Effect of age and gender on sudomotor and cardiovagal function and blood pressure response to tilt in normal subjects

Low, Phillip A.; Denq, Jong Chyou; Opfer‐Gehrking, Tonette L.; Dyck, Peter J.; O’Brien, Peter C.; Slezak, Jeff

doi:10.1002/(sici)1097-4598(199712)20:12<1561::aid-mus11>3.0.co;2-3

Cited by 244 publications

(264 citation statements)

References 45 publications

(57 reference statements)

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“…Lowet al (19) reported that sex and age should be considered when evaluating autonomic function. They found that sweating volume on QSARTis greater in menand progressively declines with age at lower extremity sites.…”

Section: Discussionmentioning

confidence: 99%

Early Detection of Orthostatic Hypotension by Quantitative Sudomotor Axon Reflex Test (QSART) in Type 2 Diabetic Patients

et al. 2003

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Objective Orthostatic hypotension is caused by autonomic nerve dysfunction, mainly by severe sympathetic nerve dysfunction in diabetic patients. Diabetes affects the peripheral nerves in a length-dependent manner.Quantitative sudomotor axon reflex test (QSART)is one of the sensitive tests for detecting sympathetic nerve function. Weexamined the relation between orthostatic hypotension and QSARTat the foot and hand in type 2 diabetic patients.Methods Thirty-eight type 2 diabetic patients (age, 48.9±11.9 years; duration of diabetes, 13.4±8.6 years) and 13 age-matched non-diabetic controls were evaluated. All subjects aged under 65 years old were recruited. All subjects underwent Schellong tests and quantitative sudomotor axon reflex tests (QSART)at the back of the hand and dorsum of the foot. Results The sweating volume at the foot dorsum, but not the back of the hand, during the first 10 minutes of QSART was significantly related to the orthostatic hypotension on the Schellong test. In patients with normal, borderline and abnormal blood pressure response to standing, 6 out of 17 (35.3%), 9 out of 12 (75.0%) and 9 out of 9 (100%) had decreased sweating volume of the foot dorsum, respectively. Conclusions Our results suggest that orthostatic hypotension may be detected early by QSART at the dorsum of the foot in type 2 diabetic patients. (Internal Medicine 42: 560-564, 2003)

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Section: Discussionmentioning

confidence: 99%

Early Detection of Orthostatic Hypotension by Quantitative Sudomotor Axon Reflex Test (QSART) in Type 2 Diabetic Patients

et al. 2003

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“…Results were compared to normative data derived from studies of 223 healthy people aged 10 to 83 years. 12 Cardiovagal function was assessed using HR response to deep breathing and Valsalva ratio. Results were compared to normative data derived from 157 healthy people aged 10 to 83 years.…”

Section: Autonomic Testingmentioning

confidence: 99%

“…Results were compared to normative data derived from 157 healthy people aged 10 to 83 years. 12 Cardiovascular adrenergic function was evaluated by measuring blood pressure and HR responses to Valsalva maneuver and HUT. 10,11 The thermoregulatory sweat test (TST) was performed as previously described 13 ; it provides a quantitative measure of total body sweating.…”

Section: Autonomic Testingmentioning

confidence: 99%

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Effect of Pregnancy on Postural Tachycardia Syndrome

Kimpinski

Iodice

Sandroni

et al. 2010

Mayo Clinic Proceedings

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P ostural tachycardia syndrome (POTS) is defined as the development of orthostatic symptoms associated with an increase in heart rate (HR) greater than 30 beats/min. More severe cases are associated with a standing HR increase greater than 120 beats/min. 1 Orthostatic symptoms most often include light-headedness, palpitations, presyncope, and exacerbations with heat or exercise. 2 Overall, the prognosis of POTS has been reported to be favorable in follow-up studies, with 80% of patients reporting improvement and 60% becoming functionally normal. 3 Onset of POTS occurs predominantly between the ages of 15 and 50 years, 4 with a female predominance. 1,2,[5][6][7] The female-to-male ratio has been reported to be as high as 5:1. 8 Given the female predominance and the occurrence of POTS during the childbearing years, the effects of this disorder on pregnancy is often raised in clinical practice.ObjECTIvES: To compare the clinical presentation, autonomic dysfunction, and pregnancy outcomes in parous and nulliparous women with postural tachycardia syndrome (POTS) and in women with POTS before and after pregnancy. PATIENTS AND METHODS:This study consists of women who had at least 1 pregnancy during which time they met criteria for POTS between May 1993 and July 2009. All patients underwent standard autonomic testing. POTS was defined as a heart rate (HR) increase of greater than 30 beats/min on head-up tilt (HUT) with symptoms of orthostatic intolerance. Patients' charts were reviewed retrospectively to determine pregnancy outcomes. RESULTS:Clinical characteristics related to POTS did not differ between parous and nulliparous women except for disease duration (parous, 3.7±2.6; nulliparous, 2.1±2.2; P<.001). Autonomic dysfunction did not differ between groups (change in HR on HUT: parous, 42.6±12.0 beats/min; nulliparous, 41.3±10.6 beats/min; P=.39). Of 116 total pregnancies, adverse pregnancy outcomes were reported in 9% and maternal complications in 1%. No complication was related to POTS. There was a trend toward modest improvement in autonomic dysfunction before and after pregnancy (change in HR on HUT: before pregnancy, 38.1±22.7 beats/min; after pregnancy, 21.9±14.9 beats/min; P=.07). CONCLUSION:The long-term impact of pregnancy on POTS does not appear to be clinically important. However, there does appear to be a trend toward improvement in the short-term postpartum period. Adverse pregnancy events were similar to those seen in the general public and do not present a barrier to women with POTS who want to have children.Mayo Clin Proc. 2010;85(7):639-644 CASS = composite autonomic severity score; HR = heart rate; HUT = head-up tilt; OI = orthostatic intolerance; POTS = postural tachycardia syndrome; TST = thermoregulatory sweat test However, until recently published data have been minimal. A recent study in 22 women indicated that, although the effect on symptoms related to POTS during pregnancy varied, the actual pregnancy was not affected. 9 The objectives of this study were as follows: (1) to determine whether ...

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“…A value of 30 mm Hg fall in systolic blood pressure would reduce the frequency of false positives to 1%. 2 With therapeutic advances, it is important to have a more quantitative approach to grade and quantify orthostatic intolerance. It is possible to generate a formal grading scale (Table 1) 3 based on the frequency and severity of symptoms, standing time before onset of symptoms, influence on activities of daily living, and BP.…”

Section: Introductionmentioning

confidence: 99%

Management of neurogenic orthostatic hypotension: an update

Low

Singer

2008

The Lancet Neurology

205

160

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Orthostatic hypotension (OH) is common in the elderly and in disorders like diabetes and Parkinson's disease. It is important to grade its severity and its impact on the person's quality of life. It is also possible to quantitate the severity of OH. Symptoms of OH vary with orthostatic stress, and it is important to recognize subtle symptoms such as tiredness and cognitive impairment. Standard drug treatment is efficacious in improving OH and its symptoms but will worsen supine hypertension. Pyridostigmine will modestly but significantly improve OH without worsening supine hypertension. Since orthostatic stress varies from moment to moment and drug treatment is suboptimal, it is necessary to combine drug treatment of OH with non-pharmacological approaches, such as compression of venous capacitance bed, use of physical counter-maneuvers, and intermittent water bolus treatment. Search Strategy:The manuscript is based on a focused review. To achieve this, references for this review were identified by searches of PubMed between 1995 and January 2008 using the search term "orthostatic hypotension". Articles were also identified through searches of the authors own files. Only papers published in English were selected. The final reference list was generated on the basis of originality and relevance to the topic covered in this review, with a particular focus on data supported by clinical trials.

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Effect of age and gender on sudomotor and cardiovagal function and blood pressure response to tilt in normal subjects

Cited by 244 publications

References 45 publications

Early Detection of Orthostatic Hypotension by Quantitative Sudomotor Axon Reflex Test (QSART) in Type 2 Diabetic Patients

Early Detection of Orthostatic Hypotension by Quantitative Sudomotor Axon Reflex Test (QSART) in Type 2 Diabetic Patients

Effect of Pregnancy on Postural Tachycardia Syndrome

Management of neurogenic orthostatic hypotension: an update

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