Increased multimorbidity is associated with impaired cerebral and peripheral hemodynamic stabilization during active standing

Abstract

Background Age‐related morbidities and frailty are associated with impaired blood pressure (BP) and heart rate (HR) recovery after standing. Here we investigate how multimorbidity affects cerebral and peripheral hemodynamics during standing in a large sample of older patients. Methods Patients were recruited from a national Falls and Syncope Unit. They underwent an active stand test (5–10 min lying +3 min standing) with monitoring of continuous BP, HR, total peripheral resistance (TPR), stroke volume (SV), and a near‐infrared spectroscopy (NIRS) derived cerebral tissue saturation index (TSI). A multimorbidity count was derived from a 26‐item list of conditions. Features derived from the signals included: nadir, overshoot, value at 30 s, steady‐state and recovery rate. Robust linear regression was used to assess the association between multimorbidity, TSI and peripheral hemodynamics while correcting for covariates. A p‐value <0.05 was considered statistically significant. Results Multimorbidity was associated with poorer recovery of TSI at 30 s after standing (β: −0.15, CI:[−0.25–0.06], p = 0.009) independent of all peripheral hemodynamics. Impaired diastolic BP (DBP) recovery at 30s (β:−1.34, CI:[−2.29–0.40], p = 0.032), DBP steady‐state (β:−1.18, CI:[−2.04–0.32], p = 0.032), TPR overshoot‐to‐nadir difference (β:−0.041, CI:[−0.070–0.013], p = 0.045), and SV at 30s (β:1.30, CI:[0.45 2.15], p = 0.027) were also associated with increasing multimorbidity. After sex stratification, only females demonstrated impaired TSI with multimorbidity at overshoot (β: −0.19, CI: [−0.32 ‐0.07], p = 0.009), 30 s (β: −0.22 [−0.35–0.10], p = 0.005) and steady‐state (β: −0.20, CI:[−0.35–0.04], p = 0.023), independent of peripheral hemodynamics. Conclusions Transient cerebral oxygenation and peripheral hemodynamic responses are impaired with multimorbidity (frailty) in older patients, particularly in females. This study demonstrates the feasibility of using NIRS in this clinical context and may inform the development of clinical management strategies targeting both cerebral oxygenation and blood pressure impairments in patients with faints and falls.

The Impact of Type 2 Diabetes on Peripheral and Cerebral Hemodynamic Responses to Active Stand

“…Figure 1 describes the signal features extracted for univariate analysis. These features were also described in ( 41 ). Briefly, for SBP, DBP, and TSI, the nadir was detected as the minimum value between 5 and 40 seconds post-stand and the overshoot as the first peak after the nadir and before 60 seconds after stand.…”

Associations of Orthostatic Hypotension and Frailty With Dementia and Mortality in Older Adults: A Population-Based Cohort Study

“…Frailty reflects reduced physiological reserve and increased vulnerability to stressors and is considered a marker of biological aging ( 4 , 47 ). People with frailty have been shown to have impaired stabilization of cerebral oxygenation during postural change, which can be independent of the arterial blood pressure response ( 7 , 8 ). In addition, previous research suggested that frailty may lower the threshold of brain pathologies needed to trigger the clinical presentation of dementia ( 23 , 48 ).…”

“…Previous studies showed that people with frailty were more likely to have orthostatic intolerance, which is generally considered a result of insufficient cerebral perfusion ( 3 , 6 ). In addition, recent data showed that slow walking speed, an indicator of frailty, and multimorbidity, a risk factor for frailty, were both associated with impaired stabilization of cerebral oxygenation independently of arterial blood pressure response ( 7 , 8 ). It is possible that frailty adds to the effects of OH on end-organ perfusion and modifies the effects of OH on morbidity and mortality.…”

Slower speed of blood pressure recovery after standing is associated with accelerated brain ageing: Evidence from The Irish Longitudinal Study on Ageing (TILDA)

“…The measure used to evaluate the recovery of BP, following the initial drop that occurs after standing, was the recovery response rate, or the speed of BP increase. This measure was previously used to assess early hemodynamic responses after standing [38] and it can be useful for assessing the effectiveness of the autonomic system in recovering from the BP drop.…”

“…The time of standing was considered as the moment at which the participant initiated the change of position, identified with the height correction unit of the Finometer. The recovery of SBP and DBP was described as the slope measured between the point where BP reaches the nadir and where it peaks after that (the overshoot, in most cases) [38] ( Fig. 2 ).…”