First morning standing up may be risky in acutely ill older inpatients

Gorelik, Oleg; Fishlev, Gregory; Litvinov, Vita; Almoznino‐Sarafian, Dorit; Alon, Irena; Shteinshnaider, Miriam; Chachashvily, Shulamit; Modai, David; Cohen, Natan

doi:10.1080/08037050510008968

Cited by 24 publications

(15 citation statements)

References 7 publications

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“…That is, periods of HDBR, and possibly supine rest, might impact blood pressure regulation on transition to an upright posture. Such an effect has been proposed for the first rise of the day in acutely ill older persons (18). Knowledge gained from the HDBR model can be applied to other populations that experience orthostatic symptoms on assuming an upright posture.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular responses to lower body negative pressure before and after 4 h of head-down bed rest and seated control in men and women

Edgell

Grinberg

Gagné

et al. 2012

Journal of Applied Physiology

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Edgell H, Grinberg A, Gagné N, Beavers KR, Hughson RL. Cardiovascular responses to lower body negative pressure before and after 4 h of head-down bed rest and seated control in men and women. J Appl Physiol 113: 1604 -1612, 2012. First published September 13, 2012 doi:10.1152/japplphysiol.00670.2012.-Cardiovascular deconditioning after a 4-h head-down bed rest (HDBR) might be a consequence of the time of day relative to pre-HDBR testing, or simply 4 h of confinement and inactivity rather than the posture change. Ten men and 11 women were studied during lower body negative pressure (LBNP) before and after 4-h HDBR and 4-h seated posture (SEAT) as a control for time of day and physical inactivity effects to test the hypotheses that cardiovascular deconditioning was a consequence of the HDBR posture, and that women would have a greater deconditioning response. Following HDBR, men and women had lower blood volume, higher heart rate with a greater increase during LBNP, a greater decrease of stroke volume during LBNP, lower central venous pressure, smaller inferior vena cava diameter, higher portal vein resistance index with a greater increase during LBNP, but lower forearm vascular resistance, lower norepinephrine, and lower renin. Women had lower vasopressin and men had higher vasopressin after HDBR, and women had lower pelvic impedance and men higher pelvic impedance. Following SEAT, brachial vascular resistance was reduced, thoracic impedance was elevated, the reduction of central venous pressure during LBNP was changed, women had higher angiotensin II whereas men had lower levels, and pelvic impedance increased in women and decreased in men. Cardiovascular deconditioning was greater after 4-h HDBR than after SEAT. Women and men had similar responses for most cardiovascular variables in the present study that tested the responses to LBNP after short-duration HDBR compared with a control condition. cardiovascular deconditioning; orthostatic challenge; sex differences; regional blood flow HEAD-DOWN BED REST (HDBR), as short as 4 h, is used as a simulation of microgravity exposure (6, 13). The body adapts quickly to this change in posture and reveals cardiovascular deconditioning that is characterized by elevations in heart rate (HR) and altered hormonal responses during application of lower body negative pressure (LBNP; i.e., lower baseline renin and angiotensin II which increased more in response to LBNP) (13) and by dramatic reduction in tolerance to an upright tilt (6). Thus acute alterations in the normal gravitational loading of the body appear to induce changes in the normal regulation of arterial blood pressure in the upright posture (13,19,35). But whether the changes during an orthostatic challenge after 4-h HDBR are an effect of the change in gravitational loading of the cardiovascular system or simply an effect of time of day and/or confinement has not been examined.Inherent in 4-h HDBR studies is the comparison of responses at different times of day for pre-vs. post-HDBR measurements. Several studies ha...

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Section: Discussionmentioning

confidence: 99%

Cardiovascular responses to lower body negative pressure before and after 4 h of head-down bed rest and seated control in men and women

Edgell

Grinberg

Gagné

et al. 2012

Journal of Applied Physiology

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“…Since bedrest, even if relatively short-term, is associated with an increased risk of postural hypotension [7,8,10] , early mobilization of patients with decompensated heart failure and measures for prevention of postural hypotension are advisable. Acceptable pharmacological treatment with midodrine or fludrocortisone is problematic in heart failure due to adverse effects [6,10] .…”

Section: Discussionmentioning

confidence: 99%

“…Postural hypotension was detected on assumption of the upright position in 83.3% of 36 older women hospitalized for heart failure [5] . Moreover, postural hypotension occurred in 81.8% of 33 older heart failure inpatients upon rising for the first time in the morning [7] . Older age, bedrest, intravascular volume depletion, use of diuretics, vasodilators and other relevant drugs are predisposing factors for postural hypotension [1,4,6,[8][9][10] .…”

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Seating-Induced Postural Hypotension Is Common in Older Patients with Decompensated Heart Failure and May Be Prevented by Lower Limb Compression Bandaging

et al. 2008

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Background: Postural hypotension induced by transition from supine to sitting position and measures for its prevention in heart failure has not been investigated. Objective: Our purpose was to evaluate the prevalence of postural hypotension and associated clinical manifestations as well as the contribution of various risk factors for postural hypotension on transition from lying to sitting in older patients with decompensated heart failure, and to study the eventual preventive effect of leg bandaging. Methods: Seating-induced postural hypotension (≥20 mm Hg systolic and/or ≥10 mm Hg diastolic blood pressure fall) was assessed on the first study day in 108 patients aged ≥60 years, hospitalized for acutely decompensated heart failure. On the next day, in patients manifesting postural hypotension, compression bandages were applied along both legs before seating. Blood pressure, heart rate, O₂ saturation, and the occurrence of dizziness or palpitations were recorded prior to and 1, 3 and 5 min following seating. Results: Postural hypotension occurred in 49.1% of patients. Dizziness and/or palpitations manifested in 25%. Diastolic (36.1%) versus systolic (23.1%) postural hypotension prevailed (p = 0.05). On univariate analysis, postural hypotension was associated with female sex (p = 0.03), more severe heart failure (p = 0.05), longer bedrest (p = 0.04), higher supine systolic (p = 0.01) or diastolic (p = 0.002) blood pressure, nonischemic heart failure (p = 0.002), and not using nitrates (p = 0.01). On multivariate analysis, longer bedrest (OR = 1.58, 95% CI = 1.13–2.2, p < 0.001), higher supine diastolic blood pressure (OR = 1.33, 95% CI = 1.1–1.61, p = 0.001), and nonischemic heart failure (OR = 3.48, 95% CI = 1.4–8.63, p = 0.009) were the most predictive of postural hypotension. Compression bandages prevented postural hypotension in 21 of 49 patients and decreased the degree of postural blood pressure fall (p < 0.001). Conclusion: Seating-induced postural hypotension is common among older inpatients with decompensated heart failure, especially with longer bedrest, higher supine diastolic blood pressure and non-ischemic etiology. Leg compression bandaging may be useful for the prevention of postural hypotension in these patients.

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“…It in particular higher than the 20,5% is obtained by Baragou [12], difference who could be explained by the research of OH in our study up to 5 minutes. This variability of the prevalence of OH depends on several factors and conditions [11][12][13][14][15][16][17][18] a higher mean age of OH patients and the increase in the prevalence of OH with the age (46,3% of our 60 years and older patients) as in other studies [1,[12][13][14]. our data suggested that more the blood pressure and the basic heart rate are high, more frequently occurred OH, this explainable on the one hand by the need for a greater number of drugs to lower BP.…”

Section: Discussionmentioning

confidence: 99%

Orthostatic Hypotension (OH) in a Population of Hypertensive Patients in the University Hospital Gabriel Touré (UH GT)

Oumar¹

2015

CMR

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Abstract:Objective: This study was intended to determine the prevalence of HO and characteristics of patients who had an OH. Methodology: The study was cross-sectional, conducted in the cardiology department of the UH GT from January to June 2013 in a population of known hypertensive patients aged over 15 years seen as outpatients and who agreed to participate in the study. OH and NonOH were used to name patients with and without OH. OH was looked up to 5 min. The analysis was performed with SPSS software. Results: The overall prevalence of OH was 31.8% Age, SBP, DBP and HR were lower for NonHO patients resp. p = 0.004, <0.0001 <0.0001 and 0.016. The female sex had a low predictive value compared to male (OR 0.594 and p = 0.011). The OR for the occurrence of OH versus the age group > = 60 years were 1.974, 2.616 and 1.692 respectively for ages < 30, 30-44 and 45-59 years (p = 0.004). The OR for the occurrence of OH versus compared to higher education level were 0,411, 0,326 et 0,716 (p=0,049) resp. for unschooled, primary and secondary level. Conclusion: OH is frequent in the hypertensive population with nearly a third of patients. His research must be extended up to 5 minutes.

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First morning standing up may be risky in acutely ill older inpatients

Cited by 24 publications

References 7 publications

Cardiovascular responses to lower body negative pressure before and after 4 h of head-down bed rest and seated control in men and women

Cardiovascular responses to lower body negative pressure before and after 4 h of head-down bed rest and seated control in men and women

Seating-Induced Postural Hypotension Is Common in Older Patients with Decompensated Heart Failure and May Be Prevented by Lower Limb Compression Bandaging

Orthostatic Hypotension (OH) in a Population of Hypertensive Patients in the University Hospital Gabriel Touré (UH GT)

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