Insights into the clinical management of the syndrome of supine hypertension – orthostatic hypotension (SH-OH): The Irish Longitudinal Study on Ageing (TILDA)

Romero-Ortuño, Román; O’Connell, Matthew; Finucane, Ciarán; Soraghan, Christopher; Fan, Chie Wei; Kenny, Rose Anne

doi:10.1186/1471-2318-13-73

Cited by 53 publications

(59 citation statements)

References 69 publications

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“…Changes in SBP, DBP, and HR from baseline after standing were derived. 19 Normative reference values for the difference in BP and HR from supine baseline during active standing were estimated 21 with GAMLSS. 22 SBP, DBP, and HR distributions were individually modeled at each time point after standing using the Box-Cox power exponential distribution.…”

Section: Discussionmentioning

confidence: 99%

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Age-Related Normative Changes in Phasic Orthostatic Blood Pressure in a Large Population Study

et al. 2014

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Background-In this report, we provide the first normative reference data and prevalence estimates of impaired orthostatic blood pressure (BP) stabilization, initial orthostatic hypotension, and orthostatic hypotension based on beat-to-beat blood pressure methods in a population-representative sample. Methods and Results-Participants were recruited from a nationally representative cohort study (≥50 years). Beat-tobeat systolic BP, diastolic BP, and heart rate records were analyzed among those who underwent an active stand test (n=4475). Normograms were estimated by use of generalized additive models for location, shape, and scale with BoxCox power exponential distribution. ) of the population aged ≥50 years, with no age gradient evident. The prevalence of orthostatic hypotension was 6.9% (95% CI, 5.9%-7.8%) in the total population, increasing to 18.5% (95% CI, 9.0%-28.0%) in those aged ≥80 years old. Conclusions-Significant age-related differences exist in the time course of postural BP responses, with abnormal responses taking longer than 30 seconds to stabilize. Impaired BP stabilization is more common as we age, affecting more than two-fifths of the population aged ≥80 years, and may play a future role in the management of falls and syncope. (Circulation. 2014;130:1780-1789.)

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Section: Discussionmentioning

confidence: 99%

“…[18][19][20] Custom-written MATLAB R2013 version 8.2 software was used to perform this first stage of analysis. Values extracted for analysis are defined in Table 1 and included supine values and transient stabilization parameters (Figure 1).…”

Section: Orthostatic Bp Analysismentioning

confidence: 99%

Age-Related Normative Changes in Phasic Orthostatic Blood Pressure in a Large Population Study

et al. 2014

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“…Over the past twenty years emerging clinical and epidemiological practice has shifted towards the use of continuous beat-to-beat BP(CBP) measurements [3]. Impairments in CBP responses are related to increased levels of frailty [4], cognitive impairment [5], and falls risk [6] in crosssectional and longitudinal studies.…”

Section: Introductionmentioning

confidence: 99%

“…Numerous approaches for characterising altered CBP behaviour [7] are suggested in the literature e.g. initial orthostatic hypotension [8], classical orthostatic hypotension (OH) [3], impaired BP stabilisation [9], and morphological approaches [6]. Given that traditional BP measurements have considerable intra-and inter-individual variability [10] and intra-observer effects [11] we hypothesize that CBP are similarly affected.…”

Section: Introductionmentioning

confidence: 99%

Reliability of orthostatic beat-to-beat blood pressure tests: implications for population and clinical studies

Finucane

Kenny

2017

Clin Auton Res

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ObjectiveTo assess the test-retest reliability of orthostatic beat-to-beat blood pressure responses to active standing and related clinical definitions of orthostatic hypotension. MethodsA random sample of community dwelling older adults from the pan-European Survey of Health, Ageing and Retirement in Europe, Ireland underwent a health assessment which mimicked that of the Irish Longitudinal Study on Ageing. An active stand test was performed using continuous blood pressure measurements. Participants attended a repeat assessment 4-12 weeks after the initial measurement. A mixed-effects regression model estimated the reliability and minimum detectable change while controlling for fixed observer and time of day effects. ResultsA total of 125 individuals underwent repeat assessment (mean age 66.2±7.5;55.6% women).Mean time between visits was 84.3±23.3 days. There was no significant mean difference in heart rate or blood pressure recovery variables between the first and repeat assessments.Minimum detectable change was noted for changes from resting values in systolic blood pressure(26.4mmHg) and diastolic blood pressure(13.7mmHg) at 110 seconds and for changes in heart rate(10.9bpm) from resting values at 30 seconds after standing. Intra-class correlation values ranged from 0.47 for nadir values to 0.80 for heart rate and systolic blood pressure values measured 110 seconds after standing. ConclusionContinuous orthostatic beat-to-beat blood pressure and related clinical definitions show moderate reliability and substantial natural variation over a 4-12 week period.Understanding variation in measures is essential for study design or estimating the effects of orthostatic hypotension, while clinically it can be used when evaluating longer term treatment effects.

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“…Orthostatic hypotension can be either symptomatic or asymptomatic [11]. Only 33 % of patients with both Parkinson's disease and orthostatic hypotension reported related symptoms by questionnaires [10••].…”

Section: Introductionmentioning

confidence: 99%

Pathophysiology and Treatment of Orthostatic Hypotension in Parkinsonian Disorders

Sinn

Gibbons

2016

Curr Treat Options Neurol

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Orthostatic hypotension (OH) is defined as a sustained pathological reduction in blood pressure within 3 min after orthostatic stress such as tilt-table testing or active standing. Non-neurogenic OH is caused by either decreased cardiac output or impaired vasoconstriction without a primary autonomic disorder whereas neurogenic OH results from inadequate release of norepinephrine in the vasomotor sympathetic system. Once non-neurogenic causes of OH such as medications and cardiac problems are ruled out, neurogenic OH can be considered. Neurogenic OH can accompany parkinsonian diseases in different stages and is associated with increased risk of morbidity and mortality. The pathophysiology of neurogenic OH in parkinsonian diseases includes sympathetic neurocirculatory failure and impaired cardiovagal activity. The inadequate release of peripheral norepinephrine upon orthostatic stress is a final pathologic pathway for neurogenic OH and is important for many therapeutic interventions. With mild or early autonomic failure, OH that occurs beyond 3 min of standing (defined as delayed OH) can result in orthostatic intolerance. Supine hypertension and postprandial hypotension are frequent comorbidities and may exacerbate orthostatic hypotension. The non-pharmacologic therapies should be tried initially, followed by pharmacologic treatments. Common medications used in the treatment of OH include fludrocortisone, midodrine, pyridostigmine, and droxidopa. Only midodrine and droxidopa have received FDA approval for the treatment of orthostatic hypotension.

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Insights into the clinical management of the syndrome of supine hypertension – orthostatic hypotension (SH-OH): The Irish Longitudinal Study on Ageing (TILDA)

Cited by 53 publications

References 69 publications

Age-Related Normative Changes in Phasic Orthostatic Blood Pressure in a Large Population Study

Age-Related Normative Changes in Phasic Orthostatic Blood Pressure in a Large Population Study

Reliability of orthostatic beat-to-beat blood pressure tests: implications for population and clinical studies

Pathophysiology and Treatment of Orthostatic Hypotension in Parkinsonian Disorders

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