Orthostatic hypertension: An underestimated cause of orthostatic intolerance

Lee, Hyung; Kim, Hyun-Ah

doi:10.1016/j.clinph.2015.12.017

Cited by 30 publications

(27 citation statements)

References 24 publications

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“…In addition to OH or POTS, we assured the presence of orthostatic hypertension during HUT in patients with orthostatic symptoms. We have previously reported that orthostatic intolerance due to orthostatic hypertension has been underestimated 19 . The prevalence of orthostatic hypertension in the present study was 3.2% and only 20% of them were symptomatic.…”

Section: Discussionmentioning

confidence: 99%

Patients with Orthostatic Intolerance: Relationship to Autonomic Function Tests results and Reproducibility of Symptoms on Tilt

Lee

Low

Kim

2017

Sci Rep

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This study was designed to investigate the frequency and pattern of orthostatic symptoms during head-up tilt (HUT) in patients with orthostatic intolerance during daily life, and to identify the relationship between the orthostatic symptoms during HUT and autonomic parameters. We prospectively collected autonomic data from 464 patients with orthostatic symptoms. Adrenergic and cardiovagal function tests including HUT were performed. Based on HUT results, we divided patients into orthostatic hypotension (OH), postural tachycardia syndrome (POTS), or normal HUT groups. We also investigated orthostatic symptoms during HUT. Only 25% of the patients reported orthostatic symptoms during HUT and 75% were asymptomatic. Typical orthostatic symptoms such as orthostatic dizziness and blurred vision, and atypical symptoms like chest tightness and headache occurred in 86% and 66%, respectively. Patients with POTS had symptoms more frequently than patients with OH during HUT. There were no differences in degrees of BP or HR changes between symptomatic and asymptomatic groups within the OH and POTS groups. HUT fails to reproduce symptoms of orthostatic intolerance in the majority of patients. Clinicians need to be aware that most patients with OH are asymptomatic during HUT and patients with POTS are more likely to be symptomatic than patients with OH.

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Section: Discussionmentioning

confidence: 99%

Patients with Orthostatic Intolerance: Relationship to Autonomic Function Tests results and Reproducibility of Symptoms on Tilt

Lee

Low

Kim

2017

Sci Rep

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“…Early pathogenetic studies [ 35 ] on orthostatic hypertension showed that in patients with this condition, excessive gravitational pooling of blood in the lower extremities causes a reduction of cardiac output, which leads to a compensatory sympathetic hyperactivity followed by an abnormally intense arterial vasoconstriction which raises the diastolic blood pressure. Increased peripheral vascular resistance has been demonstrated in patients with orthostatic hypertension who underwent a head-up tilt test [ 36 ]. Further support of a role for peripheral resistance in the pathogenesis of this condition comes from a case report in which a patient with severe symptomatic orthostatic hypertension was successfully treated with an alpha blocker [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Diastolic orthostatic hypertension and cardiovascular prognosis in type 2 diabetes: a prospective cohort study

Wijkman

Länne

Östgren

et al. 2016

Cardiovasc Diabetol

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BackgroundIn patients with type 2 diabetes, the prognostic impact of an orthostatic rise in blood pressure is not known. Therefore, the aim of this study was to determine the prognostic implications of the diastolic orthostatic blood pressure response in a cohort of patients with type 2 diabetes. We also evaluated associations between different orthostatic blood pressure responses and markers of subclinical cardiovascular organ damage.MethodsOffice blood pressures were measured in the sitting and in the standing position in 749 patients with type 2 diabetes who participated in the CARDIPP study (Cardiovascular Risk factors in Patients with Diabetes—a Prospective study in Primary care). Diastolic orthostatic hypertension was defined as a rise of diastolic blood pressure ≥10 mmHg and diastolic orthostatic hypotension was defined as a drop of diastolic blood pressure ≥10 mmHg. Recruitment took place between the years 2005–2008, and patients were followed until any of the primary outcome events (cardiovascular death or hospitalization for either myocardial infarction or stroke) occurred or until December 31st, 2014. Measurements of aortic pulse wave velocity and of carotid intima-media thickness were performed at base-line.ResultsDiastolic orthostatic hypertension was found in 140 patients (18.7 %) and was associated with significantly lower risk of cardiovascular events (crude hazard ratio compared with patients with normal systolic and diastolic orthostatic blood pressure response: 0.450, 95 % C.I. 0.206–0.987, P = 0.046). Diastolic orthostatic hypotension was found in 31 patients (4.1 %) and was associated with higher values for aortic pulse wave velocity and carotid intima-media thickness, compared with patients with normal systolic and diastolic orthostatic blood pressure response.ConclusionsDiastolic orthostatic hypertension is common in patients with type 2 diabetes, and may be a novel marker for decreased cardiovascular risk in these patients.

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“…The recurrent symptoms of OHT greatly impact on the academic performance and daily life in children and adolescents (11). Moreover, previous studies showed that OHT in young adults was associated with elevated risk of suffering from essential hypertension in the future (5,14), which also drew focus on adolescents and children with OHT. However, up to now, the mechanism for pediatric OHT is poorly understood (13,15,16).…”

Section: Introductionmentioning

confidence: 99%

Sympathetic Overactivation From Supine to Upright Is Associated With Orthostatic Hypertension in Children and Adolescents

Wang

et al. 2020

Front. Pediatr.

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There are no prior publications or submissions with any overlapping information, including studies and patients. The study data have not been presented as an abstract or poster before the submission. Objectives: The study was conducted to analyze the changes of baroreflex sensitivity and heart rate variability from supine to upright standing in children and adolescents with orthostatic hypertension to explore whether and how the autonomic nerve regulation was involved in the development of pediatric orthostatic hypertension. Methods: This case-control study included twenty-five children with orthostatic hypertension (the patient group) and twenty-six healthy controls (the control group). All subjects underwent a standing test, during which their hemodynamic parameters were continuously monitored by a Finapres Medical System, and baroreflex sensitivity and heart rate variability were calculated. Results: The demographic characteristics, supine baroreflex sensitivity, and supine heart rate variability including time domain and frequency domain indices did not differ between the patients with orthostatic hypertension and healthy subjects (P > 0.05). However, a more obvious drop of baroreflex sensitivity and a greater increase of low frequency/high frequency ratio from supine to upright were observed in subjects with orthostatic hypertension compared with those in the healthy children (P < 0.001 and P < 0.01, respectively). Changes of baroreflex sensitivity were negatively related to mean arterial pressure changes from supine to upright in all subjects (P < 0.01), and the increases in low frequency/high frequency ratio from supine to standing were positively correlated with those in mean arterial pressure in the study subjects (P < 0.001). Conclusion: Upright sympathetic overactivation is associated with pediatric orthostatic hypertension.

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Orthostatic hypertension: An underestimated cause of orthostatic intolerance

Cited by 30 publications

References 24 publications

Patients with Orthostatic Intolerance: Relationship to Autonomic Function Tests results and Reproducibility of Symptoms on Tilt

Patients with Orthostatic Intolerance: Relationship to Autonomic Function Tests results and Reproducibility of Symptoms on Tilt

Diastolic orthostatic hypertension and cardiovascular prognosis in type 2 diabetes: a prospective cohort study

Sympathetic Overactivation From Supine to Upright Is Associated With Orthostatic Hypertension in Children and Adolescents

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