An Emerging Role for Understanding Orthostatic Hyp‘er’tension in the Cardiorenal Syndrome

Buddineni, Jaya P.; Chauhan, Laxmi; Ahsan, Syed T.; Whaley‐Connell, Adam

doi:10.1159/000327141

Cited by 11 publications

(13 citation statements)

References 86 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…OH was defined as a decline in SBP of at least 20 mm Hg and/or a decline in DBP of at least 10 mm Hg after either 0 or 2 minutes from a supine to an upright posture . The definition of OHT was a postural increase of at least 20 mm Hg in the orthostatic SBP change . Participants with neither of these two patterns were classified into an orthostatic normotension (ONT) group.…”

Section: Methodsmentioning

confidence: 99%

Orthostatic Blood Pressure Dysregulation and Polymorphisms of β‐Adrenergic Receptor Genes in Hypertensive Patients

Gao

Lin

Sun

et al. 2014

J of Clinical Hypertension

View full text Add to dashboard Cite

The genetic susceptibility to orthostatic blood pressure dysregulation remains poorly understood. The association between polymorphisms of beta-adrenergic receptor (b-AR) genes and orthostatic blood pressure dysregulation in hypertensive patients was investigated. Two polymorphisms of b 1 -AR (Arg389/Gly) and b 2 -AR (Arg16/Gly) were genotyped in untreated hypertensive patients and normotensive patients. In patients with untreated hypertension, the frequency of b 1 -AR Gly389 homozygote was significantly higher in patients with orthostatic hypotension (OH) (P<.0001) and lower in patients with orthostatic hypertension (OHT) (P=.002) as compared with patients with orthostatic normotension (ONT) even after Bonferroni correction. After analysis by sex and adjustment for conventional risk factors, the b 1 -AR Gly389 homozygote conferred about a 3-fold risk of OH and independently predicted a 6.5 mm Hg greater orthostatic SBP decrease (GG À8.9AE13 mm Hg vs CC+CG À2.4AE12 mm Hg, P<.001) only in female hypertensive patients. The association of b 2 -AR Arg16/Gly with OH was not significant after adjustment for conventional risk factors. In normotensive patients, no association was identified between these two polymorphisms and OHT or OH. These results indicated that the b 1 -AR Arg389/Gly polymorphism may be associated with increased risk of OH in female hypertensive patients.

show abstract

Section: Methodsmentioning

confidence: 99%

Orthostatic Blood Pressure Dysregulation and Polymorphisms of β‐Adrenergic Receptor Genes in Hypertensive Patients

Gao

Lin

Sun

et al. 2014

J of Clinical Hypertension

View full text Add to dashboard Cite

show abstract

“…Orthostatic hypertension may develop in cases of reduced renal blood flow during standing. This particular condition has been observed in patients with nephroptosis, a clinical entity characterized by increased mobility of the kidneys and defined as significant descend of the kidney (by at least 5 cm or two vertebral bodies on intravenous urography) when standing . Descend of the kidney can cause stretching and torsion of the renal artery, reduction of renal blood flow and, consequently, OHT .…”

Section: Pathophysiologymentioning

confidence: 97%

“…Moreover, Vriz et al observed that OHT patients had higher resting cardiac output and heart rate, as well as higher urinary norepinephrine output compared with non‐OHT individuals, suggesting that OHT is characterized by increased baseline sympathetic activity, and the orthostasis‐induced cardiac output reduction may trigger sympathetic over‐response . ANS dysfunction is attributed to impaired arterial and cardiopulmonary baroreceptors’ sensitivity and/or baroreflex failure to adjust to “normal” BP values, while alpha‐adrenergic vascular hyperactivity is believed to be another important mechanism mediating the excessive vasoconstriction . Activation of the renin‐angiotensin‐aldosterone system (RAAS) and increased vasopressin secretion may also be involved in the development of OHT .…”

Section: Pathophysiologymentioning

confidence: 99%

“…ANS dysfunction is attributed to impaired arterial and cardiopulmonary baroreceptors’ sensitivity and/or baroreflex failure to adjust to “normal” BP values, while alpha‐adrenergic vascular hyperactivity is believed to be another important mechanism mediating the excessive vasoconstriction . Activation of the renin‐angiotensin‐aldosterone system (RAAS) and increased vasopressin secretion may also be involved in the development of OHT . Furthermore, arterial stiffness and small artery remodeling could aggravate orthostatic sympathetic response and promote an exaggerated increase in vascular resistance .…”

Section: Pathophysiologymentioning

confidence: 99%

See 1 more Smart Citation

Orthostatic hypertension: From pathophysiology to clinical applications and therapeutic considerations

Magkas

Tsioufis

Thomopoulos

et al. 2019

J of Clinical Hypertension

View full text Add to dashboard Cite

Orthostatic hypertension (OHT), that is, sustained increase in blood pressure after standing, is an increasingly recognized cardiovascular disorder having been examined in much fewer studies compared with orthostatic hypotension (OH). However, in both OHT and OH, dysfunction of the autonomous nervous system is considered to be the primary pathophysiological disturbance, while significant associations with essential hypertension have been observed. Although in many studies OHT has been related to subclinical or clinical target organ damage, there is also evidence denying such an association. Because OHT is defined variably across different studies, the comparison of relevant outcomes is at least problematic. Since evidence about OHT treatment is exclusively based on limited non‐randomized studies, no specific recommendations have been developed. Therefore, both the prognostic role and the clinical significance of OHT remain largely undefined. The aim of the present review is to summarize the available evidence regarding the definition, diagnosis, pathophysiology, prognostic role and treatment of OHT and highlight potential clinical implications of this underestimated condition.

show abstract

“…Orthostatic hypotension is also an established marker for cardiovascular risk in patients with hypertension [ 3 , 4 ], in the elderly [ 5 – 8 ] and in the general population [ 9 – 12 ]. Considerably less is known, however, about the prevalence and clinical impact of the reverse phenomenon, orthostatic hypertension, which implies an exaggerated rise in blood pressure when assuming an upright position [ 13 , 14 ]. Orthostatic hypertension has been associated with increased prevalence of silent cerebrovascular lesions in the elderly [ 15 ], and with increased risk for incident lacunar strokes in the general population [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Diastolic orthostatic hypertension and cardiovascular prognosis in type 2 diabetes: a prospective cohort study

Wijkman

Länne

Östgren

et al. 2016

Cardiovasc Diabetol

View full text Add to dashboard Cite

BackgroundIn patients with type 2 diabetes, the prognostic impact of an orthostatic rise in blood pressure is not known. Therefore, the aim of this study was to determine the prognostic implications of the diastolic orthostatic blood pressure response in a cohort of patients with type 2 diabetes. We also evaluated associations between different orthostatic blood pressure responses and markers of subclinical cardiovascular organ damage.MethodsOffice blood pressures were measured in the sitting and in the standing position in 749 patients with type 2 diabetes who participated in the CARDIPP study (Cardiovascular Risk factors in Patients with Diabetes—a Prospective study in Primary care). Diastolic orthostatic hypertension was defined as a rise of diastolic blood pressure ≥10 mmHg and diastolic orthostatic hypotension was defined as a drop of diastolic blood pressure ≥10 mmHg. Recruitment took place between the years 2005–2008, and patients were followed until any of the primary outcome events (cardiovascular death or hospitalization for either myocardial infarction or stroke) occurred or until December 31st, 2014. Measurements of aortic pulse wave velocity and of carotid intima-media thickness were performed at base-line.ResultsDiastolic orthostatic hypertension was found in 140 patients (18.7 %) and was associated with significantly lower risk of cardiovascular events (crude hazard ratio compared with patients with normal systolic and diastolic orthostatic blood pressure response: 0.450, 95 % C.I. 0.206–0.987, P = 0.046). Diastolic orthostatic hypotension was found in 31 patients (4.1 %) and was associated with higher values for aortic pulse wave velocity and carotid intima-media thickness, compared with patients with normal systolic and diastolic orthostatic blood pressure response.ConclusionsDiastolic orthostatic hypertension is common in patients with type 2 diabetes, and may be a novel marker for decreased cardiovascular risk in these patients.

show abstract

An Emerging Role for Understanding Orthostatic Hyp‘er’tension in the Cardiorenal Syndrome

Cited by 11 publications

References 86 publications

Orthostatic Blood Pressure Dysregulation and Polymorphisms of β‐Adrenergic Receptor Genes in Hypertensive Patients

Orthostatic Blood Pressure Dysregulation and Polymorphisms of β‐Adrenergic Receptor Genes in Hypertensive Patients

Orthostatic hypertension: From pathophysiology to clinical applications and therapeutic considerations

Diastolic orthostatic hypertension and cardiovascular prognosis in type 2 diabetes: a prospective cohort study

Contact Info

Product

Resources

About