Abstract
Carotid sinus hypersensitivity has a high prevalence in the elderly and is a possible cause of falls. In carotid sinus hypersensitivity, external triggers cause sudden reductions in blood pressure, leading to dizziness or syncope, resulting in falls. Turning of the head is considered an important example of such an external trigger in everyday life, wherein rotation of the neck is thought to manipulate the hypersensitive carotid sinus. However, direct evidence for this is lacking. The aim of this study was to investigate the effects of head turning in elderly with carotid sinus hypersensitivity. We performed a prospective, observational study in 105 elderly patients who visited a geriatric falls clinic in a university teaching hospital and in 25 community dwelling healthy elderly subjects. Continuous measurements of blood pressure and heart rate (Finapres) were performed before, during, and after head turning. Head turning-induced hypotension was defined as a drop in systolic blood pressure of at least 20 mmHg during head turning. Carotid sinus hypersensitivity was examined with carotid sinus massage. We also tested for two other common geriatric hypotensive syndromes, orthostatic hypotension and post prandial hypotension, using active standing and a meal test. All three hypotensive syndromes were defined using consensus definitions. Head turning resulted in hypotension in 39% of patients (mean systolic blood pressure drop 36 mm Hg) and in 44% of the healthy elderly, irrespective of the direction of the head movement. Carotid sinus hypersensitivity was associated with head-turning induced hypotension (OR= 3.5, 95% CI= 1.48 to 8.35). We conclude that head turning is indeed an important cause of sudden drops in blood pressure in elderly with carotid sinus hypersensitivity.
Highlights
Falls are common in elderly people, 30% of those aged 65 years and older fall at least once a year [1]; [2]
We considered that changes in systolic blood pressure less than 20 mmHg can fall within the normal range of blood pressure fluctuations [16], and to attribute these changes to head turning would promote false-positive association
This head-turning induced hypotension appears to be a manifestation of carotid sinus hypersensitivity and can be added to the list of common hypotensive triggers in the elderly, including orthostatic and postprandial hypotension, as it is comparable both in prevalence and in its hypotensive effect [6]; [7]
Summary
Falls are common in elderly people, 30% of those aged 65 years and older fall at least once a year [1]; [2]. Guidelines recommend that primary care physicians screen for fall risks in all elderly people and that a comprehensive geriatric fall risk assessment be performed in those patients who have fallen [4]. The elderly are prone to the so-called hypotensive syndromes (e.g. orthostatic and post prandial hypotension). Cerebral blood flow is temporarily reduced, which may manifest as dizziness or syncope. Through this mechanism, hypotensive syndromes contribute importantly to falls in the elderly [5]; [6]
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