Association between orthostatic blood pressure dysregulation and geriatric syndromes: a cross-sectional study

Roca, Frédéric; Rougette, Kévin; Zmuda, Louise; Noel, G; Larose, Solène; Bordage, Mathilde; Chassagne, Philippe

doi:10.1186/s12877-022-02844-8

Cited by 9 publications

(8 citation statements)

References 51 publications

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“…De Bruine et al [ 39 ] found that participants with the worst performance on 5CST, compared to intermediate and best groups, had significantly higher odds of OH measured with beat-to-beat BP. Chen et al [ 40 ] found significantly increased odds of OH with auscultatory BP measurements for those with weak grip strength, whilst Roca et al [ 41 ] reported similar results with oscillometric measurement of BP. Looking at muscle mass alone, Benton et al [ 42 ] found greater drops in BP measured oscillometrically on standing, in a low muscle mass group compared to a normal muscle mass group, both before and after overnight fast.…”

Section: Discussionmentioning

confidence: 99%

Relationship between sarcopenia and orthostatic blood pressure recovery in older falls clinic attendees

2023

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Purpose Sarcopenia and delayed orthostatic blood pressure (BP) recovery are two disorders increasingly associated with adverse clinical outcomes in older adults. There may exist a pathophysiological link between the two via the skeletal muscle pump of the lower limbs. Previously in a large population-based study, we found an association between probable sarcopenia and orthostatic BP recovery. Here, we sought to determine the association between confirmed sarcopenia and orthostatic BP recovery in falls clinic attendees aged 50 years or over. Methods One hundred and nine recruited patients (mean age 70 years, 58% women) underwent an active stand with non-invasive beat-to-beat haemodynamic monitoring. Hand grip strength and five-chair stands time were measured, and bioelectrical impedance analysis was performed. They were then classified as robust, probable sarcopenic or sarcopenic as per the European Working Group on Sarcopenia in Older People guidelines. Mixed effects models with linear splines were used to model the effect of sarcopenia status on orthostatic BP recovery, whilst controlling for potential confounders. Results Probable sarcopenia was identified in 32% of the sample and sarcopenia in 15%. Both probable and confirmed sarcopenia were independently associated with an attenuated rate of recovery of both systolic and diastolic BP in the 10–20 s period after standing. Attenuation was larger for confirmed than probable sarcopenia (systolic BP β − 0.85 and − 0.59, respectively, P < 0.01; diastolic BP β − 0.65, − 0.45, P < 0.001). Conclusion Sarcopenia was independently associated with slower BP recovery during the early post-stand period. The potentially modifiable effect of the skeletal muscle pump in orthostatic haemodynamics requires further study.

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Section: Discussionmentioning

confidence: 99%

Relationship between sarcopenia and orthostatic blood pressure recovery in older falls clinic attendees

2023

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“…Conditions associated with higher activity of the sympathetic nervous system and baroreflex dysregulation, such as obesity, diabetes, essential hypertension, and aging have been found to be often associated with ERTS or OHT 4,51–57 (Figure 3; Text S3). Also, factors related to BP assessment may influence the RTS.…”

Section: Risk Factors Associated With Ohtmentioning

confidence: 99%

Orthostatic Hypertension: A Newcomer Among the Hypertension Phenotypes

Palatini

2023

Hypertension

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The prognostic role and the clinical significance of orthostatic hypertension (OHT) remained undefined for long because data were sparse and often inconsistent. In recent years, evidence has been accumulating that OHT is associated with an increased risk of masked and sustained hypertension, hypertension-mediated organ damage, cardiovascular disease, and mortality. Most evidence came from studies in which OHT was defined using systolic blood pressure (BP) whereas the clinical relevance of diastolic OHT is still unclear. Recently, the American Autonomic Society and the Japanese Society of Hypertension defined OHT as an orthostatic systolic BP increase ≥20 mm Hg associated with a systolic BP of at least 140 mm Hg while standing. However, also smaller orthostatic BP increases have shown clinical relevance especially in people ≤45 years of age. A possible limitation of the BP response to standing is poor reproducibility. OHT concordance is better when the between-assessment interval is shorter, when OHT is evaluated using a larger number of BP readings, and if home BP measurement is used. The pathogenetic mechanisms leading to OHT are still controversial and may vary according to age. Excessive neurohumoral activation seems to be the main determinant in younger adults whereas vascular stiffness plays a more important role in older individuals. Conditions associated with higher activity of the sympathetic nervous system and/or baroreflex dysregulation, such as diabetes, essential hypertension, and aging have been found to be often associated with OHT. Measurement of orthostatic BP should be included in routine clinical practice especially in people with high-normal BP.

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“…The majority of existing studies that investigated HGS and OH ( 8 , 13 , 15 , 35 , 36 ) used oscillometric BP, and therefore they were unable to consider the BP recovery phase. Romero-Ortuno et al ( 9 ) assessed the relationship between frailty and OH with continuous BP and did not find a difference in HGS in those with delayed BP recovery; however, they used a morphological clustering approach rather than a strict OH definition and had a smaller sample ( n = 442).…”

Section: Discussionmentioning

confidence: 99%

“…In the steady state period, postrecovery (40–180 seconds), probable sarcopenia had little (5CST) or no (HGS) association with SBP or DBP. Studies looking at classically measured (oscillometric) OH at 3 minutes have found it to be associated with weak HGS ( 35 , 36 ) and confirmed sarcopenia ( 15 ), they however, adjusted for limited confounders, and recruited in outpatient ( 15 , 36 ) or hospital inpatient ( 35 ) setting, where the demographics and prevalence of OH, sarcopenia and severe sarcopenia may be different. Soysal et al ( 13 ) did not find a significant relationship between OH at 3 minutes and either probable or confirmed sarcopenia.…”

Section: Discussionmentioning

confidence: 99%

Differential Associations Between Two Markers of Probable Sarcopenia and Continuous Orthostatic Hemodynamics in The Irish Longitudinal Study on Ageing

Duggan

Murphy

Knight

et al. 2022

The Journals of Gerontology: Series A

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Background Sarcopenia and orthostatic hypotension are growing age-related health burdens associated with adverse outcomes including falls. Despite a possible pathophysiological link, the association between the two disorders is not well elucidated. We sought to investigate this relationship in The Irish Longitudinal Study on Ageing (TILDA). Methods Data from 2,858 participants at wave 3 of TILDA were analyzed. Probable sarcopenia was defined as per the European Working Group on Sarcopenia in Older People revised definition cut-offs (hand grip strength (HGS) < 27kg in men, <16kg in women and/or five-chair stand test (5CST) time >15s). Participants underwent an active stand orthostatic test with continuous blood pressure (BP) monitoring. Multi-level mixed effects models, controlling for possible confounders, were used to assess the effect of probable sarcopenia by HGS and 5CST criteria on the change in BP after standing. Results HGS- and 5CST-defined probable sarcopenia were independently associated with an attenuated BP recovery at 10-20s post-stand (systolic BP: β -0.54, P<0.001; β -0.25, P<0.001). On average, those meeting HGS probable sarcopenia criteria had a significantly lower BP at 20, 30 and 40s (differences in systolic BP: -5.01mmHg, -3.68mmHg, -2.32mmHg, P<0.05 for all). Those meeting 5CST probable sarcopenia criteria had a significant difference in systolic BP at 20s (-1.94mmHg, P=0.002) but not at 30 or 40s. Conclusions Probable sarcopenia had a significant association with delayed orthostatic blood pressure recovery, with HGS-defined probable sarcopenia having a stronger association than 5CST-defined probable sarcopenia. Results support a modest but significant pathophysiological link between probable sarcopenia and orthostatic hypotension.

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Association between orthostatic blood pressure dysregulation and geriatric syndromes: a cross-sectional study

Cited by 9 publications

References 51 publications

Relationship between sarcopenia and orthostatic blood pressure recovery in older falls clinic attendees

Relationship between sarcopenia and orthostatic blood pressure recovery in older falls clinic attendees

Orthostatic Hypertension: A Newcomer Among the Hypertension Phenotypes

Differential Associations Between Two Markers of Probable Sarcopenia and Continuous Orthostatic Hemodynamics in The Irish Longitudinal Study on Ageing

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