Hemodynamic Mechanisms Underlying Initial Orthostatic Hypotension, Delayed Recovery and Orthostatic Hypotension

Wijnen, Veera K. van; Hove, D Ten; Finucane, Ciarán; Wieling, Wouter; Roon, Arie M. van; Maaten, Jan C. ter; Harms, Mark P M

doi:10.1016/j.jamda.2018.05.031

Cited by 25 publications

(19 citation statements)

References 24 publications

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“…It requires an integrated neurocardiovascular response to maintain adequate blood pressure and subsequently end-organ (e.g. brain) perfusion (5). Hypotension in response to orthostasis has been considered as a final pathway of disordered physiology (6) and impairs cerebral function which commonly governs organ systems regulated via the autonomic nervous system.…”

Section: Introductionmentioning

confidence: 99%

One-Dimensional Statistical Parametric Mapping Identifies Impaired Orthostatic Cerebrovascular and Cardiovascular Response in Frailty Index

Maguire

Romero-Ortuño

O’Connor

et al. 2020

The Journals of Gerontology: Series A

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Background Orthostasis is a potent physiological stressor which adapts with age. The age-related accumulation of health deficits in multiple physiological systems may impair the physiological response to orthostasis and lead to negative health outcomes such as falls, depression, and cognitive decline. Research to date has focused on changes with orthostasis at prespecified intervals of time, without consideration for whole signal approaches. Methods One-dimensional statistical parametric mapping identified regions in time of significant association between variables of interest using a general linear model. Frailty index operationalized accumulated health and social deficits using 32-items from a computer-assisted interview. This study examined the association of frailty index on blood pressure, heart rate, and cerebral oxygenation during an orthostatic test in a sample of 2742 adults aged 50 or older from The Irish Longitudinal Study on Ageing. Results Frailty index was seen to be negatively associated with cerebral oxygenation changes from baseline over a period of 7 seconds (p = .036). Heart rate and systolic blood pressure were positively and negatively associated with frailty index over periods of 17 seconds (p = .001) and 10 seconds (p = .015), respectively. Conclusions Statistical parametric mapping demonstrated these significant regions of cerebral oxygenation during orthostasis provide indirect evidence of impaired autoregulation associated with frailty. Statistical parametric mapping also replicated prior relationships in heart rate and systolic blood pressure associated with a higher frailty index. These findings highlight the utility of 1-dimensional statistical parametric modeling in identifying significant regions of interest in physiological recordings.

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Section: Introductionmentioning

confidence: 99%

One-Dimensional Statistical Parametric Mapping Identifies Impaired Orthostatic Cerebrovascular and Cardiovascular Response in Frailty Index

Maguire

Romero-Ortuño

O’Connor

et al. 2020

The Journals of Gerontology: Series A

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“…It was found that the amplitude and rate of change of haemodynamic parameters were the greatest and the fastest in the rst minute after tilting upright and that the changes gradually slowed down in the following two minutes. This pattern of haemodynamic changes was distinct from initial OH and delayed OH 25 . Previous studies 25,26 in healthy teenagers and young adult subjects using beat-to-beat measurement of SV with calculation of CO and SVR have established that CO actually increases with the onset of tilting upright, whereas SVR falls markedly.…”

Section: Pattern Of Haemodynamic Changes In the Upright Positionmentioning

confidence: 76%

“…This pattern of haemodynamic changes was distinct from initial OH and delayed OH 25 . Previous studies 25,26 in healthy teenagers and young adult subjects using beat-to-beat measurement of SV with calculation of CO and SVR have established that CO actually increases with the onset of tilting upright, whereas SVR falls markedly. Herein, the initial fall in BP upon standing was due to a mismatch of this increase in CO and a decrease in SVR and did not occur or was far less pronounced in a passive change of posture.…”

Section: Pattern Of Haemodynamic Changes In the Upright Positionmentioning

confidence: 76%

“…Herein, the initial fall in BP upon standing was due to a mismatch of this increase in CO and a decrease in SVR and did not occur or was far less pronounced in a passive change of posture. In delayed OH patients, a previous study 25 showed that the SVR increase was signi cantly lower, whereas changes in CO were not different. These ndings 7,27 indicated that delayed OH was associated with an impaired SVR response, which can point towards impaired sympathetic vasoconstrictor function or the use of vasodilators.…”

Section: Pattern Of Haemodynamic Changes In the Upright Positionmentioning

confidence: 82%

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Haemodynamic Characteristics And Factors Influencing The Head-Up Tilt Test In Patients With Orthostatic Hypotension

Wang¹,

Yueyang²,

Wang³

et al. 2021

Preprint

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Background: Failure to activate autonomic neural and hormonal reflex mechanisms could result in orthostatic hypotension. Patients with orthostatic hypotension often experience symptoms of cerebral hypoperfusion, including syncope. The purpose of this study was to investigate the haemodynamic characteristics of patients with orthostatic hypotension and the factors affecting blood pressure regulation.Methods: This retrospective study enrolled 45 patients who were diagnosed with typical orthostatic hypotension by the head-up tilt test at Beijing Tiantan Hospital, Capital Medical University from June 2019 to December 2020. Changes in haemodynamic parameters in these patients were compared in the supine and tilted upright positions.Results: For all patients, haemodynamic parameters in the supine and tilted upright positions were compared, and systolic blood pressure, diastolic blood pressure, mean blood pressure, cardiac output and stroke volume were all significantly decreased per minute. Heart rate significantly increased per minute, but systemic vascular resistance did not significantly change. The absolute value, percentage and rate of increases in heart rate and the absolute value, percentage and rate of decreases in stroke volume from the supine to the titled upright position were significantly lower in patients 60 years and older than in patients under 60 years old. Linear regression analyses found that the changes in heart rate, stroke volume and systemic vascular resistance were related to changes in systolic blood pressure, while the changes in stroke volume and systemic vascular resistance had more important effects on systolic blood pressure.Conclusions: In patients with orthostatic hypotension, we observed no significant increase in systemic vascular resistance from the supine position to the tilted upright position. Nevertheless, an increase in systemic vascular resistance had a significant impact on the maintenance of systolic blood pressure. In addition, in orthostatic hypotension patients younger than 60 years of age, heart rate increased while stroke volume decreased significantly after tilting upright compared with orthostatic hypotension patients older than 60 years of age and older.

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“…To avoid using the same term "OH" for the entire group as well as for one of its parts, "OH" now is an umbrella term. The discussion will center on cOH; for iOH and dOH we refer to other sources (56)(57)(58).…”

Section: Syncope Due To Orthostatic Hypotensionmentioning

confidence: 99%

Timing of Circulatory and Neurological Events in Syncope

Dijk

Rossum

Thijs

2020

Front. Cardiovasc. Med.

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Syncope usually lasts less than a minute, in which short time arterial blood pressure temporarily falls enough to decrease brain perfusion so much that loss of consciousness ensues. Blood pressure decreases quickest when the heart suddenly stops pumping, which happens in arrhythmia and in severe cardioinhibitory reflex syncope. Loss of consciousness starts about 8 s after the last heart beat and circulatory standstill occurs after 10-15 s. A much slower blood pressure decrease can occur in syncope due to orthostatic hypotension Standing blood pressure can then stabilize at low values often causing more subtle signs (i.e., inability to act) but often not low enough to cause loss of consciousness. Cerebral autoregulation attempts to keep cerebral blood flow constant when blood pressure decreases. In reflex syncope both the quick blood pressure decrease and its low absolute value mean that cerebral autoregulation cannot prevent syncope. It has more protective value in orthostatic hypotension. Neurological signs are related to the severity and timing of cerebral hypoperfusion. Several unanswered pathophysiological questions with possible clinical implications are identified.

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Hemodynamic Mechanisms Underlying Initial Orthostatic Hypotension, Delayed Recovery and Orthostatic Hypotension

Cited by 25 publications

References 24 publications

One-Dimensional Statistical Parametric Mapping Identifies Impaired Orthostatic Cerebrovascular and Cardiovascular Response in Frailty Index

One-Dimensional Statistical Parametric Mapping Identifies Impaired Orthostatic Cerebrovascular and Cardiovascular Response in Frailty Index

Haemodynamic Characteristics And Factors Influencing The Head-Up Tilt Test In Patients With Orthostatic Hypotension

Timing of Circulatory and Neurological Events in Syncope

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