Abstract-Both age and gender influence cardiovascular autonomic control, which in turn may influence the ability to withstand adverse cardiac events and respond to orthostatic stress. The purpose of this study was (1) to quantify age-and gender-related alterations in autonomic control of blood pressure (BP) and (2) to examine the impact of these autonomic alterations on BP response to orthostatic stress. We measured continuous BP and R-R intervals and vasoactive peptide levels in the supine and 60°head-up tilt positions during paced respiration (0.25 Hz) in 89 carefully screened healthy subjects (41 men, 48 women, aged 20 to 83 years). Data were analyzed by gender (age adjusted) and by age group (gender adjusted). During tilt, women had greater decreases in systolic BP than men (Ϫ10.2Ϯ2 versus Ϫ1.2Ϯ3 mm Hg; Pϭ0.02) and smaller increases in low-frequency (sympathetically mediated) BP power (Pϭ0.02). Upright plasma norepinephrine was lower in women (Pϭ0.02). Women had greater supine high-frequency R-R interval power than men (Pϭ0.0001). In elderly subjects, the tilt-induced increase in low-frequency BP power was also diminished (Pϭ0.01), despite higher supine (Pϭ0.02) and similar upright norepinephrine levels compared with younger subjects. Thus, healthy women have less sympathetic influence on BP and greater parasympathetic influence on R-R interval than men. Elderly subjects also have reduced sympathetic influence on BP, but this appears to be more consistent with a reduction in vasomotor sympathetic responsiveness. (Hypertension. 1999;33:1195-1200.)Key Words: sympathetic nervous system Ⅲ norepinephrine Ⅲ spectral analysis Ⅲ hypotension A nalyses of the beat-to-beat variability of cardiac R-R intervals have been used to quantify alterations in autonomic function and predict adverse clinical events. 1,2 Since both age and gender have a profound influence on the risk of cardiovascular disease and death, it is important to understand the effects of healthy aging and gender on autonomic control of cardiovascular function. Previous studies have shown reductions in heart rate (HR) variability with aging 3,4 and increases in high-frequency HR variability in women compared with men. [5][6][7] Since many studies did not rigorously screen subjects to exclude occult cardiovascular disease, it is not known whether abnormalities in short-term autonomic control of HR reflect subclinical cardiovascular disease or whether they represent "normal" age-or gender-related alterations in autonomic function.The effects of age and gender on beat-to-beat blood pressure (BP) dynamics have been less well studied, and it is not known whether changes in the autonomic regulation of beat-to-beat BP are associated with hemodynamic impairment. Therefore, we asked the following questions: (1) Are there specific age-and gender-related alterations in the autonomic control of beat-tobeat BP dynamics in healthy individuals free of cardiovascular disease? (2) If so, what are the hemodynamic consequences of these changes during orthostatic stress?We u...
SYNOPSISPostoperative complications are directly related to poor surgical outcomes in the elderly. This review outlines evidence based quality initiatives focused on decreasing neurologic, cardiac, and pulmonary complications in the elderly surgical patient. Delirium is the most common neurologic complication in the elderly. Important anesthesia quality initiatives for prevention of delirium in elderly surgical patients include use of structured clinical protocols focused on delirium risk factor modification, avoiding meperidine when managing postoperative pain, and careful selection and titration of drugs when sedation is required. There are few age-specific quality measures aimed at prevention of cardiac and pulmonary complications. However, some recommendations for adults such as avoidance of long acting muscle relaxants and perioperative use of statins and beta blockers in high risk patients can be applied to the geriatric surgical population. In the future, process measures may provide a more global assessment of quality in the elderly surgical population.
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