U-curve relationship between orthostatic blood pressure change and silent cerebrovascular disease in elderly hypertensives

Abstract

Silent cerebrovascular disease is advanced in elderly hypertensives having OHT. Elderly hypertensives with OHT or OHYPO may have an elevated risk of developing hypertensive cerebrovascular disease.

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

“…In a previous report, we had already observed a suppression of orthostatic SBP increase in elderly hypertensives with OHT following doxazosin administration. 5 However, in that previous study, we evaluated orthostatic SBP once before and once after the administration of doxazosin only. In contrast, in the present study, we included several observations obtained over a 6-month follow-up period, and it was found that the continuous administration of doxazosin successfully reduced not only sitting SBP but also the SBP increase while standing observed in OHT subjects throughout the follow-up period; furthermore, this amelioration of symptoms was seen with both clinic and home BP-monitoring modalities.…”

“…Moreover, it has been reported that OHT might be associated with overactivity of the sympathetic nervous system. 1,5,27 Therefore, doxazosin might break the vicious cycle between the sympathetic nervous hyperactivity, orthostatic BP increase and renal damage by reducing both the orthostatic BP increase and excessive urinary albumin excretion.…”

“…1,2 The last condition, referred to as orthostatic hypertension (OHT), has been reported to be associated with target organ damage such as silent cerebral infarction, cardiac hypertrophy and urinary albuminuria. [3][4][5] In most previous studies, post-ural BP changes have been evaluated by clinical BP or by BP readings taken during head up-tilt test, although the reproducibility of these BP measurements is still matter of controversy. 3,[5][6][7][8] Home BP monitoring (HBPM) has been recently recommended as a convenient and reproducible method of BP measurement in hypertension management, with a better prognostic value than clinical BP measurements.…”

“…[3][4][5] In most previous studies, post-ural BP changes have been evaluated by clinical BP or by BP readings taken during head up-tilt test, although the reproducibility of these BP measurements is still matter of controversy. 3,[5][6][7][8] Home BP monitoring (HBPM) has been recently recommended as a convenient and reproducible method of BP measurement in hypertension management, with a better prognostic value than clinical BP measurements. [9][10][11] However, no data are available on the reproducibility of orthostatic BP changes when assessed by means of HBPM, which we previously showed to be more closely associated with increased albuminuria than when patients were assessed by clinical BP.…”

“…4 Hyperactivation of the sympathetic nervous system has been suggested as one of the mechanisms of OHT, in line with our previous finding that BP increase during head-up tilt in OHT subjects was blunted by alpha-adrenergic blockade. 5 However, alpha blockers are not commonly used in this context, because orthostatic hypotension (OHYPO) is known to be a frequent side effect of alpha-adrenergic blockade. Selective alpha-1 receptor blockade by doxazosin was reported to be less frequently associated with OHYPO than was administration of traditional alpha-adrenergic blockers.…”