Orthostatic hypotension is associated with more severe hypertension in elderly autonomous diabetic patients from the French Gerodiab study at inclusion

Bouhanick, Béatrice; Meliani, S.; Doucet, J.; Bauduceau, B.; Verny, C.; Chamontin, B.; Floch, J.-P. Le

doi:10.1016/j.ancard.2014.05.013

Cited by 23 publications

(19 citation statements)

References 23 publications

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“…This could indicate that subjects with OHypoT are less prone to be aggressively treated by physicians, 18 but, on the contrary, there is a statistical likelihood of a greater reduction in BP in standing position in patients with higher baseline BP. On the other hand, remarkably, ONT and OHyperT groups presented similar sitting BP values.…”

Section: Discussionmentioning

confidence: 86%

Evidence for a Prognostic Role of Orthostatic Hypertension on Survival in a Very Old Institutionalized Population

et al. 2016

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Abstract-In old individuals, regulation of blood pressure during postural changes is impaired. Several studies have assessed the clinical impact of orthostatic hypotension (OHypoT) during the aging process. By contrast, the prevalence and prognostic role of the increase in blood pressure in upright position (orthostatic hypertension, OHyperT) in old adults remain unknown. We investigated the association of OHyperT with cardiovascular morbidity and mortality in a population of old institutionalized subjects. A 2-year follow-up longitudinal study was conducted on 972 subjects ( In conclusion, in a old frail population, the increase in systolic blood pressure during upright position occurs frequently and is associated with higher cardiovascular morbidity and mortality independently of sitting blood pressure levels and major comorbidities. Health professional should take into account not only the decrease but also the increase in blood pressure when standing up. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00901355.

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Section: Discussionmentioning

confidence: 86%

Evidence for a Prognostic Role of Orthostatic Hypertension on Survival in a Very Old Institutionalized Population

et al. 2016

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“…Increasing BP per se, a known risk factor for orthostatic hypotension, (24) was not associated with increasing PH incidence; however, data for baseline BP were, surprisingly, only reported in 13 studies, limiting our ability to explore this association. The relationship of PH with hypertension is complex; PH is associated with both uncontrolled hypertension and the number of antihypertensive drugs used in managing high BP, (25)(26)(27)(28) but effective treatment of high BP in elderly persons is associated with reduced PH prevalence. (29,30) Consequently, a non-linear or 'U' shaped relationship of prevalence to absolute BP might be expected, with interaction in analyses between a diagnosis of hypertension (indicating treatment) and absolute BP values.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Prevalence of postural hypotension in primary, community and institutional care: A systematic review and meta-analysis

McDonagh

Mejzner

Clark

2020

Preprint

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Background: Postural hypotension (PH), the reduction in blood pressure when rising from sitting or lying to standing, is a risk factor for falls, cognitive decline and mortality. However, it is not often tested for in primary care. PH prevalence varies according to definition, population, care setting and measurement method. The aim of this study was to determine the prevalence of PH across different care settings and disease subgroups. Methods: Systematic review, meta-analyses and meta-regression. We searched Medline and Embase to October 2019 for studies based in primary, community or institutional care settings reporting PH prevalence. Data and study level demographics were extracted independently by two reviewers. Pooled estimates for mean PH prevalence were compared between care settings and disease subgroups using random effects meta-analyses. Predictors of PH were explored using meta-regression. Quality assessment was undertaken using an adapted Newcastle-Ottawa Scale. Results: 1816 studies were identified; 61 contributed to analyses. Pooled prevalences for PH using the consensus definition were 17% (95% CI, 14-20%; I2=99%) for community cohorts, 19% (15-25%; I2=98%) for 23 primary care cohorts and 31% (15-50%; I2=0%) for 3 residential care or nursing homes cohorts (P=0.16 between groups). By condition, prevalences were 20% (16-23%; I2=98%) with hypertension (20 cohorts), 21% (16-26%; I2=92%) with diabetes (4 cohorts), 25% (18-33%; I2=88%) with Parkinson’s disease (7 cohorts) and 29% (25-33%; I2=0%) with dementia (3 cohorts), compared to 14% (12-17%; I2=99%) without these conditions (P<0.01 between groups). Multivariable meta-regression modelling identified increasing age and diabetes as predictors of PH (P<0.01, P=0.13, respectively; R2=36%). PH prevalence was not affected by blood pressure measurement device (P=0.65) or sitting or supine resting position (P=0.24), however, when the definition of PH did not fulfil the consensus description, but fell within its parameters, prevalence was underestimated (P=0.01) irrespective of study quality (P=0.04). Conclusions: PH prevalence in populations relevant to primary care is substantial and the definition of PH used is important. Our findings emphasise the importance of considering checking for PH, particularly in vulnerable populations, to enable interventions to manage it. These data should contribute to future guidelines relevant to the detection and treatment of PH. PROSPERO:CRD42017075423.

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“…Le traitement hypotenseur doit être prudent en commençant par une monothérapie à faible dose et en vérifiant l'absence d'hypotension orthostatique [25]. Les IEC, les ARA2 et les bloqueurs calciques associés si besoin aux diurétiques sont les médicaments les plus souvent utilisés.…”

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Management of Diabetes in Elderly

Bauduceau

Bordier

2017

IJMS

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RESUMELa prise en charge des patients diabétiques âgés est devenue aujourd'hui un véritable problème de santé publique du fait de l'augmentation du nombre des malades. Dans cette population, les complications du diabète sont plus graves et s'intriquent avec les manifestations plus spécifiquement gérontologiques. L'évaluation gériatrique standardisée est indispensable pour définir la situation de chaque malade selon son degré d'autonomie et de dénutrition, ses fonctions cognitives et son environnement social. Les objectifs thérapeutiques doivent être individualisés en fonction de la présentation clinique du patient. L'insulinothérapie est fréquemment incontournable et nécessite l'éducation du patient ou de son entourage. La prise en charge des patients diabétiques âgés doit éviter un trop grand laxisme chez une personne restée en bonne santé mais aussi un activisme déraisonnable chez les sujets fragiles en raison du risque hypoglycémique. MOTS CLÉS :Diabète, Sujet Agé, Complications, Insuline, Hypoglycémie. ABSTRACTThe management of elderly diabetic patients has become a real public health problem due to the increase in the number of patients. In this population, the complications of diabetes are more serious and are associated with manifestations more specifically gerontological. The standardized geriatric assessment is essential to define the situation of each patient according to his degree of autonomy and undernutrition, his cognitive functions and his social environment. The therapeutic objectives must be individualized according to the clinical status of the patient. Insulin therapy is often unavoidable and requires a good education of the patient or his family. The management of diabetes in elderly patients must also avoid too much laxity in a person who is remained healthy but also an unreasonable activism in the fragile subjects due to the hypoglycemic risk.

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Orthostatic hypotension is associated with more severe hypertension in elderly autonomous diabetic patients from the French Gerodiab study at inclusion

Cited by 23 publications

References 23 publications

Evidence for a Prognostic Role of Orthostatic Hypertension on Survival in a Very Old Institutionalized Population

Evidence for a Prognostic Role of Orthostatic Hypertension on Survival in a Very Old Institutionalized Population

Prevalence of postural hypotension in primary, community and institutional care: A systematic review and meta-analysis

Management of Diabetes in Elderly

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