A practical guide to active stand testing and analysis using continuous beat-to-beat non-invasive blood pressure monitoring

Finucane, Ciarán; Wijnen, Veera K. van; Fan, Chie Wei; Soraghan, Christopher; Byrne, Lisa; Westerhof, Berend E.; Freeman, Roy; Fedorowski, Artur; Harms, Mark P M; Wieling, Wouter; Kenny, Rose Anne

doi:10.1007/s10286-019-00606-y

Cited by 80 publications

(109 citation statements)

References 64 publications

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“…In addition, the intervention had no effect on ADAS-cog scores ( 26 ), but in the substudy, we found an effect of nilvadipine on hippocampal cerebral blood flow ( 50 ). A particular strength of this study is the use of continuous beat-to-beat finger arterial BP measurements instead of the traditional arm-cuff-based approaches, which allows capturing transient information instead of steady-state measurements ( 51 ). The initial drop in BP upon standing in our study (±18/9 mm Hg) was smaller compared with previous studies, for example, in the normative data of people aged 70–79 years from TILDA (±40/25 mm Hg) ( 31 ).…”

Section: Discussionmentioning

confidence: 99%

Orthostatic Blood Pressure Recovery Is Associated With the Rate of Cognitive Decline and Mortality in Clinical Alzheimer’s Disease

Heus

Jong

Rijpma

et al. 2020

The Journals of Gerontology: Series A

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Background Impaired recovery of blood pressure (BP) after standing has been shown to be related to cognitive function and mortality in people without dementia, but its role in people with Alzheimer’s disease (AD) is unknown. The aim of this study was to investigate the association of the orthostatic BP response with cognitive decline and mortality in AD. Methods In this post hoc analysis of a randomized controlled trial (Nilvad), we measured the beat-to-beat response of BP upon active standing in mild-to-moderate AD. This included the initial drop (nadir within 40 seconds) and recovery after 1 minute, both expressed relative to resting values. We examined the relationship between a small or large initial drop (median split) and unimpaired (≥100%) or impaired recovery (<100%) with 1.5-year change in Alzheimer’s Disease Assessment—cognitive subscale (ADAS-cog) scores and all-cause mortality. Results We included 55 participants (age 73.1 ± 6.2 years). Impaired BP recovery was associated with higher increases in ADAS-cog scores (systolic: β [95% confidence interval] = 5.6 [0.4–10.8], p = .035; diastolic: 7.6 [2.3–13.0], p = .006). During a median follow-up time of 49 months, 20 participants died. Impaired BP recovery was associated with increased mortality (systolic: HR [95% confidence interval] = 2.9 [1.1–7.8], p = .039; diastolic: HR [95% confidence interval] = 5.5 [1.9–16.1], p = .002). The initial BP drop was not associated with any outcome. Results were adjusted for age, sex, and intervention group. Conclusions Failure to fully recover BP after 1 minute of standing is associated with cognitive decline and mortality in AD. As such, BP recovery can be regarded as an easily obtained marker of progression rate of AD.

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Section: Discussionmentioning

confidence: 99%

Orthostatic Blood Pressure Recovery Is Associated With the Rate of Cognitive Decline and Mortality in Clinical Alzheimer’s Disease

Heus

Jong

Rijpma

et al. 2020

The Journals of Gerontology: Series A

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“…This was used to derive measures of heart rate variability (HRV) during supine resting and provocative testing. A detailed description of continuous blood pressure (BP) monitoring using beat-to-beat systolic BP, diastolic BP and pulse rate using the volume clamp method (Finometer NOVA, FMS Medical Systems, Arnheim, Netherlands) during autonomic testing is available elsewhere [32]. Briefly, a pressure cuff was applied to the patient (left hand, middle finger) with height correction.…”

Section: Autonomic Testingmentioning

confidence: 99%

Fatigue following COVID-19 infection is not associated with autonomic dysfunction

et al. 2021

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Background The long-term clinical and physiological consequences of COVID-19 infection remain unclear. While fatigue has emerged as a common symptom following infection, little is known about its links with autonomic dysfunction. SARS-CoV-2 is known to infect endothelial cells in acute infection, resulting in autonomic dysfunction. Here we set out to test the hypothesis that this results in persistent autonomic dysfunction and is associated with post-COVID fatigue in convalescent patients. Methods We recruited 20 fatigued and 20 non-fatigued post-COVID patients (median age 44.5 years, 36/40 (90%) female, median time to follow up 166.5 days). Fatigue was assessed using the Chalder Fatigue Scale. These underwent the Ewing’s autonomic function test battery, including deep breathing, active standing, Valsalva manoeuvre and cold-pressor testing, with continuous electrocardiogram and blood pressure monitoring, as well as near-infrared spectroscopy-based cerebral oxygenation. 24-hour ambulatory blood pressure monitoring was also conducted, and patients completed the generalised anxiety disorder-7 questionnaire. We assessed between-group differences in autonomic function test results and used unadjusted and adjusted linear regression to investigate the relationship between fatigue, anxiety, and autonomic test results. Results We found no pathological differences between fatigued and non-fatigued patients on autonomic testing or on 24-hour blood pressure monitoring. Symptoms of orthostatic intolerance were reported by 70% of the fatigued cohort at the time of active standing, with no associated physiological abnormality detected. Fatigue was strongly associated with increased anxiety (p <0.001), with no patients having a pre-existing diagnosis of anxiety. Conclusions These results demonstrate the significant burden of fatigue, symptoms of autonomic dysfunction and anxiety in the aftermath of COVID-19 infection, but reassuringly do not demonstrate pathological findings on autonomic testing.

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“…perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version posted December 8, 2020. ; https://doi.org/10.1101/2020.12.07.20241109 doi: medRxiv preprint et al 2017; Wieling et al 1992;Smith, Porth, and Erickson 1994;Finucane et al 2019). These responses are characteristic of an aging autonomic nervous system and are evident here.…”

Section: Discussionmentioning

confidence: 52%

Machine learning for analysis of active stand responses in older adults with vasovagal syncope

Kwok

Nolan

Fan

et al. 2020

Preprint

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ObjectivesTo assess 1) differences in the hemodynamic response to the active stand test in older adults with a clinical diagnosis of vasovagal syncope compared to age-matched controls 2) if the active stand test combined with machine learning approaches can be used to identify the presence of vasovagal syncope in older adults.ApproachAdults aged 50 and over (Vasovagal Syncope N=46 Age=66.9±10.3; Control N=86 Age=65.3±9.5) completed an active stand test. Multiple features were extracted to characterize the hemodynamic responses to the active stand test and were compared between groups. Classification was performed using machine learning algorithms including linear discriminant analysis, quadratic discriminant analysis, support vector machine and an ensemble majority vote classifier.Main ResultsSubjects with vasovagal syncope demonstrated a higher resting (supine) heart rate (69.8±13.1 bpm vs 63.3±12.1 bpm; P=0.007), a smaller initial systolic blood pressure drop (−20.2±20.1% vs −27.3±17.5%; P=0.005), larger drops in stroke volume (−14.7±24.0% vs −2.7±23.3%; P=0.010) and cardiac output (−6.4±18.5% vs 5.8±22.3%;P<0.001) and a larger increase in total peripheral resistance (8.1±30.4% vs −6.03±22.8%; P=0.002) compared to controls. A majority vote classifier identified the presence of vasovagal syncope with 82.6% sensitivity, 76.8% specificity, and average accuracy of 78.9%.SignificanceOlder adults with vasovagal syncope display a unique hemodynamic and autonomic response to active standing characterized by relative autonomic hypersensitivity and larger drops in cardiac output compared to age-matched controls. With suitable machine learning algorithms, the active stand test holds the potential to be used to screen older adults for reflex syncopes and hypotensive susceptibility potentially reducing test time, cost, and patient discomfort. More broadly this paper presents a machine learning framework to support use of the active stand test for classification of clinical outcomes of interest.

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A practical guide to active stand testing and analysis using continuous beat-to-beat non-invasive blood pressure monitoring

Abstract: R. (2019). A practical guide to active stand testing and analysis using continuous beat-to-beat non-invasive blood pressure monitoring. Clinical autonomic research, 29(4), 427-441.

Cited by 80 publications

References 64 publications

Orthostatic Blood Pressure Recovery Is Associated With the Rate of Cognitive Decline and Mortality in Clinical Alzheimer’s Disease

Orthostatic Blood Pressure Recovery Is Associated With the Rate of Cognitive Decline and Mortality in Clinical Alzheimer’s Disease

Fatigue following COVID-19 infection is not associated with autonomic dysfunction

Machine learning for analysis of active stand responses in older adults with vasovagal syncope

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