Prospective Evaluation of Clinical Characteristics of Orthostatic Hypotension

Low, Phillip A.; Opfer‐Gehrking, Tonette L.; McPhee, Benjamin R.; Fealey, Robert D.; Benarroch, Eduardo E.; Willner, Catherine L.; Suárez, Guillermo A.; Proper, Carol J.; Felten, Jasper; Huck, Christine A.; Corfits, Jeanne L.

doi:10.4065/70.7.617

Cited by 152 publications

(83 citation statements)

References 9 publications

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“…These include room temperature, exercise, alcohol or nicotine consumption, positioning of the arm, muscle tension, bladder distension, talking, and background noise. 28 The patient should be asked to remove all clothing that covers the location of cuff placement. The individual should be comfortably seated, with the legs uncrossed, and the back and arm supported, such that the middle of the cuff on the upper arm is at the level of the right atrium (the mid-point of the sternum).…”

Section: Subject Preparationmentioning

confidence: 99%

Recommendations for Blood Pressure Measurement in Humans and Experimental Animals

Pickering¹,

Hall²,

Appel³

et al. 2005

Hypertension

2,024

963

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Abstract-Accurate measurement of blood pressure is essential to classify individuals, to ascertain blood pressure-related risk, and to guide management. The auscultatory technique with a trained observer and mercury sphygmomanometer continues to be the method of choice for measurement in the office, using the first and fifth phases of the Korotkoff sounds, including in pregnant women. The use of mercury is declining, and alternatives are needed. Aneroid devices are suitable, but they require frequent calibration. Hybrid devices that use electronic transducers instead of mercury have promise. The oscillometric method can be used for office measurement, but only devices independently validated according to standard protocols should be used, and individual calibration is recommended. They have the advantage of being able to take multiple measurements. Proper training of observers, positioning of the patient, and selection of cuff size are all essential. It is increasingly recognized that office measurements correlate poorly with blood pressure measured in other settings, and that they can be supplemented by self-measured readings taken with validated devices at home. There is increasing evidence that home readings predict cardiovascular events and are particularly useful for monitoring the effects of treatment. Twenty-four-hour ambulatory monitoring gives a better prediction of risk than office measurements and is useful for diagnosing white-coat hypertension. There is increasing evidence that a failure of blood pressure to fall during the night may be associated with increased risk. In obese patients and children, the use of an appropriate cuff size is of paramount importance.

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Section: Subject Preparationmentioning

confidence: 99%

Recommendations for Blood Pressure Measurement in Humans and Experimental Animals

Pickering¹,

Hall²,

Appel³

et al. 2005

Hypertension

2,024

963

View full text Add to dashboard Cite

show abstract

“…30,31 A test of HR variability (HRV) in response to autonomic stimuli is regarded as safe with a minimal risk of cardiac dysrhytmias. 16,30 The Ewing test score (range, 0-5) is composed of 5 autonomic tests, and each is scored as normal (0 points), borderline (0.5 points), or positive (1 point); >2 is reported as the cut-off score to diagnose moderate-to-severe autonomic dysfunction.…”

Section: Autonomic Dysfunctionmentioning

confidence: 99%

“…A BP !30 mm Hg is considered abnormal, and a BP in the range from 11 mm Hg to 29 mm Hg is considered borderline. 31 Associated symptoms are reported by using a standard checklist.…”

Section: Autonomic Dysfunctionmentioning

confidence: 99%

The impact of hypogonadism and autonomic dysfunction on fatigue, emotional function, and sexual desire in male patients with advanced cancer

Strasser

Palmer

Schover

et al. 2006

Cancer

106

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BACKGROUND.The objective of this study was to determine whether hypogonadism and autonomic dysfunction contribute substantially to cancer‐related fatigue, decreased sexual desire, and depression in male patients with advanced, incurable cancer.METHODS.Forty‐eight patients who had received no major antineoplastic intervention for at least 2 weeks were tested for autonomic dysfunction by using Ewing tests. Total and free testosterone levels were measured. Multivariate analyses were performed to test the relation of these factors with the Functional Assessment of Cancer Therapy (FACT) (the Functional Assessment of Anorexia/Cachexia Therapy [FAACT] scale and the Functional Assessment of Chronic Illness Therapy‐Fatigue [FACIT‐F] subscale), the Hospital Anxiety and Depression Scale (HADS), the Edmonton Symptom Assessment Scale, the Sexual Desire Inventory, and sexual function (Cancer Rehabilitation Evaluation System subscale). Common causes for fatigue (anemia, depression, malnutrition, symptom distress, and medications) also were considered.RESULTS.Thirty‐eight of 47 patients (81%) had autonomic dysfunction, although it was not associated significantly with the other variables examined. Twenty‐nine of 45 patients (64%) had a low level of free testosterone (hypogonadism), which was correlated with the HADS Anxiety score (P = .002), the FACT Emotional Well‐Being score (P = .02), and the HADS Depression score (P = .04). Hypogonadal men also had lower scores on the FACT Functional Well‐Being scale (P = .01) and the FACIT‐F subscale (P = .05). Men who reported symptoms related to weight loss (FAACT scale) had significantly lower levels of free testosterone (r = 0.34; P = .02) but did not differ from the other group in actual weight loss (P = .22). The total testosterone level was not appropriate for screening of hypogonadism unless the patients had values <100 ng/ mL. Logistic regression analysis failed to reveal a distinct multivariate model of autonomic dysfunction or hypogonadism that predicted clinical outcomes.CONCLUSIONS.Hypogonadism is a frequent condition in patients with advanced, incurable cancer and is associated with negative mood, fatigue, and symptoms related to anorexia/cachexia. Cancer 2006. © 2006 American Cancer Society.

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“…Symptoms of palpitations, tremulousness, anxiety, and nausea are symptoms of autonomic hyperactivity, and occur in patients who have only partial autonomic failure, typically seen in the autonomic neuropathies and in younger patients. 16 Symptoms are typically worse in the early AM, after meals, with a rise in core temperature, prolonged standing, and with activity. The early AM severity of OH relates to the nocturnal diuresis that many of these patients have.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…However, difficulty in concentrating and thinking is present in about half the patients. 16 In patients over the age of 70 years, this may be the most common symptom, and while subtle, seriously impairs quality of life. Symptoms of palpitations, tremulousness, anxiety, and nausea are symptoms of autonomic hyperactivity, and occur in patients who have only partial autonomic failure, typically seen in the autonomic neuropathies and in younger patients.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Management of neurogenic orthostatic hypotension: an update

Low

Singer

2008

The Lancet Neurology

201

160

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Orthostatic hypotension (OH) is common in the elderly and in disorders like diabetes and Parkinson's disease. It is important to grade its severity and its impact on the person's quality of life. It is also possible to quantitate the severity of OH. Symptoms of OH vary with orthostatic stress, and it is important to recognize subtle symptoms such as tiredness and cognitive impairment. Standard drug treatment is efficacious in improving OH and its symptoms but will worsen supine hypertension. Pyridostigmine will modestly but significantly improve OH without worsening supine hypertension. Since orthostatic stress varies from moment to moment and drug treatment is suboptimal, it is necessary to combine drug treatment of OH with non-pharmacological approaches, such as compression of venous capacitance bed, use of physical counter-maneuvers, and intermittent water bolus treatment. Search Strategy:The manuscript is based on a focused review. To achieve this, references for this review were identified by searches of PubMed between 1995 and January 2008 using the search term "orthostatic hypotension". Articles were also identified through searches of the authors own files. Only papers published in English were selected. The final reference list was generated on the basis of originality and relevance to the topic covered in this review, with a particular focus on data supported by clinical trials.

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Prospective Evaluation of Clinical Characteristics of Orthostatic Hypotension

Cited by 152 publications

References 9 publications

Recommendations for Blood Pressure Measurement in Humans and Experimental Animals

Recommendations for Blood Pressure Measurement in Humans and Experimental Animals

The impact of hypogonadism and autonomic dysfunction on fatigue, emotional function, and sexual desire in male patients with advanced cancer

Management of neurogenic orthostatic hypotension: an update

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