Hemodynamic characterization of hypertensive patients with an exaggerated orthostatic blood pressure variation

Barochiner, Jessica; Aparicio, Lucas S.; Alfie, José; Rada, Marcelo A.; Morales, Margarita S.; Galarza, Carlos; Cuffaro, Paula E.; Marín, Marcos J.; Martínez, Rocío; Waisman, Gabriel

doi:10.1080/10641963.2017.1368539

Cited by 9 publications

(7 citation statements)

References 18 publications

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“…Altogether, differences in the regulation of SVR seem to be a crucial explanation for various hemodynamic phenotypes during orthostatic challenge. A pivotal role for SVR in orthostatic hypertension was also suggested in a study constituting 186 medicated hypertensive individuals, as those with orthostatic hypertension exhibited exaggerated posture-related rises in SVR [36].…”

Section: Discussionmentioning

confidence: 88%

Individual changes of central blood pressure in response to upright posture: different hemodynamic phenotypes

Suojanen

Koskela

Wilenius

et al. 2021

Journal of Hypertension

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Objectives: Most studies about upright regulation of blood pressure have focused on orthostatic hypotension despite the diverse hemodynamic changes induced by orthostatic challenge. We investigated the effect of passive head-up tilt on aortic blood pressure.Methods: Noninvasive peripheral and central hemodynamics in 613 volunteers without cardiovascular morbidities or medications were examined using pulse wave analysis, whole-body impedance cardiography and heart rate variability analysis.Results: In all participants, mean aortic SBP decreased by À4 (À5 to À3) mmHg [mean (95% confidence intervals)] and DBP increased by 6 (5-6) mmHg in response to upright posture. When divided into tertiles according to the supineto-upright change in aortic SBP, two tertiles presented with a decrease [À15 (À14 to À16) and À4 (À3 to À4) mmHg, respectively] whereas one tertile presented with an increase [R7 (7-8) mmHg] in aortic SBP. There were no major differences in demographic characteristics between the tertiles. In regression analysis, the strongest explanatory factors for upright changes in aortic SBP were the supine values of, and upright changes in systemic vascular resistance and cardiac output, and supine aortic SBP. Conclusion:In participants without cardiovascular disease, the changes in central SBP during orthostatic challenge are not uniform. One-third presented with higher upright than supine aortic SBP with underlying differences in the regulation of systemic vascular resistance and cardiac output. These findings emphasize that resting blood pressure measurements give only limited information about the blood pressure status.

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Section: Discussionmentioning

confidence: 88%

Individual changes of central blood pressure in response to upright posture: different hemodynamic phenotypes

Suojanen

Koskela

Wilenius

et al. 2021

Journal of Hypertension

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“…This pattern of diurnal blood pressure variation was found to be associated with silent cerebral infarcts, a higher incidence of cerebral ischemia during the night and an elevated risk of haemorrhagic stroke in the morning due to exaggerated morning BP surge [ 30 – 36 ]. Two other studies also found that extreme night-time dipping of blood pressure was associated with silent cerebral infarcts [ 35 , 37 ]. The association between OH and reverse-dipping blood pressure at night has been widely studied and shown to be associated with increased risk of cardiovascular events [ 38 ].…”

Section: Discussionmentioning

confidence: 91%

“…The findings from a post-mortem study of stroke patients show that the mechanism underlying the association between cerebrovascular disease and OHT may be severe carotid baroreceptor damage associated with severe carotid atheromatosis in ischemic stroke patients [ 13 ]. One study that specifically aimed to study the hemodynamics of postural changes in BP found that patients with OHT have a significantly more prominent increase in heart rate and systemic vascular resistance upon standing compared to other groups of hypertensive patients [ 37 ]. The study conducted by Petersen et al shows that cardiac sympathetic input and cerebrovascular resistance were higher among young people with symptomatic transient OHT compared to symptomatic and asymptomatic controls [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of orthostatic hypertension and its association with cerebrovascular diagnoses in patients with suspected TIA and minor stroke

Barzkar

Myint

Kwok

et al. 2022

BMC Cardiovasc Disord

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Purpose We aimed to compare the rate of stroke, transient ischemic attack, and cerebrovascular disease diagnoses across groups of patients based on their orthostatic blood pressure response in a transients ischemic attack clinic setting. Materials and Methods We retrospectively analysed prospectively collected data from 3201 patients referred to a transient ischemic attack (TIA)/minor stroke outpatients clinic. Trained nurses measured supine and standing blood pressure using an automated blood pressure device and the patients were categorized based on their orthostatic blood pressure change into four groups: no orthostatic blood pressure rise, systolic orthostatic hypertension, diastolic orthostatic hypertension, and combined orthostatic hypertension. Then, four stroke physicians, who were unaware of patients' orthostatic BP response, assessed the patients and made diagnoses based on clinical and imaging data. We compared the rate of stroke, TIA, and cerebrovascular disease (either stroke or TIA) diagnoses across the study groups using Pearson's χ2 test. The effect of confounders was adjusted using a multivariate logistic regression analysis. Results Cerebrovascular disease was significantly less common in patients with combined systolic and diastolic orthostatic hypertension compared to the "no rise" group [OR = 0.56 (95% CI 0.35–0.89]. The odds were even lower among the subgroups of patients with obesity [OR = 0.31 (0.12–0.80)], without history of smoking [OR 0.34 (0.15–0.80)], and without hypertension [OR = 0.42 (95% CI 0.19–0.92)]. We found no significant relationship between orthostatic blood pressure rise with the diagnosis of stroke. However, the odds of TIA were significantly lower in patients with diastolic [OR 0.82 (0.68–0.98)] and combined types of orthostatic hypertension [OR = 0.54 (0.32–0.93)]; especially in patients younger than 65 years [OR = 0.17 (0.04–0.73)] without a history of hypertension [OR = 0.34 (0.13–0.91)], and patients who did not take antihypertensive therapy [OR = 0.35 (0.14–0.86)]. Conclusion Our data suggest that orthostatic hypertension may be a protective factor for TIA among younger and normotensive patients.

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“…OHYPO was defined as a decrease in SBP of at least 20 mmHg and/or a decrease in DBP of at least 10 mmHg 20 after postural change. In the absence of consensus, OHYPER was defined according to the most common definition used in the literature, 17,[21][22][23][24][25] as a rise of SBP of at least 20 mmHg and/or a rise of DBP of at least 10 mmHg after postural change.…”

Section: Assessment Of Orthostatic Bp Changesmentioning

confidence: 99%

Orthostatic hypotension and orthostatic hypertension are both associated with lower cognitive function: The S.AGES cohort

Strumia,

Vidal,

Cestac

et al. 2023

J American Geriatrics Society

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BackgroundBlood pressure (BP) postural changes, both orthostatic hypotension (OHYPO) and orthostatic hypertension (OHYPER) are common in older adults. Few studies have investigated their association with cognition, particularly for OHYPER, an emerging cardiovascular risk factor. We aimed to assess the association between OHYPO, OHYPER and cognition in non‐institutionalized older subjects.MethodsThe S.AGES (Sujets ÂGES, Aged Subjects) cohort followed every 6 months for 3 years non‐institutionalized subjects aged ≥65 years without dementia at inclusion, in France. OHYPO and OHYPER were respectively defined as a fall or an increase of ≥20 mmHg in systolic BP and/or ≥10 mmHg in diastolic BP after standing from a sitting position. Cognition was assessed using the Mini‐Mental State Examination (MMSE). Linear mixed models were used for the analyses.ResultsAmong the 3170 subjects included (mean age 78 years, 56% women), 209 (6.5%) had OHYPO and 226 (7.1%) had OHYPER at baseline. After adjustment for demographics, cardiovascular risk factors and disease, seated SBP/DBP and BP lowering treatment, mean MMSE was 0.52 point lower in participants with OHYPER compared to those with normal BP postural changes (β adjusted [95% CI] = −0.52 [−0.96; −0.09], p = 0.02) and 0.50 point lower in participants with OHYPO compared to those with normal BP postural changes (β adjusted [95% CI] = −0.50 [−0.95; −0.06], p = 0.03). Sensitivity analyses showed a dose–response relationship between OHYPO and cognition.ConclusionAlthough the absolute differences in MMSE were small, both OHYPO and OHYPER were associated with lower cognition. Orthostatic BP measurements could help identify patients with risk of cognitive impairment. Further studies are needed to assess whether controlling orthostatic BP could be a promising interventional target in preserving cognition among older adults.

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Hemodynamic characterization of hypertensive patients with an exaggerated orthostatic blood pressure variation

Abstract: Patients with OHyper have a distinct hemodynamic pattern, with an exaggerated increase in SVRI and HR when standing.

Cited by 9 publications

References 18 publications

Individual changes of central blood pressure in response to upright posture: different hemodynamic phenotypes

Individual changes of central blood pressure in response to upright posture: different hemodynamic phenotypes

Prevalence of orthostatic hypertension and its association with cerebrovascular diagnoses in patients with suspected TIA and minor stroke

Orthostatic hypotension and orthostatic hypertension are both associated with lower cognitive function: The S.AGES cohort

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