Orthostatic Hypotension Associated With Baroreceptor Dysfunction: Treatment Approaches

Briasoulis, Αlexandros; Silver, A.; Yano, Yuichiro; Bakris, George L.

doi:10.1111/jch.12258

Cited by 23 publications

(16 citation statements)

References 22 publications

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“…This hypothesis is supportive of the greater age-associated atrophy of the carotid baroreceptors, which is also a cause for orthostatic hypotension in the geriatric population, especially with dehydration [ 50–52 ]. Apart from diminished thirst, older individuals often consume less fluids because of problems associated withurinary incontinence, ambulation, manual dexterity or cognition, which predisposes them to dehydration often in poorly staffed nursing facilities [ 52–54 ].…”

Section: Discussionmentioning

confidence: 99%

Hydration health literacy in the elderly

Picetti

Foster

Pangle

et al. 2017

NHA

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BACKGROUND:Inadequate hydration in the elderly is associated with increased morbidity and mortality. However, few studies have addressed the knowledge of elderly individuals regarding hydration in health and disease. Gaps in health literacy have been identified as a critical component in health maintenance, and promoting health literacy should improve outcomes related to hydration associated illnesses in the elderly.METHODS:We administered an anonymous survey to community-dwelling elderly (n = 170) to gauge their hydration knowledge.RESULTS:About 56% of respondents reported consuming >6 glasses of fluid/day, whereas 9% reported drinking ≤3 glasses. About 60% of respondents overestimated the amount of fluid loss at which moderately severe dehydration symptoms occur, and 60% did not know fever can cause dehydration. Roughly 1/3 were not aware that fluid overload occurs in heart failure (35%) or kidney failure (32%). A majority of respondents were not aware that improper hydration or changes in hydration status can result in confusion, seizures, or death.CONCLUSIONS:Overall, our study demonstrated that there were significant deficiencies in hydration health literacy among elderly. Appropriate education and attention to hydration may improve quality of life, reduce hospitalizations and the economic burden related to hydration-associated morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Hydration health literacy in the elderly

Picetti

Foster

Pangle

et al. 2017

NHA

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“…1 Aging, comorbidities like diabetes and Parkinson’s disease and a variety of drugs are known to exaggerate these changes. 2,3 In some cases, the compensatory mechanisms underrespond, or are absent, resulting in a sustained fall in SBP of more than 20 mm Hg, a sustained fall in DBP of 10 mm Hg, or a combination of these events, which are typical criteria to diagnoses orthostatic intolerance. 4 Orthostatic changes in blood pressure (BP) are important predictors for future cardiovascular events (eg, stroke, heart attack, heart failure, and death) in addition to being important components of falls and their resultant complications like fracture and long-term immobility.…”

Section: Introductionmentioning

confidence: 99%

Orthostatic changes in systolic blood pressure among SPRINT participants at baseline

Townsend

Chang

Cohen

et al. 2016

Journal of the American Society of Hypertension

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Orthostatic changes in systolic blood pressure (SBP) impact cardiovascular outcomes. In this study, we aimed to determine the pattern of orthostatic systolic pressure changes in participants enrolled in the SBP Intervention Trial (SPRINT) at their baseline visit before randomization and sought to understand clinical factors predictive of these changes. Of the 9323 participants enrolled in SPRINT, 8662 had complete data for these analyses. The SBP after 1 minute of standing was subtracted from the mean value of the three preceding seated SBP values. At the baseline visit, medical history, medications, anthropometric measures, and standard laboratory testing were undertaken. The mean age of SPRINT participants was 68 years, two-thirds were male, with 30% black, 11% Hispanic, and 55% Caucasian. The spectrum of SBP changes on standing demonstrated that increases in SBP were as common as declines, and about 5% of participants had an increase, and 5% had a decrease of >20 mm Hg in SBP upon standing. Female sex, taller height, more advanced kidney disease, current smoking, and several drug classes were associated with larger declines in BP upon standing, while black race, higher blood levels of glucose and sodium, and heavier weight were associated with more positive values of the change in BP upon standing. Our cross-sectional results show a significant spectrum of orthostatic SBP changes, reflecting known (eg, age) and less well-known (eg, kidney function) relationships that may be important considerations in determining the optimal target blood pressure in long-term outcomes of older hypertensive patients.

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“…Impairment of this compensatory mechanism due to autonomic dysfunction results in orthostatic hypotension [32]. Very often patients with orthostatic hypotension may develop the supine hypertension which lead to non-dipping hypertension [34].…”

Section: Orthostatic Hypotensionmentioning

confidence: 99%

The current state of knowledge about the dipping and non-dipping hypertension

Dubielski

Zamojski

Wiechecki

et al. 2016

Arterial Hypertension

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Ambulatory blood pressure monitoring provides information about the day-night blood pressure profile, which can be divided into dipping and non-dipping pattern. Non-dipping hypertension is recently thought to have increased cardiovascular risk and outcomes than dipping hypertension. The dipping pattern is explained by physiological changes in circadian rhythm, while the pathomechanism of non-dipping hypertension is not fully understood. Is it considered to be a result of many factors, such as: sympathetic nervous system overactivation, which can be accompanied by impaired parasympathetic nervous system response, obesity, concurrent diabetes mellitus and metabolic syndrome. Moreover abnormalities of hormones levels such as melatonin, catecholamines, thyroid and parathyroid hormones are connected to occurrence of non-dipping hypertension. Other widely discussed problem is obstructive sleep apnoea and its influence on circadian rhythm changes. Also dysfunction in activity of renin-angiotensin-aldosterone axis is thought to cause non-dipping pattern. There are some studies that indicate on role of inappropriate sodium intake in mentioned pathology. The chronic kidney disease and relationship with non-dipping hypertension will be also described. The last considered factor is influence of age on the development of non-dipping hypertension. key words: circadian blood pressure profile, blood pressure regulation, chronobiology, nocturnal hypertension, non-dipping pathomechanism

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Orthostatic Hypotension Associated With Baroreceptor Dysfunction: Treatment Approaches

Cited by 23 publications

References 22 publications

Hydration health literacy in the elderly

Hydration health literacy in the elderly

Orthostatic changes in systolic blood pressure among SPRINT participants at baseline

The current state of knowledge about the dipping and non-dipping hypertension

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