Hypotension: The Ideal Normal Blood Pressure

Robinson, Sam

doi:10.1056/nejm194009122231103

Cited by 25 publications

(15 citation statements)

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“…19 A recent metaanalysis of observational studies on the influence of spinal cord lesion on cardiovascular outcomes failed There is controversy with regard to the specific threshold below which hypotension should be defined, whether chronic hypotension exists, 24 whether it is a problem or, quite possibly, a benefit to longevity and cardiovascular health. [25][26][27][28] However, in 1927, Norris described individuals with low BP as persons who lacked stamina, tired easily, complained of cold extremities, and showed an inability to do prolonged mental or physical work; 29 characteristics very familiar to individuals with high cord lesions. The prevalence of hypotension in our veterans varied significantly depending on which definition was used, and while the diagnosis of hypotension based on a BP ≤ 90/60 mmHg was very low (<1%), evidence of clinical BP values below the WHO threshold (i.e.…”

Section: Discussionmentioning

confidence: 99%

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A retrospective chart review of heart rate and blood pressure abnormalities in veterans with spinal cord injury

Zhu

Galea

Livote

et al. 2013

The Journal of Spinal Cord Medicine

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Objective: Autonomic impairment may lead to increased prevalence of heart rate (HR) and blood pressure (BP) abnormalities in veterans with spinal cord injury (SCI). In addition, comorbid medical conditions and prescription medication use may influence these abnormalities, including bradycardia, and tachycardia, hypotension, hypertension as well as autonomic dysreflexia (AD), and orthostatic hypotension (OH). Design: A retrospective review of clinical and administrative datasets in veterans with SCI and compared the prevalence rates between clinical values and ICD-9 diagnostic codes in individuals with tetraplegia (T: C1-C8), high paraplegia (HP: T1-T6), and low paraplegia (LP: T7 and below). Results: The prevalence of clinical values indicative of a HR ≥ 80 beats per minute was higher in the HP compared to the LP and T groups. A systolic BP (SBP) ≤ 110 mmHg was more common in the T compared to the HP and LP groups, whereas the prevalence of a SBP ≥ 140 mmHg was increased in the LP compared to the HP and T groups. Diagnosis of hypertension was 39-60% whereas the diagnosis of hypotension was less than 1%. Diagnosis of AD and OH was highest in the T group, but remained below 10%, regardless of categorical lesion level. Antihypertensive medications were commonly prescribed (55%), and patients on these medications were less likely to have high BP. The odds ratio of higher SBP and DBP increased with age and body mass index (BMI). Conclusion: In veterans with SCI, the prevalence of HR and BP abnormalities varied depending on level of lesion, age, BMI, and prescription medication use.

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Section: Discussionmentioning

confidence: 99%

“…SBP ≤ 110 for males and ≤100 for females) was much higher (10-39%), and persistent hypotension below this threshold has been associated with adverse outcomes in the general population. [30][31][32][33][34] Although several papers suggest that hypotension is the ideal "normal" BP, 26,28 the British Journal of…”

Section: Discussionmentioning

confidence: 99%

A retrospective chart review of heart rate and blood pressure abnormalities in veterans with spinal cord injury

Zhu

Galea

Livote

et al. 2013

The Journal of Spinal Cord Medicine

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“…9 A number of symptoms have been attributed to hypotension, from somatic symptoms of depression, 10 fatigue, anergia, 11 to an inability to perform prolonged physical work. 12 Some authors have speculated that symptoms of the chronic fatigue syndrome may be referable to low systemic arterial pressure. 13 Furthermore, a cross-sectional study has correlated a low systolic blood pressure with impaired mental and physical well-being, 14 and in a large populationbased study, a low diastolic pressure was independently associated with depression and fatigue in older men, an association that was independent of age, recent weight loss, the presence of chronic disease, or antihypertensive or anti-depressant drug therapy.…”

Section: Discussionmentioning

confidence: 99%

Arterial hypotension: prevalence of low blood pressure in the general population using ambulatory blood pressure monitoring

2000

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Background: Chronic constitutional hypotension has been described in a proportion of the population, and has a symptom complex ascribed to it. The true prevalence of low blood pressure in the normal population has not been defined. Aim of study: This study was undertaken to determine the prevalence of low blood pressure states, as measured using ambulatory blood pressure monitoring, in a general population cohort, and to determine the association between low blood pressure and clinical and demographic variables. Patient population: The population enrolled were a cohort of mainly urban dwelling Irish subjects, either employees or spouses of employees of a major national bank. Methods: Subjects had an ambulatory blood pressure monitor fitted between 09.00 and 12.00 and wore the monitor for 24 hours. The subjects also filled out a detailed lifestyle questionnaire, and kept an activity

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“…The concept of hypotension and its relation to psychiatric symptoms has recently been reviewed. In 1940 Robinson proposed that constitutional hypotension is a spurious disease and its symptoms were non-specific [16]. Wessely, however, recently demonstrated the importance of the relation between systemic hypotension and self-reported tiredness and feeling faint in 7383 adults [17].…”

Section: Discussionmentioning

confidence: 99%

Evidence of decreased sympathetic function in children with psychosomatic symptoms

Tanaka¹,

Borres

Thulesius

et al. 2002

Clinical Autonomic Research

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We investigated cardiovascular autonomic function using power spectral analysis of heart rate variation and beat-to-beat finger arterial pressure at rest and while standing and correlated these findings with self-reported psychosomatic and psychosocial symptoms in 122 schoolchildren. Children with three or more psychosomatic and psychosocial symptoms (somatizers) were found to have significantly lower blood pressure than children without symptoms. Somatizers had the more decreased spectral power of the low frequency (LF) band of arterial pressure and RR intervals in the supine position. The high frequency (HF) power did not differ between the two groups. Somatizers showed a more marked reduction in systolic arterial pressure at the onset of standing than did subjects without symptoms but somatizers showed an identical response in systolic arterial pressure when compared to subjects without symptoms during the later stage of standing. The increases in the LF band of arterial pressure and LF/HF of RR intervals during standing were higher in somatizers. These results suggest that somatizers have decreased sympathetic modulation. We conclude that psychosomatic and psychosocial symptoms in children might be associated with low blood pressure and decreased sympathetic modulation.

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Hypotension: The Ideal Normal Blood Pressure

Cited by 25 publications

References 0 publications

A retrospective chart review of heart rate and blood pressure abnormalities in veterans with spinal cord injury

A retrospective chart review of heart rate and blood pressure abnormalities in veterans with spinal cord injury

Arterial hypotension: prevalence of low blood pressure in the general population using ambulatory blood pressure monitoring

Evidence of decreased sympathetic function in children with psychosomatic symptoms

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