdes, and Michael Brenner. "The Treatment of Primary Orthostatic Hypotension." Annals of Pharmacotherapy 51, no. 5 (January 16, 2017): 417–28. http://dx.doi.org/10.1177/1060028016689264.
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Objective: To review the efficacy and safety of pharmacological and nonpharmacological strategies used to treat primary orthostatic hypotension (OH). Data Sources: A literature review using PubMed and MEDLINE databases searching hypotension, non-pharmacological therapy, midodrine, droxidopa, pyridostigmine, fludrocortisone, atomoxetine, pseudoephedrine, and octreotide was performed. Study Selection and Data Extraction: Randomized or observational studies, cohorts, case series, or case reports written in English between January 1970 and November 2016 that assessed primary OH treatment in adult patients were evaluated. Data Synthesis: Based on the chosen criteria, it was found that OH patients make up approximately 15% of all syncope patients, predominantly as a result of cardiovascular or neurological insults, or offending medication. Nonpharmacological strategies are the primary treatment, such as discontinuing offending medications, switching medication administration to bedtime, avoiding large carbohydrate-rich meals, limiting alcohol, maintaining adequate hydration, adding salt to diet, and so on. If these fail, pharmacotherapy can help ameliorate symptoms, including midodrine, droxidopa, fludrocortisone, pyridostigmine, atomoxetine, sympathomimetic agents, and octreotide. Conclusions: Midodrine and droxidopa possess the most evidence with respect to increasing blood pressure and alleviating symptoms. Pyridostigmine and fludrocortisone can be used in patients who fail to respond to these agents. Emerging evidence with low-dose atomoxetine is promising, especially in those with central autonomic failure, and may prove to be a viable alternative treatment option. Data surrounding other therapies such as sympathomimetic agents or octreotide are minimal. Medication management of primary OH should be guided by patient-specific factors, such as tolerability, adverse effects, and drug-drug and drug-disease interactions.
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Groothuis, J. T., R. A. J. Esselink, J. P. H. Seeger, M. J. H. van Aalst, M. T. E. Hopman, and B. R. Bloem. "Lower vascular tone and larger plasma volume in Parkinson's disease with orthostatic hypotension." Journal of Applied Physiology 111, no. 2 (August 2011): 443–48. http://dx.doi.org/10.1152/japplphysiol.00069.2011.
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The pathophysiology of orthostatic hypotension in Parkinson's disease (PD) is incompletely understood. The primary focus has thus far been on failure of the baroreflex, a central mediated vasoconstrictor mechanism. Here, we test the role of two other possible factors: 1) a reduced peripheral vasoconstriction (which may contribute because PD includes a generalized sympathetic denervation); and 2) an inadequate plasma volume (which may explain why plasma volume expansion can manage orthostatic hypotension in PD). We included 11 PD patients with orthostatic hypotension (PD + OH), 14 PD patients without orthostatic hypotension (PD − OH), and 15 age-matched healthy controls. Leg blood flow was examined using duplex ultrasound during 60° head-up tilt. Leg vascular resistance was calculated as the arterial-venous pressure gradient divided by blood flow. In a subset of 9 PD + OH, 9 PD − OH, and 8 controls, plasma volume was determined by indicator dilution method with radiolabeled albumin (125I-HSA). The basal leg vascular resistance was significantly lower in PD + OH (0.7 ± 0.3 mmHg·ml−1·min) compared with PD − OH (1.3 ± 0.6 mmHg·ml−1·min, P < 0.01) and controls (1.3 ± 0.5 mmHg·ml−1·min, P < 0.01). Leg vascular resistance increased significantly during 60° head-up tilt with no significant difference between the groups. Plasma volume was significantly larger in PD + OH (3,869 ± 265 ml) compared with PD − OH (3,123 ± 377 ml, P < 0.01) and controls (3,204 ± 537 ml, P < 0.01). These results indicate that PD + OH have a lower basal leg vascular resistance in combination with a larger plasma volume compared with PD − OH and controls. Despite the increase in leg vascular resistance during 60° head-up tilt, PD + OH are unable to maintain their blood pressure.
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Lyons, Denise L., and Kathleen Schell. "THE PREVALENCE OF ORTHOSTATIC HYPOTENSION AMONG HOSPITALIZED OLDER ADULTS AT RISK FOR FALLING." Innovation in Aging 3, Supplement_1 (November 2019): S848. http://dx.doi.org/10.1093/geroni/igz038.3120.
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Abstract Orthostatic hypotension (OH) may cause falls in hospitalized older adults. OH is a sustained drop of at least 20 mm Hg for systolic blood pressure or at least 10 mm Hg for diastolic blood pressure when changing position from supine to sitting, sitting to standing, or supine to standing. A recent systematic review revealed an inconsistent relationship between OH and falls. Orthostatic vital signs (OVS) measurement is often included in fall prevention initiatives. Some experts suggest that the time required to collect OVS and the possibility of measurement inaccuracy by nurses make this bedside screening unnecessary. The study aims were to determine: 1) the prevalence of OH, 2) if those older adults with documented OH experienced falls, and 3) the influence of medications known to be associated with OH and falls. Medication categories included antihypertensives, dopamine agonists, antipsychotics and antidepressants. A retrospective chart review was conducted on a convenience sample of 8,474 older adults on two Acute Care of the Elderly units at a large health system in the mid-Atlantic between 2015 and 2018. Results were determined using contingency tables and Chi-square analysis. More complex relationships were pursued using log linear models. The overall OH prevalence was 46.9% at some point during their hospital stay. Over the three years, 68 patients of whom 62% were hypotensive (p=.034). There was no statistical association of OH with medications or co-morbidities. The results demonstrate that although prevalent in almost half of this sample, orthostatic hypotension did not lead to falls.
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Byun, Jung-Ick, Jangsup Moon, Do-Yong Kim, Hyerim Shin, Jun-Sang Sunwoo, Jung-Ah Lim, Tae-Joon Kim, et al. "Efficacy of single or combined midodrine and pyridostigmine in orthostatic hypotension." Neurology 89, no. 10 (August 9, 2017): 1078–86. http://dx.doi.org/10.1212/wnl.0000000000004340.
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Objective:To evaluate the long-term (for up to 3 months) efficacy and safety of single or combined therapy with midodrine and pyridostigmine for neurogenic orthostatic hypotension (OH).Methods:This was a randomized, open-label clinical trial. In total, 87 patients with symptomatic neurogenic OH were enrolled and randomized to receive 1 of 3 treatments: midodrine only, pyridostigmine only, or midodrine + pyridostigmine. The patients were followed up at 1 and 3 months after treatment. The primary outcome measures were improvement in orthostatic blood pressure (BP) drop at 3 months. Secondary endpoints were improvement of the orthostatic BP drop at 1 month and amelioration of the questionnaire score evaluating OH-associated symptoms.Results:Orthostatic systolic and diastolic BP drops improved significantly at 3 months after treatment in all treatment groups. Orthostatic symptoms were significantly ameliorated during the 3-month treatment, and the symptom severity was as follows: midodrine only < midodrine + pyridostigmine < pyridostigmine only group. Mild to moderate adverse events were reported by 11.5% of the patients.Conclusions:Single or combination treatment with midodrine and pyridostigmine was effective and safe in patients with OH for up to 3 months. Midodrine was better than pyridostigmine at improving OH-related symptoms.Clinicaltrials.gov identifier:NCT02308124.Classification of evidence:This study provides Class IV evidence that for patients with neurogenic OH, long-term treatment with midodrine alone, pyridostigmine alone, or both midodrine and pyridostigmine is safe and has similar effects in improving orthostatic BP drop up to 3 months.
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Ahmed, Aamir, Mohammed Ruzieh, Shaffi Kanjwal, and Khalil Kanjwal. "Syndrome of Supine Hypertension with Orthostatic Hypotension: Pathophysiology and Clinical Approach." Current Cardiology Reviews 16, no. 1 (January 28, 2020): 48–54. http://dx.doi.org/10.2174/1573403x15666190617095032.
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This article is intended to provide guidance and clinical considerations for physicians managing patients suffering from supine hypertension with orthostatic hypotension, referred to as “SH-OH”. We review the normal physiologic response to orthostasis, focusing on the appropriate changes to autonomic output in this state. Autonomic failure is discussed with a generalized overview of the disease and examination of specific syndromes that help shed light on the pathophysiology of SH-OH. The goal of this review is to provide a better framework for clinical evaluation of these patients, review treatment options, and ultimately work toward achieving a better quality of life for patients afflicted with this disease.
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Januszko-Giergielewicz, Beata, Leszek Gromadziński, Maria Dudziak, and Alicja Dębska-Ślizień. "Orthostatic Hypotension in Asymptomatic Patients with Chronic Kidney Disease." Medicina 55, no. 4 (April 20, 2019): 113. http://dx.doi.org/10.3390/medicina55040113.
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Background and objective: Orthostatic hypotension (OH) is a decrease in systolic blood pressure (BP) of 20 mm Hg and in diastolic BP of 10 mm Hg when changing the position from lying to standing. Arterial hypertension (AH), comorbidities and polypharmacy contribute to its development. The aim was to assess the presence of OH and its predictors in asymptomatic chronic kidney disease (CKD) patients. Material and methods: 45 CKD patients with estimated glomerular filtration rate (eGFR) ≤ 60 mL/min/1.73 m2 (CKD+) were examined for signs of OH and its predictors. The results were compared with the control group of 22 patients with eGFR > 60 mL/min/1.73 m2 (CKD–). Asymptomatic patients without ischemic heart disease and previous stroke were qualified. Total blood count, serum creatinine, eGFR, urea, phosphates, calcium, albumins, parathyroid hormone, uric acid, C reactive protein, N-terminal pro b-type natriuretic peptide, lipid profile, and urine protein to creatinine ratio were assessed. Simultaneously, patients underwent echocardiography. To detect OH, a modified Schellong test was performed. Results: OH was diagnosed in 17 out of 45 CKD+ patients (average age 69.12 ± 13.2) and in 8 out of 22 CKD– patients (average age 60.50 ± 14.99). The CKD+ group demonstrated significant differences on average values of systolic and diastolic BP between OH+ and OH– patients, lower when standing. In the eGFR range of 30–60 mL/min/1.73 m2 correlation was revealed between OH and β-blockers (p = 0.04), in the entire CKD+ group between β-blockers combined with diuretics (p = 0.007) and ACE-I (p = 0.033). Logistic regression test revealed that chronic heart failure (CHF, OR = 15.31), treatment with β-blockers (OR = 13.86) were significant factors influencing the presence of OH. Conclusions: Predictors of OH in CKD may include: CHF, treatment with β-blockers, combined with ACE-I and diuretics.
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Tran, Jennifer, Sarah L. Hillebrand, Carel G. M. Meskers, Rebecca K. Iseli, and Andrea B. Maier. "Prevalence of initial orthostatic hypotension in older adults: a systematic review and meta-analysis." Age and Ageing 50, no. 5 (July 14, 2021): 1520–28. http://dx.doi.org/10.1093/ageing/afab090.
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Abstract Background Initial orthostatic hypotension (OH) is a clinical syndrome of exaggerated transient orthostasis associated with higher risks of falls, frailty and syncope in older adults. Objective To provide a prevalence estimate of initial OH in adults aged 65 years or older. Methods Literature search of MEDLINE (from 1946), Embase (from 1947) and Cochrane Central Register of Controlled Trials was performed until 6 December 2019, using the terms ‘initial orthostatic hypotension’, ‘postural hypotension’ and ‘older adults’. Articles were included if published in English and participants were 65 years or older. Random effects models were used for pooled analysis. Results Of 5,136 articles screened, 13 articles (10 cross-sectional; 3 longitudinal) reporting data of 5,465 individuals (54.5% female) from the general (n = 4,157), geriatric outpatient (n = 1,136), institutionalised (n = 55) and mixed (n = 117) population were included. Blood pressure was measured continuously and intermittently in 11 and 2 studies, respectively. Pooled prevalence of continuously measured initial OH was 29.0% (95% CI: 22.1–36.9%, I2 = 94.6%); 27.8% in the general population (95% CI: 17.9–40.5%, I2 = 96.1%), 35.2% in geriatric outpatients (95% CI: 24.2–48.1%, I2 = 95.3%), 10.0% in institutionalised individuals (95% CI: 2.4–33.1%, I2 = 0%) and 21.4% in the mixed population (95% CI: 7.0–49.6, I2 = 0%). Pooled prevalence of intermittently measured initial OH was 5.6% (95% CI: 1.5–18.9%, I2 = 81.1%); 1.0% in the general population (95% CI: 0.0–23.9%, I2 = 0%) and 7.7% in geriatric outpatients (95% CI: 1.8–27.0%, I2 = 86.7%). Conclusion The prevalence of initial OH is high in older adults, especially in geriatric outpatients. Proper assessment of initial OH requires continuous blood pressure measurements.
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Qayyum, Ali, Ehsan Ul Haq, Shoaib Zafar, Javaria ., Muhammad Moss, and Munashra Anam. "Frequency of Orthostatic Hypotension in Parkinson’s Disease." Pakistan Journal of Medical and Health Sciences 15, no. 11 (November 30, 2021): 2886–89. http://dx.doi.org/10.53350/pjmhs2115112886.
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Background: Parkinson’s Diseases (PD) cause some non-motor issues that could lead to disability. One of such determinal non-motor symptoms is orthostatic hypotension (OH) which is still understudied in our local setting despite of its high prevalence worldwide among patients of PD. Aim: To determine frequency of orthostatic hypotension in Parkinson’s disease Methods: This Cross-sectional study was conducted at Department of Neurology, Mayo Hospital, Lahore for 6 months after the approval of synopsis [April 9, 2018 till Oct 9, 2018]. A sample of 95 cases was selected using non probability consecutive sampling from 95 patients of Parkinson’s Disease aged 25 years and more. After taking consent from patient and recording sociodemographic information, a lying-to-standing orthostatic test was performed to evaluate the orthostatic hypotension and SBP and DBP was recorded. All data was collected using a self structured proforma and analyzed using SPSS v 21. Results: The mean age of cases was 47.46 ± 8.97 years with male to female ratio of 1.97:1. The mean systolic and diastolic blood pressure was 120.60 ± 11.80 and 86.20 ± 8.68 respectively. The frequency of orthostatic hypotension was seen in 51(53.7%) while other 44(46.3%) cases did not have orthostatic hypotension. Conclusion: Through the findings of this study we conclude that frequency of orthostatic hypotension in Parkinson’s disease is very much high i.e. 53.7% with highest frequency in cases with longer duration of disease. Keywords: Autonomic diseases, Parkinson’s disease, Systolic blood pressure, diastolic blood pressure, Orthostatic hypotension,
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Schekotov, V. V., S. G. Shulkina, A. A. Antipova, O. V. Shanko, and N. L. Kiseleva. "Arterial hypertension in patients with type 1 diabetes mellitus and orthostatic disorders and its correction: Clinical features and possibilities of correction." "Arterial’naya Gipertenziya" ("Arterial Hypertension") 16, no. 4 (August 28, 2010): 418–22. http://dx.doi.org/10.18705/1607-419x-2010-16-4-418-422.
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Objective. To characterize diabetic nephropathy and cognitive function in patients with arterial hypertension (AH) and diabetes mellitus (DM) type 1, complicated by orthostatic hypotension (OH), and to assess the benefits of venoprotector therapy for the correction of dyscirculatory encephalopathy (DE) and diabetic nephropathy (DN). Design and methods. Sixty patients with AH, DM type 1 and OH were included in the study. Schellongs' orthostatic probe, microalbuminuria (MAU) screening with «Micral-Test-11», Mini Mental State examination (MMSE) test, 10 words memo probe, Spielberg test, Beck questionnaire were used. Antihypertensive therapy included «Enalapril» («Hemofarm», Serbia), venoprotective therapy - with «Detralex» («Servier», France). Results. Adequate antihypertensive therapy in patients with DM type 1 in combination with AH and OH leads to aggravation of postural hypertension symptoms. Blood pressure decrease in orthostatic probe and cognitive disorders are associated (r = 0,56, p = 0,009). Use of active orthostatic probe (AOP) leads to the increase of MAU. Venotonic therapy attenuates the symptoms of postural hypotension, leads to the decrease of MAU in AOP and improves cognitive function.
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Ovchynnykova, A. S., and Y. O. Trufanov. "ORTHOSTATIC HYPOTENSION AS A NON-MOTOR SYMPTOM OF PARKINSON’S DISEASE." East European Journal of Parkinson`s Disease and Movement Disorders 8, no. 1 (June 30, 2022): 3–12. http://dx.doi.org/10.33444/2414-0007.8.1.3-12.
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The objective of our research was to raise awareness of neurologists about orthostatic hypotension (OH) in Parkinson’s disease (PD) and to explore the current approach to the problem. Materials and methods. This work was performed by searching for current information on OH in PD, reflecting the pathophysiology, classification, symptoms, diagnosis, and treatment. PubMed and Google Scholar resources were used to write the review. Results. An important task in the management of patients with PD is diagnostic and treatment of OH due to the negative impact of the syndrome on somatic, psychological and cognitive status. According to recent data, the prevalence of OH among PD patients is 30-50% [1] with no association with the stage of the disease [2]. OH in PD is neurogenic (NOH); it results from neurodegenerative damage to the central and peripheral structures of the sympathetic nervous system, which leads to reduced postganglionic release of epinephrine [3]. It is often asymptomatic, as a result of compensatory tolerance mechanisms [1]. In about of 50% of patients [4], OH is associated with supine hypertension [2] and may have a connection with REM-sleep disorders [5]. Classification features of OH include: onset period under orthostatic stress, the relationship of OH to different parts of the cardiac cycle, mechanism of pathophysiology, clinical course, presence of symptoms and clinical severity [20, 31, 32]. OH symptoms usually occur during orthostatic stress. They include dizziness, blurred vision, cognitive slowing, syncope, coat-hanger pain, difficulty breathing, leg buckling or leg weakness, general weakness and fatigue [1, 5, 17, 18]. Bedside orthostatic test with blood pressure measurement at the 1st, 3rd and 5th minutes of standing and ambulatory blood pressure monitoring (ABPM) are used for diagnosis [6]. The treatment strategy is to evaluate the medications taken by the patient and obligatory inclusion of non-pharmacological treatment. Pharmacological treatment for supine hypertension and OH is only given if necessary [1, 2]. Conclusions. OH is a widespread non-motor symptom of PD [1], which should be timely diagnosed and treated because of the negative impact on quality of life with increased risk of death and injuries due to falls [31, 32, 33]. The relationship between OH and other non-motor symptoms of PD should be further explored, and optimal therapeutic strategies for different functional classes and a combination of non-pharmacological and pharmacological treatments for OH should be found as well.
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Centi, Justin, Roy Freeman, Christopher H. Gibbons, Sandy Neargarder, Alexander O. Canova, and Alice Cronin-Golomb. "Effects of orthostatic hypotension on cognition in Parkinson disease." Neurology 88, no. 1 (November 30, 2016): 17–24. http://dx.doi.org/10.1212/wnl.0000000000003452.
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Objective:To investigate the relation between orthostatic hypotension (OH) and posture-mediated cognitive impairment in Parkinson disease (PD) using a cross-sectional and within-group design.Methods:Individuals without dementia with idiopathic PD included 18 with OH (PDOH) and 19 without OH; 18 control participants were also included. Neuropsychological tests were conducted in supine and upright-tilted positions. Blood pressure was assessed in each posture.Results:The PD groups performed similarly while supine, demonstrating executive dysfunction in sustained attention and response inhibition, and reduced semantic fluency and verbal memory (encoding and retention). Upright posture exacerbated and broadened these deficits in the PDOH group to include phonemic fluency, psychomotor speed, and auditory working memory. When group-specific supine scores were used as baseline anchors, both PD groups showed cognitive changes following tilt, with the PDOH group exhibiting a wider range of deficits in executive function and memory as well as significant changes in visuospatial function.Conclusions:Cognitive deficits in PD have been widely reported with assessments performed in the supine position, as seen in both our PD groups. Here we demonstrated that those with PDOH had transient, posture-mediated changes in excess of those found in PD without OH. These observed changes suggest an acute, reversible effect. Understanding the effects of OH due to autonomic failure on cognition is desirable, particularly as neuroimaging and clinical assessments collect data only in the supine or seated positions. Identification of a distinct neuropsychological profile in PD with OH has quality of life implications, and OH presents itself as a possible target for intervention in cognitive disturbance.
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Fereshtehnejad, Seyed-Mohammad, and Johan Lökk. "Orthostatic Hypotension in Patients with Parkinson’s Disease and Atypical Parkinsonism." Parkinson's Disease 2014 (2014): 1–10. http://dx.doi.org/10.1155/2014/475854.
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Orthostatic hypotension (OH) is one of the commonly occurring nonmotor symptoms in patients with idiopathic Parkinson’s disease (IPD) and atypical parkinsonism (AP). We aimed to review current evidences on epidemiology, diagnosis, treatment, and prognosis of OH in patients with IPD and AP. Major electronic medical databases were assessed including PubMed/MEDLINE and Embase up to February 2013. English-written original or review articles with keywords such as “Parkinson’s disease,” “atypical parkinsonism,” and “orthostatic hypotension” were searched for relevant evidences. We addressed different issues such as OH definition, epidemiologic characteristics, pathophysiology, testing and diagnosis, risk factors for symptomatic OH, OH as an early sign of IPD, prognosis, and treatment options of OH in parkinsonian syndromes. Symptomatic OH is present in up to 30% of IPD, 80% of multiple system atrophy (MSA), and 27% of other AP patients. OH may herald the onset of PD before cardinal motor symptoms and our review emphasises the importance of its timely diagnosis (even as one preclinical marker) and multifactorial treatment, starting with patient education and lifestyle approach. Advancing age, male sex, disease severity, and duration and subtype of motor symptoms are predisposing factors. OH increases the risk of falls, which affects the quality of life in PD patients.
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Juraschek, Stephen P., W. T. Longstreth, Oscar L. Lopez, John S. Gottdiener, Lewis A. Lipsitz, Lewis H. Kuller, and Kenneth J. Mukamal. "Orthostatic hypotension, dizziness, neurology outcomes, and death in older adults." Neurology 95, no. 14 (July 30, 2020): e1941-e1950. http://dx.doi.org/10.1212/wnl.0000000000010456.
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ObjectiveTo test the hypothesis that orthostatic hypotension (OH) might cause cerebral hypoperfusion and injury, we examined the longitudinal relationship between OH or orthostatic symptoms and incident neurologic outcomes in a community population of older adults.MethodsCardiovascular Health Study participants (≥65 years) without dementia or stroke had blood pressure (BP) measured after lying down for 20 minutes and after standing 3 for minutes. Participants reported dizziness immediately upon standing and any dizziness in the past 2 weeks. OH was defined as a drop in standing systolic/diastolic BP ≥20/≥10 mm Hg. We determined the association between OH or dizziness with (1) MRI brain findings (ventricular size, white matter hyperintensities, brain infarcts) using linear or logistic regression, (2) cognitive function (baseline and over time) using generalized estimating equations, and (3) prospective adjudicated events (dementia, stroke, death) using Cox models. Models were adjusted for demographic characteristics and OH risk factors. We used multiple imputation to account for missing OH or dizziness (n = 534).ResultsPrior to imputation, there were 5,007 participants (mean age 72.7 ± 5.5 years, 57.6% women, 10.9% Black, 16% with OH). OH was modestly associated with death (hazard ratio [HR] 1.11; 95% confidence interval 1.02–1.20), but not MRI findings, cognition, dementia, or stroke. In contrast, dizziness upon standing was associated with lower baseline cognition (β = −1.20; −1.94 to −0.47), incident dementia (HR 1.32; 1.04–1.62), incident stroke (HR 1.22; 1.06–1.41), and death (HR 1.13; 1.06–1.21). Similarly, dizziness over the past 2 weeks was associated with higher white matter grade (β = 0.16; 0.03–0.30), brain infarcts (OR 1.31; 1.06–1.63), lower baseline cognition (β = −1.18; −2.01 to −0.34), and death (HR 1.13; 1.04–1.22).ConclusionsDizziness was more consistently associated with neurologic outcomes than OH 3 minutes after standing. Delayed OH assessments may miss pathologic information related to cerebral injury.
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Ong, Edward Tien-En, Lincoln Kai-Pheng Yeo, Arun-Kumar Kaliya-Perumal, and Jacob Yoong-Leong Oh. "Orthostatic Hypotension Following Cervical Spine Surgery: Prevalence and Risk Factors." Global Spine Journal 10, no. 5 (July 16, 2019): 578–82. http://dx.doi.org/10.1177/2192568219863805.
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Study Design: Retrospective case series. Objectives: This study aims to determine the prevalence and risk factors for orthostatic hypotension (OH) in patients undergoing cervical spine surgery. Methods: Data was collected from records of 190 consecutive patients who underwent cervical spine procedures at our center over 24 months. Statistical comparison was made between patients who developed postoperative OH and those who did not by analyzing characteristics such as age, gender, premorbid medical comorbidities, functional status, mechanism of spinal cord injury, preoperative neurological function, surgical approach, estimated blood loss, and length of stay. Results: Twenty-two of 190 patients (11.6%) developed OH postoperatively. No significant differences in age, gender, medical comorbidities, or premorbid functional status were observed. Based on univariate comparisons, traumatic mechanism of injury ( P = .002), poor ASIA (American Spinal Injury Association) grades (A, B, or C) ( P < .001), and posterior surgical approach ( P = .045) were found to significantly influence occurrence of OH. Among the significant variables, after adjusting for mechanism of injury and surgical approach, only ASIA grade was found to be an independent predictor. Having an ASIA grade of A, B, or C increased the likelihood of developing OH by approximately 5.978 times ( P = .003). Conclusion: Our study highlights that OH is not an uncommon manifestation following cervical spine surgery. Patients with poorer ASIA grades A, B, or C were more likely to have OH when compared with those with ASIA grades D or E (43.5% vs 7.2%). Hence, we suggest that postural blood pressure should be routinely monitored in this group of patients so that early intervention can be initiated.
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Méndez, Andrea S., Jesús D. Melgarejo, Luis J. Mena, Carlos A. Chávez, Alicex C. González, José Boggia, Joseph D. Terwilliger, Joseph H. Lee, and Gladys E. Maestre. "Risk Factors for Orthostatic Hypotension: Differences Between Elderly Men and Women." American Journal of Hypertension 31, no. 7 (March 30, 2018): 797–803. http://dx.doi.org/10.1093/ajh/hpy050.
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Abstract BACKGROUND Orthostatic hypotension (OH) occurs when mechanisms regulating blood pressure (BP) levels after standing-up are altered. It is unclear how prevalence and risk factors for OH are different between sexes. We aimed to investigate sex differences in prevalence and risk factors for OH elderly individuals. METHODS We included 882 participants from Maracaibo Aging Study. OH was a sustained reduction of ≥20 mm Hg in systolic BP, ≥10 mm Hg in diastolic BP, or both, after 3 minutes of changing positions from supine to standing. Multivariable logistic regression models were used to examine the relationships among risk factors for OH in men and women considering interaction sex-term and stratified by sex. RESULTS The mean age was 66.7 ± 8.5 years, being similar by sex. Women and men 55–74 years had similar prevalence of OH+ (18.5% vs. 20.9%, respectively). After 75 years, the proportion of women with OH+ was lower than men (11% vs. 30%, respectively). Hypertension, specifically systolic BP ≥140 mm Hg, and high pulse pressure (PP) were related with OH+ accounted by interaction sex-term, while diastolic BP ≥90 mm Hg, antihypertensive treatment, body mass index (BMI), diabetes mellitus and age were not. Systolic BP ≥140 mm Hg increases the risk of OH only among women, while BMI showed an inverse association in both sexes. CONCLUSIONS Although the prevalence of OH is similar in both sexes, there are different risk factors associated by sex. Systolic BP ≥140 mm Hg was associated with increased risk of OH only with women while BMI was a protective factor for OH in men and women.
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Fedorova, D. N., A. E. Soloveva, M. Fudim, V. L. Galenko, A. V. Kozlenok, A. V. Berezina, and S. V. Villevalde. "Frequency of hemodynamic response to orthostatic stress in heart failure with reduced ejection fraction, associations with clinical blood pressure." Russian Journal of Cardiology 27, no. 2S (May 20, 2022): 5005. http://dx.doi.org/10.15829/1560-4071-2022-5005.
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Aim. To assess hemodynamic response to active standing test (AST) with beat-to-beat blood pressure (BP) monitoring, their association with office BP and symptoms of orthostatic intolerance in patients with heart failure (HF).Material and methods. Outpatient HF patients with documented left ventricular ejection fraction <40%, followed up in a HF center and receiving optimal medical therapy, underwent AST with beat-to-beat non-invasive BP monitoring.Hemodynamic response was assessed according to the European Federation of Autonomic Societies criteria.Results. The study included 87 patients (mean age, 57±10 years; men, 76%). Normal hemodynamic response to orthostatic stress was observed in 36 (41,4%) patients. Pathological response prevailed during the first minute of orthostatic stress — initial orthostatic hypotension (OH) (n=29, 33,3%) and delayed BP recovery (n=18, 20,7%). Classical OH was detected in 4 (4,6%) patients. There was no orthostatic hypertension, defined as an increase in systolic BP (SBP) ≥20 mm Hg. According to office BP, hypotension was observed in 19 (21,8%) patients (SBP <90 mm Hg in 4 patients and 90-100 mm Hg in 15), hypertension (SBP >140 mm Hg) in 11 (12,6%) patients. Pathological response to orthostatic stress were more often observed in office SBP >140 mm Hg compared to SBP ≤140 mmHg (90,9% and 53,9%, p=0,020).Orthostatic intolerance was noted in 43 (49,4%) patients and were not associated with the level of office SBP (p=0,398) or pathological responses to orthostatic stress (p=0,758 for initial OH and p=0,248 for delayed BP recovery).Conclusion. The pathological hemodynamic response in AST with beat-to-beat BP monitoring in ambulatory patients with HF is most often represented by initial OH and delayed BP recovery associated with office SBP >140 mmHg. The frequency of symptoms of orthostatic intolerance did not differ between groups depending on the presence of an inadequate response to orthostatic stress.
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GOLDSTEIN, David S., Courtney HOLMES, Nicholas PATRONAS, and Irwin J. KOPIN. "Cerebrospinal fluid levels of catechols in patients with neurogenic orthostatic hypotension." Clinical Science 104, no. 6 (June 1, 2003): 649–54. http://dx.doi.org/10.1042/cs20020315.
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In multiple system atrophy (MSA) and pure autonomic failure (PAF), orthostatic hypotension (OH) results from deficient noradrenaline release from sympathetic nerves during standing. Post-mortem findings have indicated loss of central noradrenergic cells in both diseases. The present study sought in vivo neurochemical evidence for central noradrenergic deficiency in patients with OH due to MSA or PAF. A total of 28 patients with OH (18 with MSA; 10 with PAF) had cerebrospinal fluid and blood sampled for levels of noradrenaline and its neuronal metabolite dihydroxyphenylglycol. A control group of 44 subjects included 10 elderly normal volunteers, 10 patients with Alzheimer's disease, 18 patients with dysautonomia (postural tachycardia syndrome or neurocardiogenic syncope) and six patients with MSA in the absence of OH. Patients with OH had lower cerebrospinal fluid concentrations of noradrenaline (0.53±0.07 nmol/l) and dihydroxyphenylglycol (6.52±0.46 nmol/l) than did control subjects (0.90±0.09 and 9.64±0.46 nmol/l respectively; P=0.0001). The MSA + OH group had higher plasma levels of both catechols (noradrenaline, 1.31±0.16 nmol/l; dihydroxyphenylglycol, 5.08±0.43 nmol/l) than did the PAF group (noradrenaline, 0.38±0.08 nmol/l; dihydroxyphenylglycol, 2.53±0.30 nmol/l; P<0.001), despite similarly low cerebrospinal fluid levels. Among MSA patients, those with OH had lower cerebrospinal fluid levels of noradrenaline and dihydroxyphenylglycol than those without OH (noradrenaline, 1.71±0.64 nmol/l; dihydroxyphenylglycol, 10.41±1.77 nmol/l respectively; P=0.006). The findings are consistent with central noradrenergic deficiency in both MSA + OH and PAF. In MSA, central noradrenergic deficiency seems to relate specifically to OH.
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Yoo, Sang-Won, Seunggyun Ha, Hyukjin Yoon, Ji-Yeon Yoo, Kwang-Soo Lee, and Joong-Seok Kim. "Paradoxical Cerebral Perfusion in Parkinson’s Disease Patients with Orthostatic Hypotension: A Dual-Phase 18F-Florbetaben Positron Emission Tomography Study." Journal of Parkinson's Disease 11, no. 3 (August 2, 2021): 1335–44. http://dx.doi.org/10.3233/jpd-212596.
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Background: Orthostatic hypotension (OH) may antedate Parkinson’s disease (PD) or be found in early stages of the disease. OH may induce a PD brain to chronic hypotensive insults. 18F-Florbetaben (18F-FBB) tracer has a high first-pass influx rate and can be used with positron emission tomography (PET) as a surrogate marker for early- and late-phase evaluation of cerebral perfusion and cerebral amyloidosis, respectively. Objective: In this study, we evaluated whether 18F-FBB uptake in the early- and late-phases of PD was related to OH. This study manipulated the imaging modality to illustrate the physiology of cerebral flow with OH in PD (PD + OH). Methods: A group of 73 early-stage PD patients was evaluated with a head-up tilt-test and 18F-FBB PET imaging. The cognitive status was assessed by a comprehensive battery of neuropsychological tests. PET images were normalized, and both early- and late-phase standardized uptake value ratios (SUVRs) of pre-specified regions were obtained. The associations between regional SUVRs and OH and cognitive status were analyzed. Results: Twenty (27.4%) participants had OH. Thirteen (17.8%) patients were interpreted as having amyloid pathology based on regional 18F-FBB uptake. Early-phase SUVRs were higher in specific brain regions of PD + OH patients than those without OH. However, late-phase SUVRs did not differ between the groups. The early-phase SUVRs were not influenced by amyloid burden or by interaction between amyloid and orthostatic hypotension. Cognitive functions were not disparate when PD + OH patients were contrasted with non-OH patients in this study. Conclusion: Cerebral blood flow was elevated in patients with early PD + OH. This finding suggests augmented cerebral perfusion in PD + OH might be a compensatory regulation in response to chronic OH.
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Laird, Eamon, Aisling M. O’halloran, Artur Fedorowski, Olle Melander, Ann Hever, Marketa Sjögren, Daniel Carey, and Rose Anne Kenny. "Orthostatic Hypotension and Novel Blood Pressure Associated Gene Variants in Older Adults: Data From the TILDA Study." Journals of Gerontology: Series A 75, no. 11 (December 10, 2019): 2074–80. http://dx.doi.org/10.1093/gerona/glz286.
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Abstract Orthostatic hypotension (OH) is associated with increased risk of trauma and cardiovascular events. Recent studies have identified new genetic variants that influence orthostatic blood pressure (BP). The aim of this study was to investigate the associations of candidate gene loci with orthostatic BP responses in older adults. A total of 3,430 participants aged ≥50 years from The Irish Longitudinal Study on Ageing (TILDA) with BP measures and genetic data from 12 single-nucleotide polymorphism (SNP) linked to BP responses were analyzed. Orthostatic BP responses were recorded at each 10 s interval and were defined as OH (SBP drop ≥20 mmHg or DBP drop ≥10 mmHg) at the time-points 40, 90, and 110 s. We defined sustained OH (SOH) as a drop that exceeded consensus BP thresholds for OH at 40, 90, and 110 s after standing. Logistic regression analyses modeled associations between the candidate SNP alleles and OH. We report no significant associations between OH and measured SNPs after correction for multiple comparisons apart from the SNP rs5068 where proportion of the minor allele was significantly different between cases and controls for SOH 40 (p = .002). After adjustment for covariates in a logistic regression, those with the minor G allele (compared to the A allele) had a decreased incidence rate ratio (IRR) for SOH 40 (IRR 0.45, p = .001, 95% CI 0.29–0.72). Only one SNP linked with increased natriuretic peptide concentrations was associated with OH. These results suggest that genetic variants may have a weak impact on OH but needs verification in other population studies.
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Cai, Xiao-qi, Xin-lei Gao, Ting-jun Wang, Yi-hua Shen, Guo-yan Xu, Ying Han, and Liang-di Xie. "Relationship Between the Accumulation of Metabolic Syndrome Components and Orthostatic Hypotension." American Journal of Hypertension 34, no. 7 (July 1, 2021): 775–76. http://dx.doi.org/10.1093/ajh/hpab012.
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Abstract Background To investigate the relationship between the accumulation of metabolic syndrome (MS) components and orthostatic hypotension (OH). Methods A total of 2,201 subjects were enrolled and divided into 0 component (n = 199), 1–2 components (n = 1,003), and 3–4 components (n = 999) groups based on the number of MS components according to the criteria of 2018 Chinese Guidelines for Prevention and Management of Hypertension. Stratified analyses and binary logistic regression analysis were performed. Results The incidence of OH was significantly increased with the number of MS components (5.0% in 0 component group, 13.5% in 1–2 components group, and 17.9% in 3–4 components group, P < 0.05). Compared with subjects without OH, the incidence of MS in those with OH was significantly elevated (55.2% vs. 43.7%, P < 0.05). The incidence of OH in the elderly subjects was significantly higher than that in the young and middle-aged subjects (22.3% vs. 10.9%, P < 0.01). Binary logistic regression analysis showed that the number of MS components was associated with OH in all subjects, and the risk of OH was increased with the increment of MS components. Compared with the subjects without any MS component, the risk of OH increased by 2.3 times in the subjects with 4 MS components (odds ratio = 3.274, 95% confidence interval 1.626–6.594, P < 0.05). Stratified analyses found that the number of MS components was independently associated with OH in young to middle-age, female and non-MS subjects. Conclusions The incidence of OH is elevated with accumulations of MS components, especially in young to middle-age, female and non-MS subjects.
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Yasa, Ekrem, Fabrizio Ricci, Martin Magnusson, Richard Sutton, Sabina Gallina, Raffaele De Caterina, Olle Melander, and Artur Fedorowski. "Cardiovascular risk after hospitalisation for unexplained syncope and orthostatic hypotension." Heart 104, no. 6 (August 3, 2017): 487–93. http://dx.doi.org/10.1136/heartjnl-2017-311857.
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ObjectiveTo investigate the relationship of hospital admissions due to unexplained syncope and orthostatic hypotension (OH) with subsequent cardiovascular events and mortality.MethodsWe analysed a population-based prospective cohort of 30 528 middle-aged individuals (age 58±8 years; males, 40%). Adjusted Cox regression models were applied to assess the impact of unexplained syncope/OH hospitalisations on cardiovascular events and mortality, excluding subjects with prevalent cardiovascular disease.ResultsAfter a median follow-up of 15±4 years, 524 (1.7%) and 504 (1.7%) participants were hospitalised for syncope or OH, respectively, yielding 1.2 hospital admissions per 1000 person-years for each diagnosis. Syncope hospitalisations increased with age (HR, per 1 year: 1.07, 95% CI 1.05 to 1.09), higher systolic blood pressure (HR, per 10 mm Hg: 1.06, 95% CI 1.01 to 1.12), antihypertensive treatment (HR: 1.26, 95% CI 1.00 to 1.59), use of diuretics (HR: 1.77, 95% CI 1.31 to 2.38) and prevalent cardiovascular disease (HR: 1.59, 95% CI 1.14 to 2.23), whereas OH hospitalisations increased with age (HR: 1.11, 95% CI 1.08 to 1.12) and prevalent diabetes (HR: 1.82, 95% CI 1.23 to 2.70). After exclusion of 1399 patients with prevalent cardiovascular disease, a total of 473/464 patients were hospitalised for unexplained syncope/OH before any cardiovascular event. Hospitalisation for unexplained syncope predicted coronary events (HR: 1.85, 95% CI 1.49 to 2.30), heart failure (HR: 2.24, 95% CI 1.65 to 3.04), atrial fibrillation (HR: 1.84, 95% CI 1.50 to 2.26), aortic valve stenosis (HR: 2.06, 95% CI 1.28 to 3.32), all-cause mortality (HR: 1.22, 95% CI 1.09 to 1.37) and cardiovascular death (HR: 1.72, 95% CI 1.23 to 2.42). OH-hospitalisation predicted stroke (HR: 1.66, 95% CI 1.24 to 2.23), heart failure (HR: 1.78, 95% CI 1.21 to 2.62), atrial fibrillation (HR: 1.89, 95% CI 1.48 to 2.41) and all-cause mortality (HR: 1.14, 95% CI 1.01 to 1.30).ConclusionsPatients discharged with the diagnosis of unexplained syncope or OH show higher incidence of cardiovascular disease and mortality with only partial overlap between these two conditions.
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Xia, Xin, Rui Wang, Davide L. Vetrano, Giulia Grande, Erika J. Laukka, Mozhu Ding, Laura Fratiglioni, and Chengxuan Qiu. "From Normal Cognition to Cognitive Impairment and Dementia: Impact of Orthostatic Hypotension." Hypertension 78, no. 3 (September 2021): 769–78. http://dx.doi.org/10.1161/hypertensionaha.121.17454.
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The role of orthostatic hypotension (OH) in the continuum of cognitive aging remains to be clarified. We sought to investigate the associations of OH with dementia, cognitive impairment, no dementia (CIND), and CIND progression to dementia in older adults while considering orthostatic symptoms. This population-based cohort study included 2532 baseline (2001–2004) dementia-free participants (age ≥60 years; 62.6% women) in the SNAC-K (Swedish National Study on Aging and Care in Kungsholmen) who were regularly examined over 12 years. We further divided the participants into a baseline CIND-free cohort and a CIND cohort. OH was defined as a decrease by ≥20/10 mm Hg in systolic/diastolic blood pressure upon standing and further divided into asymptomatic and symptomatic OH. Dementia was diagnosed following the international criteria. CIND was defined as scoring ≥1.5 SDs below age group-specific means in ≥1 cognitive domain. Data were analyzed with flexible parametric survival models, controlling for confounding factors. Of the 2532 participants, 615 were defined with OH at baseline, and 322 were diagnosed with dementia during the entire follow-up period. OH was associated with an adjusted hazard ratio of 1.40 for dementia (95% CI, 1.10–1.76), 1.15 (0.94–1.40) for CIND, and 1.54 (1.05–2.25) for CIND progression to dementia. The associations of dementia and CIND progression to dementia with asymptomatic OH were similar to overall OH, whereas symptomatic OH was only associated with CIND progression to dementia. Our study suggests that OH, even asymptomatic OH, is associated with increased risk of dementia and accelerated progression from CIND to dementia in older adults.
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McNicholas, Triona, Paul Claffey, Susie O'Callaghan, Robert Briggs, Louise Newman, Katy Tobin, and Rose Anne Kenny. "343 Atrial Fibrillation, Orthostatic Hypotension and Cerebral Perfusion – Data from The Irish Longitudinal Study on Ageing." Age and Ageing 48, Supplement_3 (September 2019): iii1—iii16. http://dx.doi.org/10.1093/ageing/afz102.70.
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Abstract Background It is thought that cerebral hypoperfusion in Atrial Fibrillation (AF) increases the risk of falls, cognitive impairment, and worse outcome in stroke. This aim of this study is to assess frontal lobe perfusion in response to active stand, and to assess the impact of OH on this association. Methods Data from wave 3 of The Irish Longitudinal Study on Ageing were used, a cohort study of community-dwelling adults aged over 50. Frontal lobe perfusion in response to orthostasis was measured using near infra-red spectroscopy (NIRS), reported as tissue saturation index (TSI%). Orthostatic hypotension (OH) was assessed using beat-to-beat blood pressure measurement. Linear regression assessed whether AF was associated with lower baseline TSI. Mixed effects linear regression assessed whether TSI differed across specific time points – 10, 20, 30, 40 60, 90, and 120 seconds. The analysis were repeated including an interaction with OH to assess the impact of OH on this association. Results There was no difference in baseline TSI in participants with AF compared to those without. Mixed effects models demonstrated lower TSI at 10 seconds in AF (β -0.52; 95% CI -0.88, -0.16; p-value 0.004), at 40 seconds (β -0.40; 95% CI -0.76, -0.04; p-value 0.031) and at 60 seconds (β -0.40; 95% CI --0.76, -0.04; p-value 0.028). Including an interaction with OH found that in isolated AF, TSI was lower at 10 seconds (β -0.62; 95% CI -1.04, -0.19; p-value 0.005). Those with both AF and OH had lower TSI at 40 (β -0.89; 95% CI -1.55, -0.24; p-value 0.007), 60 (β -0.89; 95% CI -1.54, -0.23; p-value 0.008) and 90 (β -0.68; 95% CI -1.33, -0.03; p-value 0.041) seconds. Conclusion There is evidence that frontal lobe perfusion is lower during orthostasis in individuals with AF, and that the presence of OH modifies this association.
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Meng, Qingtao, Si Wang, Yong Wang, Shixi Wan, Kai Liu, Xiaoyan Zhou, Guiyou Zhong, Xin Zhang, and Xiaoping Chen. "Arterial stiffness is a potential mechanism and promising indicator of orthostatic hypotension in the general population." Vasa 43, no. 6 (November 1, 2014): 423–32. http://dx.doi.org/10.1024/0301-1526/a000389.
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Background: Orthostatic hypotension (OH) is a disease prevalent among middle-aged men and the elderly. The association between arterial stiffness and OH is unclear. This study evaluates whether arterial stiffness is correlated with OH and tests the usefulness of brachial-ankle pulse wave velocity (baPWV), an arterial stiffness marker, with regard to identifying OH. Patients and methods: A sample of 1,010 participants was recruited from the general population (64.8 ± 7.7 years; 426 men) who attended health check-ups. BaPWV and the radial augmentation index (rAI) were both assessed as the arterial stiffness markers, and OH was determined using blood pressure (BP) measured in the supine position, as well as 30 seconds and 2 minutes after standing. Results: The prevalence of OH in this population was 4.9 %. Compared with the non-OH group, both baPWV (20.5 ± 4.5 vs 17.3 ± 3.7, p < 0.001) and rAI (88.1 ± 10.8 vs 84.2 ± 10.7, p < 0.05) were significantly higher in the OH group. In the multiple logistic regression analysis, baPWV (OR, 1.3; 95 % CI, 1.106–1.528; p < 0.05) remained associated with OH. Moreover, the degree of orthostatic BP reduction was related to arterial stiffness. In addition, increases in arterial stiffness predicted decreases in the degree of heart rate (HR) elevation. Finally, a receiver operating characteristic (ROC) curve analysis showed that baPWV was useful in discriminating OH (AUC, 0.721; p < 0.001), with the cut-off value of 18.58 m/s (sensitivity, 0.714; specificity, 0.686). Conclusions: Arterial stiffness determined via baPWV, rather than rAI, was significantly correlated with the attenuation of the orthostatic hemodynamic response and the resultant OH. The impaired baroreceptor sensitivity might be the mechanism. In addition, baPWV appears to be a relatively sensitive and reliable indicator of OH in routine clinical practice.
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Jung, Kyu-On, Deok-Hyun Heo, Eek-Sung Lee, and Tae-Kyeong Lee. "Reduction in Pulse Pressure during Standing Can Distinguish Neurogenic Orthostatic Hypotension." Diagnostics 11, no. 8 (July 24, 2021): 1331. http://dx.doi.org/10.3390/diagnostics11081331.
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Background: We investigated whether changes in the pulse pressure (PP) reduction ratio during the head-up tilt test (HUTT) can aid in distinguishing neurogenic orthostatic hypotension (OH) from non-neurogenic OH. Methods: We enrolled consecutive patients with NOH and non-neurogenic OH between January 2015 and October 2018. We compared the Valsalva ratio, the presence or absence of late phase II and IV overshoot, the pressure recovery time, and the PP reduction ratio during HUTT between the two OH groups. Results: The expiratory–inspiratory (E:I) ratio and Valsalva ratio were significantly decreased in the NOH group (p = 0.026, p < 0.001, respectively). The absence of late phase II and phase IV overshoot was more frequent in the NOH group than in the non-neurogenic OH group (p = 0.001, p < 0.001, respectively). The pressure recovery time was significantly prolonged in the NOH group (p < 0.001), which exhibited increases in the PP reduction ratio (1—minimal PP/baseline PP) during the HUTT (p < 0.001). We calculated the cutoff point for the PP reduction ratio during HUTT, which exhibited an area under the receiver operating characteristic curve of 0.766 (0.659–0.840, 95% confidence interval). The cutoff value for the PP reduction ratio during HUTT (0.571) exhibited sensitivity of 0.879 and specificity of 0.516. Conclusions: Increases in the PP reduction ratio during HUTT may be a meaningful NOH laboratory marker.
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Fan, Chie Wei, and Conal J. Cunningham. "Non-pharmacological management of orthostatic hypotension in the elderly patient." Reviews in Clinical Gerontology 15, no. 3-4 (August 2005): 165–73. http://dx.doi.org/10.1017/s0959259806001924.
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Orthostatic hypotension (OH) is defined as a systolic blood pressure (SBP) drop of at least 20 mmHg, or a diastolic blood pressure drop of at least 10 mm Hg within three minutes of standing from a supine position. It can be symptomatic or asymptomatic and is a common condition that can affect up to one in three older people living in the community. The prevalence is higher amongst those with Parkinson's disease and, unsurprisingly, amongst those attending a syncope clinic. The aetiology and pathophysiology of OH have been comprehensively discussed in a previous article in this journal.
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Kim, Jung Bin, Hayom Kim, Chan-Nyung Lee, Kun-Woo Park, and Byung-Jo Kim. "Regional Gray Matter Volume Changes in Parkinson’s Disease with Orthostatic Hypotension." Brain Sciences 11, no. 3 (February 26, 2021): 294. http://dx.doi.org/10.3390/brainsci11030294.
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Neurodegenerative change in the central nervous system has been suggested as one of the pathophysiological mechanisms of autonomic nervous system dysfunction in Parkinson’s disease (PD). We analyzed gray matter (GM) volume changes and clinical parameters in patients with PD to investigate any involvement in the brain structures responsible for autonomic control in patients with PD having orthostatic hypotension (OH). Voxel-based morphometry was applied to compare regional GM volumes between PD patients with and without OH. Multivariate logistic regression analysis using a hierarchical model was carried out to identify clinical factors independently contributing to the regional GM volume changes in PD patients with OH. The Sobel test was used to analyze mediation effects between the independent contributing factors to the GM volume changes. PD patients with OH had more severe autonomic dysfunction and reduction in volume in the right inferior temporal cortex than those without OH. The right inferior temporal volume was positively correlated with the Qualitative Scoring MMSE Pentagon Test (QSPT) score, reflecting visuospatial/visuoperceptual function, and negatively correlated with the Composite Autonomic Severity Score (CASS). The CASS and QSPT scores were found to be factors independently contributing to regional volume changes in the right inferior temporal cortex. The QSPT score was identified as a mediator in which regional GM volume predicts the CASS. Our findings suggest that a decrease in the visuospatial/visuoperceptual process may be involved in the presentation of autonomic nervous system dysfunction in PD patients.
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Razia, Deepika, Sofya Tokman, Sharjeel Israr, Hesham Mohamed, Hesham Abdelrazek, Bhuvin Buddhdev, Ashwini Arjuna, et al. "Orthostatic Hypotension and Concurrent Autonomic Dysfunction: A Novel Complication of Lung Transplantation." Journal of Transplantation 2022 (March 3, 2022): 1–8. http://dx.doi.org/10.1155/2022/3308939.
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Background. Persistent orthostatic hypotension (OH) is a lesser-known complication of lung transplantation (LTx). In this retrospective case series, we describe the clinical manifestations, complications, and treatment of persistent OH in 13 LTx recipients. Methods. We identified LTx recipients who underwent transplantation between March 1, 2018, and March 31, 2020, with persistent symptomatic OH and retrospectively queried the records for clinical information. Results. Thirteen patients were included in the analysis, 9 (69%) had underlying pulmonary fibrosis, and 12 (92%) were male. The median age, height, and body mass index at LTx were 68 years, 70 inches, and 27 kg/m2, respectively. Six (46%) patients were deceased at the time of chart abstraction with a median (IQR) posttransplant survival of 12.6 months (6, 21); the 7 remaining living patients were a median of 19.6 months (18, 32) posttransplant. Signs and symptoms of OH developed a median of 60 (7, 75) days after transplant. Patients were treated with pharmacological agents and underwent extensive physical therapy. Most patients required inpatient rehabilitation (n = 10, 77%), and patients commonly developed comorbid conditions including weight loss, renal insufficiency with eGFR <50 (n = 13, 100%), gastroparesis (n = 7, 54%), and tachycardia-bradycardia syndrome (n = 2, 15%). Falls were common (n = 10, 77%). The incidence of OH in LTx recipients at our center during the study period was 5.6% (13/234). Conclusions. Persistent OH is a lesser-known complication of LTx that impacts posttransplant rehabilitation and may lead to comorbidities and shortened survival. In addition, most LTx recipients with OH at our center were tall, thin men with underlying pulmonary fibrosis, which may offer an opportunity to instate pretransplant OH screening of at-risk patients.
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Li, Jingjing, Yi Li, Shihui Xing, Jian Zhang, Baoshan Qiu, Jinsheng Zeng, and Yuhua Fan. "Orthostatic Hypotension and Albuminocytologic Dissociation as Primary Manifestations of the Paraneoplastic Syndrome." European Neurology 80, no. 1-2 (2018): 78–81. http://dx.doi.org/10.1159/000493865.
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Background: Orthostatic hypotension (OH) is the key manifestation of autonomic dysfunction with many causes. Systemic neurological causes such as paraneoplastic syndrome are usually ignored. Methods: We retrospectively analyzed clinical and examination data of 2 patients who were hospitalized, with onset symptom of OH and who were diagnosed as paraneoplastic syndrome. Results: The patients were characteristic of an initial symptom of OH, positive anti-Hu antibody and albuminocytologic dissociation in the cerebrospinal fluid. Patient 2 died and Patient 1 worsened during follow-up. Conclusions: The diagnosis of paraneoplastic syndrome is usually neglected when the onset symptoms are autonomic dysfunctions such as OH. Neurologists should improve their knowledge to diagnose accurately.
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Rose, Kathryn M., Kathleen C. Light, A. R. Sharrett, and Herman A. Tyroler. "The association between orthostatic hypotension and the six-year incidence of hypertension:." Circulation 103, suppl_1 (March 2001): 1348. http://dx.doi.org/10.1161/circ.103.suppl_1.9999-20.
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0020 This study examined the association between orthostatic hypotension (OH) and the six-year incidence of hypertension and isolated systolic hypertension (ISH) in 6,951 normotensive men and women free of CHD who participated in the baseline examination of the Atherosclerosis Risk in Communities (ARIC) study. OH, measured at baseline, was defined as a decrease in SBP ≥ 20 mm Hg or a decrease in DBP ≥ 10 mm Hg after changing from the supine to the standing position. Hypertension (SBP ≥ 140 mm Hg or DBP ≥ 90 mm Hg or current use of antihypertensive medications) and ISH (SBP ≥ 140 mm Hg and DBP < 90 mm Hg) status were ascertained at the second follow-up examination, which occurred approximately six years later. In unadjusted analyses, OH was associated with an increased risk of both hypertension (Odds Ratio (OR)= 2.07, 95% confidence interval (CI) = 1.51, 2.84) and ISH (OR=2.28, 95% CI = 1.53, 3.41). These associations were modestly attenuated after controlling for age, race, gender, BMI, and carotid intima media thickness. Baseline seated SBP was a significant effect modifier of both the OH - hypertension and the OH - ISH associations. Specifically, associations of OH with each of the outcomes were strongest among those with the lowest levels of baseline seated SBP (e.g., seated SBP of 90 mm Hg: OR = 4.8 for hyperetnsion and OR = 9.4 for ISH) and did not persist among those with the highest levels of baseline seated SBP (e.g., seated SBP of 130 mm Hg: OR = 1.1 for hypertension and OR = 1.0 for ISH). We conclude that OH is a strong predictor of hypertension and ISH in persons with low normal blood pressure at baseline and that OH in combination with low normal blood pressure may be an early indicator of impaired blood pressure regulatory systems.
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Saedon, Nor I’zzati, Maw Pin Tan, and James Frith. "The Prevalence of Orthostatic Hypotension: A Systematic Review and Meta-Analysis." Journals of Gerontology: Series A 75, no. 1 (August 29, 2018): 117–22. http://dx.doi.org/10.1093/gerona/gly188.
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Abstract Background Orthostatic hypotension (OH) is associated with increased risk of falls, cognitive impairment and death, as well as a reduced quality of life. Although it is presumed to be common in older people, estimates of its prevalence vary widely. This study aims to address this by pooling the results of epidemiological studies. Methods MEDLINE, EMBASE, PubMed, Web of Science, and ProQuest were searched. Studies were included if participants were more than 60 years, were set within the community or within long-term care and diagnosis was based on a postural drop in systolic blood pressure (BP) ≥20 mmHg or diastolic BP ≥10 mmHg. Data were extracted independently by two reviewers. Random and quality effects models were used for pooled analysis. Results Of 23,090 identified records, 20 studies were included for community-dwelling older people (n = 24,967) and six were included for older people in long-term settings (n = 2,694). There was substantial variation in methods used to identify OH with differing supine rest duration, frequency and timing of standing BP, measurement device, use of standing and tilt-tables and interpretation of the diagnostic drop in BP. The pooled prevalence of OH in community-dwelling older people was 22.2% (95% CI = 17, 28) and 23.9% (95% CI = 18.2, 30.1) in long-term settings. There was significant heterogeneity in both pooled results (I2 > 90%). Conclusions OH is very common, affecting one in five community-dwelling older people and almost one in four older people in long-term care. There is great variability in methods used to identify OH.
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Rawlings, Andreea M., Stephen P. Juraschek, Gerardo Heiss, Timothy Hughes, Michelle L. Meyer, Elizabeth Selvin, A. Richey Sharrett, B. Gwen Windham, and Rebecca F. Gottesman. "Association of orthostatic hypotension with incident dementia, stroke, and cognitive decline." Neurology 91, no. 8 (July 25, 2018): e759-e768. http://dx.doi.org/10.1212/wnl.0000000000006027.
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ObjectiveTo examine associations of orthostatic hypotension (OH) with dementia and long-term cognitive decline and to update previously published results in the same cohort for stroke with an additional 16 years of follow-up.MethodsWe analyzed data from 11,709 participants without a history of coronary heart disease or stroke who attended the baseline examination (1987–1989) of the prospective Atherosclerosis Risk in Communities (ARIC) study. OH was defined as a drop in systolic blood pressure (BP) of at least 20 mm Hg or a drop in diastolic BP of at least 10 mm Hg on standing. Dementia was ascertained via examination, contact with participants or their proxy, or medical record surveillance. Ischemic stroke was ascertained via cohort surveillance of hospitalizations, cohort follow-up, and linkage with registries. Both outcomes were adjudicated. Cognitive function was ascertained via 3 neuropsychological tests administered in 1990 to 1992 and 1996 to 1998 and a full battery of tests in 2011 to 2013. Scores were summarized and reported as SDs. We used adjusted Cox regression and linear mixed models.ResultsOver ≈25 years, 1,068 participants developed dementia and 842 had an ischemic stroke. Compared to persons without OH at baseline, those with OH had a higher risk of dementia (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.20–1.97) and ischemic stroke (HR 2.08, 95% CI 1.65–2.62). Persons with OH had greater, although nonsignificant, cognitive decline over 20 years (SD 0.09, 95% CI −0.02 to 0.21).ConclusionsOH assessed in midlife was independently associated with incident dementia and ischemic stroke. Additional studies are needed to elucidate potential mechanisms for these associations and possible applications for prevention.
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Pilotto, Andrea, Alberto Romagnolo, Andrea Scalvini, Mario Masellis, Yasushi Shimo, Laura Bonanni, Richard Camicioli, et al. "Association of Orthostatic Hypotension With Cerebral Atrophy in Patients With Lewy Body Disorders." Neurology 97, no. 8 (June 7, 2021): e814-e824. http://dx.doi.org/10.1212/wnl.0000000000012342.
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ObjectiveTo evaluate whether orthostatic hypotension (OH) or supine hypertension (SH) is associated with brain atrophy and white matter hyperintensities (WMH), we analyzed clinical and radiologic data from a large multicenter consortium of patients with Parkinson disease (PD) and dementia with Lewy bodies (DLB).MethodsSupine and orthostatic blood pressure (BP) and structural MRI data were extracted from patients with PD and DLB evaluated at 8 tertiary-referral centers in the United States, Canada, Italy, and Japan. OH was defined as a systolic/diastolic BP fall ≥20/10 mm Hg within 3 minutes of standing from the supine position (severe ≥30/15 mm Hg) and SH as a BP ≥140/90 mm Hg with normal sitting BP. Diagnosis-, age-, sex-, and disease duration–adjusted differences in global and regional cerebral atrophy and WMH were appraised with validated semiquantitative rating scales.ResultsA total of 384 patients (310 with PD, 74 with DLB) met eligibility criteria, of whom 44.3% (n = 170) had OH, including 24.7% (n = 42) with severe OH and 41.7% (n = 71) with SH. OH was associated with global brain atrophy (p = 0.004) and regional atrophy involving the anterior-temporal (p = 0.001) and mediotemporal (p = 0.001) regions, greater in severe vs nonsevere OH (p = 0.001). The WMH burden was similar in those with and without OH (p = 0.49). SH was not associated with brain atrophy (p = 0.59) or WMH (p = 0.72).ConclusionsOH, but not SH, was associated with cerebral atrophy in Lewy body disorders, with prominent temporal region involvement. Neither OH nor SH was associated with WMH.
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Wagoner, Ashley L., Hossam A. Shaltout, John E. Fortunato, and Debra I. Diz. "Distinct neurohumoral biomarker profiles in children with hemodynamically defined orthostatic intolerance may predict treatment options." American Journal of Physiology-Heart and Circulatory Physiology 310, no. 3 (February 1, 2016): H416—H425. http://dx.doi.org/10.1152/ajpheart.00583.2015.
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Studies of adults with orthostatic intolerance (OI) have revealed altered neurohumoral responses to orthostasis, which provide mechanistic insights into the dysregulation of blood pressure control. Similar studies in children with OI providing a thorough neurohumoral profile are lacking. The objective of the present study was to determine the cardiovascular and neurohumoral profile in adolescent subjects presenting with OI. Subjects at 10–18 yr of age were prospectively recruited if they exhibited two or more traditional OI symptoms and were referred for head-up tilt (HUT) testing. Circulating catecholamines, vasopressin, aldosterone, renin, and angiotensins were measured in the supine position and after 15 min of 70° tilt. Heart rate and blood pressure were continuously measured. Of the 48 patients, 30 patients had an abnormal tilt. Subjects with an abnormal tilt had lower systolic, diastolic, and mean arterial blood pressures during tilt, significantly higher levels of vasopressin during HUT, and relatively higher catecholamines and ANG II during HUT than subjects with a normal tilt. Distinct neurohumoral profiles were observed when OI subjects were placed into the following groups defined by the hemodynamic response: postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension (OH), syncope, and POTS/syncope. Key characteristics included higher HUT-induced norepinephrine in POTS subjects, higher vasopressin in OH and syncope subjects, and higher supine and HUT aldosterone in OH subjects. In conclusion, children with OI and an abnormal response to tilt exhibit distinct neurohumoral profiles associated with the type of the hemodynamic response during orthostatic challenge. Elevated arginine vasopressin levels in syncope and OH groups are likely an exaggerated response to decreased blood flow not compensated by higher norepinephrine levels, as observed in POTS subjects. These different compensatory mechanisms support the role of measuring neurohumoral profiles toward the goal of selecting more focused and mechanistic-based treatment options for pediatric patients with OI.
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Buckley, Anne, Daniel Carey, James M. Meaney, RoseAnne Kenny, and Joseph Harbison. "Is there an association between orthostatic hypotension and cerebral white matter hyperintensities in older people? The Irish longitudinal study on ageing." JRSM Cardiovascular Disease 9 (January 2020): 204800402095462. http://dx.doi.org/10.1177/2048004020954628.
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Introduction Orthostatic Hypotension (OH) is an abnormal drop in blood pressure (BP) that occurs following orthostatic challenge. OH is associated with increased risk of falls, cognitive impairment and death. White Matter Hyperintensities (WMH) on MR Brain are associated with vascular risk factors such as hypertension, diabetes and age. We examined whether extent White matter intensities were associated with presence of OH detected in a community dwelling population of older people. Methods Individuals from the MR sub-study of the Irish Longitudinal Study of Ageing underwent a 3 Tesla MR Brain scan to assess WMH severity (Schelten’s Score). The scans were performed during the Wave 3 TILDA health assessment phase when the subjects also underwent assessment for OH with an active stand protocol. Data was analysed for association between WMH and vascular risks and orthostatic change in BP 10 second intervals during the OH evaluation. Results 440 subjects were investigated; median age 72 years (65–92 years) and 228 (51.5%) female. Range of Scheltens’ Scores was 0–32. Mean score was 9.72 (SD 5.87). OH was detected in 68.4% (301). On linear regression, positive associations were found between Scheltens’ Score and age, hypertension, prior history of stroke and TIA, and with OH at 30, 70, 90 and 100 seconds following standing (p < 0.05, O.R. 1.9–2.5). Conclusion WMD is associated with OH detected at multiple time points using active stand in community dwelling older subjects. Further research is necessary to evaluate the direction of this association.
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Thoburn, Steve, Steve Cremin, and Mark Holland. "An atypical presentation of orthostatic hypotension and falls in an older adult." British Paramedic Journal 6, no. 4 (March 1, 2022): 41–47. http://dx.doi.org/10.29045/14784726.2022.03.6.4.41.
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Introduction: Falls are a significant cause of morbidity and mortality in older adults. Orthostatic hypotension (OH) is very common in this cohort of patients and is a significant risk for falls and associated injuries. We present the case of an 89-year-old female who fell at home, witnessed by her husband. OH was identified during the clinical assessment and considered to be the predominant contributing factor, although the clinical presentation was not associated with classical symptoms.Case presentation: The patient lost balance while turning away from the kitchen sink; she noted some instability due to a complaint of generalised weakness in both of her legs. No acute medical illness or traumatic injury was identified. A comprehensive history was obtained that identified multiple intrinsic and extrinsic risk factors for falling. The cardiovascular examination was unremarkable except for OH, with a pronounced reduction in systolic blood pressure of 34 mmHg at the three-minute interval and which reproduced some generalised weaknesses in the patient’s legs and slight instability. Although classical OH symptoms were not identified, this was considered to be the predominant factor contributing to the fall. A series of recommendations was made to primary and community-based care teams based upon a rapid holistic review; this included a recommendation to review the patient’s dual antihypertensive therapy.Conclusion: It is widely known that OH is a significant risk factor for falls, but asymptomatic or atypical presentations can make diagnosis challenging. Using the correct technique to measure a lying and standing blood pressure, as defined by the Royal College of Physicians, is crucial for accurate diagnosis and subsequent management. Ambulance clinicians are ideally placed to undertake this quick and non-invasive assessment to identify OH in patients that have fallen.
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Shlyakhto, E. V., S. V. Villevalde, A. E. Soloveva, N. E. Zvartau, M. Yu Sitnikova, D. N. Fedorova, N. G. Vinogradova, and I. V. Fomin. "Rationale and design of multicenter prospective observational study of types, GRAde, VariabilITY, associations and prognosis of orthostatic responses in Heart Failure (GRAVITY-HF)." Russian Journal of Cardiology 25, no. 1 (February 10, 2020): 78–82. http://dx.doi.org/10.15829/1560-4071-2020-1-3662.
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Heart failure (HF) is one of the leading causes of adult mortality. Increased risk of death determines need for better understanding of the pathophysiological mechanisms, predictive risk stratification models and applicable methods to improve prognosis. One of the unfavorable prognostic factors may be an inadequate hemodynamic response to orthostatic stress. Orthostatic hypotension (OH) is known to be an independent predictor of many cardiovascular diseases, particularly HF, and death. Singlecenter study of HF population revealed that systolic blood pressure within 3-5 minutes after standing up may be a predictor of long-term unfavorable outcomes. Nevertheless, data about OH in patients with HF are limited and inconsistent due to heterogeneity of populations and different methodology in published studies. In this regard, a population-based study of the orthostatic response in patients with HF (stable and decompensated) is needed. The article describes the rationale and design of a multicenter prospective observational study aimed to assess the clinical and prognostic significance of orthostatic responses in HF patients.