Prognosis of Diastolic and Systolic Orthostatic Hypotension in Older Persons

Luukinen, Heikki; Koski, K; Laippala, Pékka; Kivelä, Sirkka‐Liisa

doi:10.1001/archinte.159.3.273

Cited by 192 publications

(168 citation statements)

References 33 publications

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“…[1][2][3]5,6,10,11,13,14 In the current report, lower BMI was positively related to an excess in the odds of OH. Although findings were adjusted for age, hypertension, diabetes, cigarette smoking, total cholesterol, HDL cholesterol, and triglycerides, other unknown comorbidities in leaner individuals are likely to have contributed to this finding.…”

Section: Discussionsupporting

confidence: 56%

“…Most studies of OH have focused on the elderly, [3][4][5][6][8][9][10][11][12][13][14][15] where reported prevalence ranges from 5 to 30%. Unfortunately, the use of different methods to define OH makes it difficult to compare study findings.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7] Depending on how OH is measured, however, prevalence can range markedly from 5 to 30%, [3][4][5][6][7][8][9][10][11][12][13][14][15] making it difficult to describe cross-cultural variation or to identify effects that may be associated with OH. 1,2,4,14,15 Low rates of coronary heart disease in Asia vs the US and Western Europe suggest that the prevalence and correlates of OH may also be different through associations with risk factors that are culturally unique.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and correlates of orthostatic hypotension in middle-aged men and women in Korea: the Korean Health and Genome Study

et al. 2004

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To examine the prevalence and correlates of orthostatic hypotension (OH) in middle-aged adults enrolled in the Korean Health and Genome Study. Participants were 8908 individuals aged 40-69 years. Supine blood pressure (BP) was measured three times at 30-s intervals after at least 5 min of rest in the supine position and single standing BP was measured at 0 and 2 min after standing, respectively. OH was defined as a reduction in systolic BP or diastolic BPX20 and 10 mmHg, respectively. The prevalence of OH at 0 and 2 min after standing was 12.3 and 2.9%, respectively. At 0 min of standing, OH frequency increased significantly with age from 6.4% in those aged 40-44 years to 23.1% in those aged 65-69 (Po0.001). After adjustment for age and other characteristics, hypertension was associated with a 1.7-fold excess in the odds of OH in men and a 1.6-fold excess in women (Po0.001). In contrast, an increase in body mass index (BMI) on the order of 5 kg/ m 2 was associated with a 20-30% reduction in the odds of OH (Po0.001). Diabetes in women was also associated with a 1.4-fold excess in the odds of OH (Po0.05). An increase in triglyceride by 136 mg/dl in men was associated with an increase in the odds of OH (Po0.05).In conclusion, the prevalence and correlates of OH other than diabetes and triglycerides were notably similar in men and women. While the association between hypertension and OH has been observed elsewhere, low BMI in Korean adults with OH may be an important marker for subclinical morbidity or coexisting risk factors that need to be identified.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence and correlates of orthostatic hypotension in middle-aged men and women in Korea: the Korean Health and Genome Study

et al. 2004

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“…In elderly, OH is associated with cardiovascular morbidity and mortality (31,33). The pathophysiology of OH in PD remains incompletely understood.…”

mentioning

confidence: 99%

Lower vascular tone and larger plasma volume in Parkinson's disease with orthostatic hypotension

Groothuis

Esselink

Seeger³

et al. 2011

Journal of Applied Physiology

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Here, we test the role of two other possible factors: 1) a reduced peripheral vasoconstriction (which may contribute because PD includes a generalized sympathetic denervation); and 2) an inadequate plasma volume (which may explain why plasma volume expansion can manage orthostatic hypotension in PD). We included 11 PD patients with orthostatic hypotension (PD ϩ OH), 14 PD patients without orthostatic hypotension (PD Ϫ OH), and 15 agematched healthy controls. Leg blood flow was examined using duplex ultrasound during 60°head-up tilt. Leg vascular resistance was calculated as the arterial-venous pressure gradient divided by blood flow. In a subset of 9 PD ϩ OH, 9 PD Ϫ OH, and 8 controls, plasma volume was determined by indicator dilution method with radiolabeled albumin ( 125 I-HSA). The basal leg vascular resistance was significantly lower in PD ϩ OH (0.7 Ϯ 0.3 mmHg·ml Ϫ1 ·min) compared with PD Ϫ OH (1.3 Ϯ 0.6 mmHg·ml Ϫ1 ·min, P Ͻ 0.01) and controls (1.3 Ϯ 0.5 mmHg·ml Ϫ1 ·min, P Ͻ 0.01). Leg vascular resistance increased significantly during 60°head-up tilt with no significant difference between the groups. Plasma volume was significantly larger in PD ϩ OH (3,869 Ϯ 265 ml) compared with PD Ϫ OH (3,123 Ϯ 377 ml, P Ͻ 0.01) and controls (3,204 Ϯ 537 ml, P Ͻ 0.01). These results indicate that PD ϩ OH have a lower basal leg vascular resistance in combination with a larger plasma volume compared with PD Ϫ OH and controls. Despite the increase in leg vascular resistance during 60°h ead-up tilt, PD ϩ OH are unable to maintain their blood pressure.Parkinson's disease; orthostatic hypotension; leg vascular resistance; plasma volume; head-up tilt SYMPTOMATIC AND ASYMPTOMATIC orthostatic hypotension (OH) is present in 30 -60% of patients with Parkinson's disease (PD) (15) and negatively correlated with quality of life (32). In elderly, OH is associated with cardiovascular morbidity and mortality (31, 33). The pathophysiology of OH in PD remains incompletely understood. Until now, the focus has been primarily on impairment of central mediated vasoconstrictor mechanisms. PD patients have a reduced baroreflex cardiovagal function, denervation of the heart, low norepinephrine levels, and no increment in norepinephrine levels during orthostatic challenges (14, 39). However, baroreflex failure and cardiac sympathetic denervation contribute to but cannot fully explain OH in PD (14, 16). During orthostatic challenges peripheral vasoconstriction contributes to maintain blood pressure via a central mediated vasoconstrictor mechanism, i.e., baroreflex, and local vasoconstrictor mechanisms, such as the venoarteriolar axon reflex (21) and the myogenic response (11). Since in PD a generalized rather than a central sympathetic denervation is present (40), central and local mediated peripheral vasoconstriction might be affected and, thereby, might play an important role in the pathophysiology of OH in PD.Furthermore, a lower plasma volume may be another contributing factor to OH in PD. This assumption is based on the important role of the s...

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“…In addition, OH has also been shown to carry significant risks for cardiovascular morbidity and mortality. [9][10][11][12] Even though OH is a common medical condition among the hospitalized elderly population, the literature focuses mainly on medical and geriatric ward patients. Prevalence data for acute surgical and trauma patients are limited despite a high frequency of elderly patients in these wards with additional risk factors for OH, such as hypovolemia and prolonged postsurgery immobilization.…”

Section: Introductionmentioning

confidence: 99%

Prevalence, Associations and Risk Factors for Orthostatic Hypotension in Medical, Surgical and Trauma Inpatients: An Observational Cohort Study

Aung

Corcoran

Nagalingam

et al. 2011

Heart, Lung and Circulation

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Background: Orthostatic hypotension (OH) is prevalent in hospitalized elderly patients. It is defined as a reduction in systolic blood pressure (SBP) of at least 20 mmHg and/or diastolic blood pressure (DBP) of at least 10 mmHg within 3 minutes of standing from a lying position. This observational cohort study describes the prevalence, association with symptoms, and risk factors for OH in medical, surgical, and trauma wards in a tertiary hospital and the differences in hemodynamic behaviors between OH-positive (OHP) and OH-negative (OHN) patients. Methods: All 76 patients who were hemodynamically stable and able to stand from 4 hospital wards had noninvasive supine and orthostatic blood pressures (BPs) and pulse rates (PRs) measured over 4 days. Results: Mean age of the 76 patients included in the study was 67.8 6 19.6 years. Overall prevalence of OH was 23.7% (95% CI: 14.7%-34.8%) with 21.2% (95% CI: 9.0%-38.9%) in medical, 31.8% (95% CI: 13.9%-54.9%) in surgical, and 19.0% (95% CI: 5.4%-41.9%) in trauma wards. OH had no association with symptoms (P 5 .53). We found no differences in age, number of comorbidities, and medication use between the OHN and OHP groups.The two groups displayed very different hemodynamic responses. The OHN group demonstrated a statistically significant compensatory rise in BP and PR over time to orthostatic

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Prognosis of Diastolic and Systolic Orthostatic Hypotension in Older Persons

Cited by 192 publications

References 33 publications

Prevalence and correlates of orthostatic hypotension in middle-aged men and women in Korea: the Korean Health and Genome Study

Prevalence and correlates of orthostatic hypotension in middle-aged men and women in Korea: the Korean Health and Genome Study

Lower vascular tone and larger plasma volume in Parkinson's disease with orthostatic hypotension

Prevalence, Associations and Risk Factors for Orthostatic Hypotension in Medical, Surgical and Trauma Inpatients: An Observational Cohort Study

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