Initial orthostatic hypotension and orthostatic intolerance symptom prevalence in older adults: A systematic review

Christopoulos, Elena M.; Tran, Jennifer; Hillebrand, Sarah L.; Lange, Peter; Iseli, Rebecca; Meskers, Carel G. M.; Maier, Andrea B.

doi:10.1016/j.ijchy.2020.100071

Cited by 7 publications

(6 citation statements)

References 60 publications

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“…Our study results show that OH is common in middle‐aged and elderly patients and is present in up to 25.2% of our studied patients, among whom 45.4% had initial OH and 54.6% had sustained OH. According to previous studies, OH is seen in 19%–68% of older inpatients, 11 and the prevalence of initial OH ranges from 3.5% to 62.5% in geriatric patients aged ≥ 65 years, 12 depending on the population characteristics, comorbidities, and medications.…”

Section: Discussionmentioning

confidence: 99%

Influencing factors and hemodynamic study of initial and sustained orthostatic hypotension in middle‐aged and elderly patients

Geng

Chen

Wang

et al. 2022

J of Clinical Hypertension

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Orthostatic hypotension (OH) is a common autonomic disorder. This study aimed to investigate the influencing factors and hemodynamic mechanisms of initial and sustained OH in middle‐aged and elderly patients. The authors analyzed the clinical characteristics and hemodynamic variables of patients aged ≥ 50 years according to the various forms of OH, diagnosed by an active orthostatic test using the CNAP monitor. The study included 473 participants; 119 (25.2%) patients had initial (54, 45.4%) or sustained (65, 54.6%) OH. Age, comorbidities, or medications did not differ significantly between the initial OH and non‐OH groups. Sustained OH was associated with age and diabetes (p = .003 and p = .015, respectively). Hemodynamic analysis revealed higher cardiac output (CO) in the sustained OH group within 15 s than in the non‐OH and initial OH groups (both p < .001); no difference in CO was observed between the initial OH and non‐OH groups. The systemic vascular resistance (SVR) in both initial OH and sustained OH groups within 15 s was lower than that in the non‐OH group (both p < .001). No differences in SVR at 3 min were observed between the initial OH and non‐OH groups. The SVR at 3 min in the sustained OH group was significantly lower than in non‐OH and initial OH groups (both p < .001). Age and diabetes emerged as the independent risk factors associated with sustained OH. Initial OH is associated with a mismatch of increase in CO and decrease in SVR. Sustained OH is mainly associated with sustained inadequate adjustment in SVR.

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Section: Discussionmentioning

confidence: 99%

Influencing factors and hemodynamic study of initial and sustained orthostatic hypotension in middle‐aged and elderly patients

Geng

Chen

Wang

et al. 2022

J of Clinical Hypertension

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“…По данным анализа исследования ARIC (Atherosclerosis Risk In Communities) [19] (n=11429, 54% женщины, средний возраст 54±6 лет), ОГ, выявленная только на первой минуте после перехода в вертикальное положение, была ассоциирована с эпизодами головокружения при вставании, наблюдавшимися у 13,5% пациентов. А данные систематического обзора исследований ранней ОГ в популяции пожилых пациентов свидетельствуют о высокой частоте сопутствующих симптомов ортостатической непереносимости, варьирующей от 24 до 100% в зависимости от используемого определения и методики АОП [20]. Важно отметить, что СН и ОГ характеризуются общими симптомами (головокружение, слабость, усталость, снижение концентрации внимания, ощущение сердцебиения, одышка, предобморочное состояние) [7], а потому отличить их проявления может быть крайне сложно.…”

Section: Discussionunclassified

Frequency of hemodynamic response to orthostatic stress in heart failure with reduced ejection fraction, associations with clinical blood pressure

et al. 2022

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Aim. To assess hemodynamic response to active standing test (AST) with beat-to-beat blood pressure (BP) monitoring, their association with office BP and symptoms of orthostatic intolerance in patients with heart failure (HF).Material and methods. Outpatient HF patients with documented left ventricular ejection fraction <40%, followed up in a HF center and receiving optimal medical therapy, underwent AST with beat-to-beat non-invasive BP monitoring.Hemodynamic response was assessed according to the European Federation of Autonomic Societies criteria.Results. The study included 87 patients (mean age, 57±10 years; men, 76%). Normal hemodynamic response to orthostatic stress was observed in 36 (41,4%) patients. Pathological response prevailed during the first minute of orthostatic stress — initial orthostatic hypotension (OH) (n=29, 33,3%) and delayed BP recovery (n=18, 20,7%). Classical OH was detected in 4 (4,6%) patients. There was no orthostatic hypertension, defined as an increase in systolic BP (SBP) ≥20 mm Hg. According to office BP, hypotension was observed in 19 (21,8%) patients (SBP <90 mm Hg in 4 patients and 90-100 mm Hg in 15), hypertension (SBP >140 mm Hg) in 11 (12,6%) patients. Pathological response to orthostatic stress were more often observed in office SBP >140 mm Hg compared to SBP ≤140 mmHg (90,9% and 53,9%, p=0,020).Orthostatic intolerance was noted in 43 (49,4%) patients and were not associated with the level of office SBP (p=0,398) or pathological responses to orthostatic stress (p=0,758 for initial OH and p=0,248 for delayed BP recovery).Conclusion. The pathological hemodynamic response in AST with beat-to-beat BP monitoring in ambulatory patients with HF is most often represented by initial OH and delayed BP recovery associated with office SBP >140 mmHg. The frequency of symptoms of orthostatic intolerance did not differ between groups depending on the presence of an inadequate response to orthostatic stress.

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“…Initial orthostatic hypotension (IOH) is a clinical syndrome defined as a transient decrease of ≥40 mm Hg systolic blood pressure (SBP) and/or ≥20 mm Hg diastolic blood pressure (DBP) within 15 s of active standing [1]. The prevalence of IOH is 27.8% in the older general populations and 35.2% in geriatric outpatients [2] with a high 952 DOI: 10.1159/000521411 prevalence of orthostatic intolerance symptoms in older adults, with IOH ranging between 24 and 100% [3]. Unlike classical orthostatic hypotension (COH) which can be detected using a conventional sphygmomanometer [4], the diagnosis of IOH requires non-invasive, beat-tobeat, continuous blood pressure monitoring to evaluate blood pressure changes occurring within 60 s after active standing [4] or passive tilting [1].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Diagnosing Initial Orthostatic Hypotension Using a Continuous Blood Pressure Device in Geriatric Rehabilitation Inpatients: RESORT

et al. 2022

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Background: Initial orthostatic hypotension (IOH) is highly prevalent in older adults and may interfere with the ability to regain function after acute hospitalization. IOH assessment requires a non-invasive, beat-to-beat continuous blood pressure device, which is not widely used in geriatric rehabilitation. Our aim was to test the feasibility of diagnosing IOH using a continuous blood pressure device in geriatric rehabilitation inpatients. Methods: Geriatric rehabilitation inpatients of the REStORing Health of Acutely Unwell AdulTs (RESORT) cohort admitted to a tertiary hospital were randomly selected to undergo continuous blood pressure monitoring (Finapres) for 5 min in the supine position and 3 min of standing or sitting when unable to stand. Interventions to warm hands and adjusting the cuff pressure sizes were attempted if no signal was obtained or an error message occurred. Results: Of 37 randomly selected inpatients, 29 {55.2% female; mean age 82.8 (standard deviation [SD]) 6.6 years} agreed to the continuous blood pressure measurement. Successful measurements were achieved in 20 out of 29 inpatients, two after hand warming. Patients with unsuccessful measurements were likely to be older (mean age 87.2 [SD] 4.4 years, p = 0.03), have cerebrovascular disease (p = 0.006), lower body mass index (p = 0.012), and a lower short physical performance battery score (p = 0.039). Eight out of 20 patients had IOH. Conclusion: The number of unsuccessful continuous blood pressure measurements was high in a population with high IOH prevalence despite multiple interventions to establish a signal. Future research should focus on improving the efficiency of continuous blood pressure devices in hospitalized patients with unsuccessful signals.

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Initial orthostatic hypotension and orthostatic intolerance symptom prevalence in older adults: A systematic review

Cited by 7 publications

References 60 publications

Influencing factors and hemodynamic study of initial and sustained orthostatic hypotension in middle‐aged and elderly patients

Influencing factors and hemodynamic study of initial and sustained orthostatic hypotension in middle‐aged and elderly patients

Frequency of hemodynamic response to orthostatic stress in heart failure with reduced ejection fraction, associations with clinical blood pressure

Feasibility of Diagnosing Initial Orthostatic Hypotension Using a Continuous Blood Pressure Device in Geriatric Rehabilitation Inpatients: RESORT

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