Delayed recovery from initial orthostatic hypotension: an expression of frailty in the elderly

Twist, Daan J.L. van; Mostard, Guy J M; Sipers, Walther

doi:10.1007/s10286-019-00664-2

Cited by 13 publications

(13 citation statements)

References 12 publications

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“…19 The ability to recover rapidly from initial OH appears to be a marker of physical fitness, but the delayed recovery from orthostatic BP changes, which is associated with an increased risk of falls, cognitive impairment, and frailty, is a major problem. 15 Our study also revealed that OH symptoms were more common in patients with sustained OH.…”

Section: Discussionsupporting

confidence: 63%

Influencing factors and hemodynamic study of initial and sustained orthostatic hypotension in middle‐aged and elderly patients

Geng

Chen

Wang

et al. 2022

J of Clinical Hypertension

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Orthostatic hypotension (OH) is a common autonomic disorder. This study aimed to investigate the influencing factors and hemodynamic mechanisms of initial and sustained OH in middle‐aged and elderly patients. The authors analyzed the clinical characteristics and hemodynamic variables of patients aged ≥ 50 years according to the various forms of OH, diagnosed by an active orthostatic test using the CNAP monitor. The study included 473 participants; 119 (25.2%) patients had initial (54, 45.4%) or sustained (65, 54.6%) OH. Age, comorbidities, or medications did not differ significantly between the initial OH and non‐OH groups. Sustained OH was associated with age and diabetes (p = .003 and p = .015, respectively). Hemodynamic analysis revealed higher cardiac output (CO) in the sustained OH group within 15 s than in the non‐OH and initial OH groups (both p < .001); no difference in CO was observed between the initial OH and non‐OH groups. The systemic vascular resistance (SVR) in both initial OH and sustained OH groups within 15 s was lower than that in the non‐OH group (both p < .001). No differences in SVR at 3 min were observed between the initial OH and non‐OH groups. The SVR at 3 min in the sustained OH group was significantly lower than in non‐OH and initial OH groups (both p < .001). Age and diabetes emerged as the independent risk factors associated with sustained OH. Initial OH is associated with a mismatch of increase in CO and decrease in SVR. Sustained OH is mainly associated with sustained inadequate adjustment in SVR.

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Section: Discussionsupporting

confidence: 63%

Influencing factors and hemodynamic study of initial and sustained orthostatic hypotension in middle‐aged and elderly patients

Geng

Chen

Wang

et al. 2022

J of Clinical Hypertension

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“…However in the absence of a clear history, IOH as a physiological sign is a less accurate predictor of outcome. Importantly IOH as a physiological sign has a high prevalence (van Twist et al, 2020) and is not associated with poor health outcomes in older adults (Finucane et al, 2017, Briggs et al, 2018, Van Twist et al, 2018 and even better physical, functional and cognitive performance has been reported in patients with IOH (Saedon et al, 2020).…”

Section: Clinical Perspectivementioning

confidence: 99%

Systemic and cerebral circulatory adjustment within the first 60 s after active standing: An integrative physiological view

Harms

Finucane

Pérez-Denia

et al. 2021

Autonomic Neuroscience

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Transient cardiovascular and cerebrovascular responses within the first minute of active standing provide the means to assess autonomic, cardiovascular and cerebrovascular regulation using a real-world everyday stimulus. Traditionally, these responses have been used to detect autonomic dysfunction, and to identify the hemodynamic correlates of patient symptoms and attributable causes of (pre)syncope and falls.This review addresses the physiology of systemic and cerebrovascular adjustment within the first 60 s after active standing. Mechanical factors induced by standing up cause a temporal mismatch between cardiac output and vascular conductance which leads to an initial blood pressure drops with a nadir around 10 s. The arterial baroreflex counteracts these initial blood pressure drops, but needs 2-3 s to be initiated with a maximal effect occurring at 10 s after standing while, in parallel, cerebral autoregulation buffers these changes within 10 s to maintain adequate cerebral perfusion. Interestingly, both the magnitude of the initial drop and these compensatory mechanisms are thought to be quite well-preserved in healthy aging.It is hoped that the present review serves as a reference for future pathophysiological investigations and epidemiological studies. Further experimental research is needed to unravel the causal mechanisms underlying the emergence of symptoms and relationship with aging and adverse outcomes in variants of orthostatic hypotension.

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“…Frailty levels are positively correlated with OH and orthostatic intolerance symptoms, even without postural BP changes. [34][35][36][37][38] Frailty also increases the risk of mortality, disability, functional decline and hospitalisation in individuals with OH. 39,40…”

Section: Frailtymentioning

confidence: 99%

Orthostatic hypotension in older people: considerations, diagnosis and management

et al. 2021

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Orthostatic hypotension (OH) is very common in older people and is encountered daily in emergency departmentsand medical admissions units. It is associated with a higher risk of falls, fractures, dementia and death, so prompt recognition and treatment are essential. In this review article, we describe the physiology of standing (orthostasis) and the pathophysiology of orthostatic hypotension. We focus particularly on aspects pertinent to older people. We review the evidence and consensus management guidelines for all aspects of management. We also tackle the challenge of concomitant orthostatic hypotension and supine hypertension, providing a treatment overview as well as practical suggestions for management. In summary, orthostatic hypotension (and associated supine hypertension) are common, dangerous and disabling, but adherence to simple structures management strategies can result in major improvements.

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Delayed recovery from initial orthostatic hypotension: an expression of frailty in the elderly

Cited by 13 publications

References 12 publications

Influencing factors and hemodynamic study of initial and sustained orthostatic hypotension in middle‐aged and elderly patients

Influencing factors and hemodynamic study of initial and sustained orthostatic hypotension in middle‐aged and elderly patients

Systemic and cerebral circulatory adjustment within the first 60 s after active standing: An integrative physiological view

Orthostatic hypotension in older people: considerations, diagnosis and management

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