Orthostatic hypertension: home blood pressure monitoring for detection and assessment of treatment with doxazosin

Hoshide, Satoshi; Parati, Gianfranco; Matsui, Yoshio; Shibazaki, Seiichi; Eguchi, Kazuo

doi:10.1038/hr.2011.156

Cited by 28 publications

(21 citation statements)

References 29 publications

(37 reference statements)

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“…In the OHT group, treatment with doxazosin reduced home orthostatic SBP increase compared with controls, while no effect was observed on sitting SBP. In the whole cohort, UAR reduction was independently associated with reduction in standing BP . Similarly, a study with 55 hypertensives (10 with OHT and 45 with no OHT/OH), reported that treatment with doxazosin administered at bedtime reduced standing BP without affecting sitting BP in OHT patients .…”

Section: Treatmentmentioning

confidence: 75%

“…Conversely, orthostatic BP change should be assessed in hypertensive patients for prompt detection of OHT . Doxazosin may be considered as the first‐choice drug if standing BP values exceed 140/90 mm Hg, provided that essential hypertension (increased sitting BP values) is absent or well‐controlled, while clonidine can also be used in severe OHT cases …”

Section: Future Directionsmentioning

confidence: 99%

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Orthostatic hypertension: From pathophysiology to clinical applications and therapeutic considerations

Magkas

Tsioufis

Thomopoulos

et al. 2019

J of Clinical Hypertension

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Orthostatic hypertension (OHT), that is, sustained increase in blood pressure after standing, is an increasingly recognized cardiovascular disorder having been examined in much fewer studies compared with orthostatic hypotension (OH). However, in both OHT and OH, dysfunction of the autonomous nervous system is considered to be the primary pathophysiological disturbance, while significant associations with essential hypertension have been observed. Although in many studies OHT has been related to subclinical or clinical target organ damage, there is also evidence denying such an association. Because OHT is defined variably across different studies, the comparison of relevant outcomes is at least problematic. Since evidence about OHT treatment is exclusively based on limited non‐randomized studies, no specific recommendations have been developed. Therefore, both the prognostic role and the clinical significance of OHT remain largely undefined. The aim of the present review is to summarize the available evidence regarding the definition, diagnosis, pathophysiology, prognostic role and treatment of OHT and highlight potential clinical implications of this underestimated condition.

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Section: Treatmentmentioning

confidence: 75%

Section: Future Directionsmentioning

confidence: 99%

Orthostatic hypertension: From pathophysiology to clinical applications and therapeutic considerations

Magkas

Tsioufis

Thomopoulos

et al. 2019

J of Clinical Hypertension

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show abstract

“…In their study, after tilting, the plasma NE level was significantly higher in the OHT group than that in the controls, while the supine plasma NE levels were comparable between the two groups. Moreover, α-receptor blockers have been shown to be capable of reducing the upright BP without effecting baseline BP in clinical studies (8,23). Based on the above facts, we hypothesized that the abnormal autonomic nervous system control is likely associated with OHT.…”

Section: Discussionmentioning

confidence: 94%

“…The previous studies showed that, after wearing inflatable pressure suits to increase returned blood volume, the upright DBP of the OHT patients was lower than before (1). Besides, we controlled the gender, age and BMI when analyzing autonomic measures to exclude their influence on autonomic activity (23,24,28).…”

Section: Discussionmentioning

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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“…Then, subjects were asked to be seated upright in a chair with feet on the floor, knees bent at right angles, hands hanging down naturally and back leaning against nothing for another 10 min. Sitting heart rate and blood pressure were recorded every minute 19 . Any symptom complaint was noted.…”

Section: Methodsmentioning

confidence: 99%

Sitting-induced hemodynamic changes and association with sitting intolerance in children and adolescents: a cross-sectional study

Tao

Han

Yan

et al. 2020

Sci Rep

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Hemodynamic alteration with postural change from supine to sitting has been unclear in the young. In the cross-sectional study, 686 participants (371 boys and 315 girls, aged 6-18 years) were recruited from 4 schools in Kaifeng city, the central area of China. The active sitting test was performed to obtain heart rate (HR) and blood pressure (BP) changes from supine to sitting in children and adolescents. Hemodynamic change-associated sitting intolerance was analyzed. In the study participants, the 95th percentile (P 95) values of changes in HR and BP within 3 min from supine to sitting were 25 beats/min and 18/19 mm Hg, respectively. Sixty-six participants had sitting intolerance symptoms. Compared with participants without sitting intolerance symptoms, those with symptoms more frequently had HR increase ≥ P 95 or BP increase ≥ P 95 within 3 min from supine to sitting (P < 0.001). Risk factors for sitting intolerance were age (odds ratio 1.218, 95% confidence interval 1.072-1.384, P = 0.002) and changes in HR or BP ≥ P 95 within 3 min after sitting (odds ratio 2.902, 95% confidence interval 1.572-5.357, P = 0.001). We firstly showed hemodynamic changing profiles from supine to sitting and their association with sitting intolerance in children and adolescents. Sitting tachycardia is likely suggested with a change in HR ≥ 25 beats/min and sitting hypertension with a change in BP ≥ 20/20 mm Hg when changing from supine to sitting within 3 min. The age and changes in HR or BP were independent risk factors for sitting intolerance. Lying, sitting and standing are inevitable postures in daily life, and blood distribution changes are accompanied by postural changes. Physiologically, changing from the supine to the orthostatic position induces an instantaneous and large shift of 10% to 25% of blood volume from the thorax to the lower extremities and splanchnic organs and a transfer from the vasculature to the interstitial tissues. This redistribution causes an immediate decrease in venous return to the heart, resulting in a transient decline in cardiac filling and blood pressure. Then, positive chronotropic and inotropic cardiac effects are stimulated by activation of the sympathetic nervous system and withdrawal of the parasympathetic nervous system to maintain a relatively stable circulatory condition,

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Orthostatic hypertension: home blood pressure monitoring for detection and assessment of treatment with doxazosin

Cited by 28 publications

References 29 publications

Orthostatic hypertension: From pathophysiology to clinical applications and therapeutic considerations

Orthostatic hypertension: From pathophysiology to clinical applications and therapeutic considerations

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

Sitting-induced hemodynamic changes and association with sitting intolerance in children and adolescents: a cross-sectional study

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