Supine Blood Pressure Research Articles

Heat-sensitive moxibustion combined with medication for orthostatic hypotension of yang-qi deficiency in the elderly: a randomized controlled trial

To observe the effect of heat-sensitive moxibustion combined with medication on orthostatic hypotension (OH) of yang -qi deficiency in the elderly. Sixty elderly patients with OH of yang -qi deficiency were randomly divided into an observation group (30 cases, 1 case dropped out) and a control group (30 cases). The patients in the control group were treated with oral midodrine hydrochloride tablets, 2.5 mg each time and twice daily, while the patients in the observation group were treated with heat-sensitive moxibustion in addition to the treatment in the control group. Acupoints selected included Dazhui (GV 14), Fengfu (GV 16), and Baihui (GV 20), with each session lasting 30-40 min, once daily. Both groups were treated for 4 weeks. Blood pressure in the supine and standing positions, as well as the decrease of blood pressure when the position changing from supine to standing, were measured before treatment and after 2 and 4 weeks of treatment. Clinical efficacy was also evaluated. After 4 weeks of treatment, both groups showed an increase in systolic blood pressure (SBP) and diastolic blood pressure (DBP) in both the supine and standing positions (P<0.05), and the decrease in SBP and DBP when the position changing from supine to standing was reduced (P<0.05). Compared with the control group, the observation group had higher SBP and DBP in both positions and a smaller decrease in SBP and DBP when the position changing from supine to standing (P<0.05). The total effective rate was 96.6% (28/29) in the observation group, which was higher than 70.0% (21/30) in the control group (P<0.05). Heat-sensitive moxibustion combined with medication could increase the blood pressure in both supine and standing position, and decrease the reducing of blood pressure when the position changing from supine to standing in elderly patients with OH of yang-qi deficiency.

Measuring only sitting blood pressure without considering supine blood pressure underestimates cardiovascular risk in the elderly

Abstract Background and Objective Elderly individuals exhibit greater variability in blood pressure (BP) readings between sitting and supine positions. Nocturnal hypertension (supine position) is closely associated with cardiovascular diseases and mortality. However, the relationship between supine BP and cardiovascular risk remains unclear. This study aims to investigate the association between the occurrence of major adverse cardiovascular events (MACEs) with BP in sitting and supine positions. Methodologies A total of 3363 participants aged 65 years or older from the Northern Shanghai Study were included. Each participant is given 3 consecutive sitting SBP readings (SBP1, SBP2, SBP3) at 2-minute intervals, we then calculated the SBP1-2 (average of SBP1 and SBP2), SBP2-3 (average of SBP2 and SBP3), SBP1-2-3 (average of SBP1, SBP2 and SBP3). we also collected two supine BP readings (S-SBP1, S-SBP2). Kaplan-Meier and Cox proportional hazard regression were used to investigate the association of sitting and supine BP with MACEs (composite of nonfatal myocardial infarction, nonfatal stroke, or death). Results The mean age of participants was 71.5 years, and 1467(43.6%) were men. After a median of 6.4-year follow-up, a total of 362 events were recorded. Among 3 successive BP readings, SBP2-3 had strongest association with MACEs incidence (hazard ratio, 1.12 [1.00-1.26] per SD). Multiple cox proportional hazard regression showed supine BP had significant value in predicting MACEs, acute myocardial infarction (AMI) and mortality compared to sitting BP. Kaplan-Meier revealed significant differences in MACEs rates among participants without hypertension (HTN) in both sitting and supine positions, with HTN in both positions, or those with HTN in either position (Log rank P &amp;lt; 0.01). Compared to participants without HTN in both sitting and supine positions, those with HTN in both positions had a 1.4-fold (hazard ratio,1.40[1.08-1.82]) higher risk of MACEs and 2-fold (hazard ratio,2.01[1.24-3.26]) higher risk of stroke. Conclusion Supine BP measurements are more valuable than sitting BP in predicting MACEs in elderly individuals. Hypertension in both positions significantly increases the risk of MACEs. Taken together, supine BP may also need to be emphasized in the elderly.central illustration

Impact of vascular biomarkers and supine hypertension on cardiovascular outcomes in hypertensive patients: first results from the Cardiovascular Prognostic COUPLING Study in Japan.

The prognostic impact of vascular biomarkers and supine blood pressure (BP) is not well understood. The multicenter, prospective Coupling study determined the prognostic impact of vascular biomarkers and supine BP in outpatients aged ≥30 years with ≥1 cardiovascular risk factor. Occurrence of major cardiovascular events during follow-up was recorded. The primary outcome was time to onset of a major cardiovascular event. Office and supine BP, the cardio-ankle vascular index (CAVI), and the ankle-brachial index (ABI) were determined annually. Of the 5109 participants in the Coupling study, 4716 were analyzed (51.9% male, mean age 68.5 ± 11.4 years); participants mostly had hypertension treated based on seated office/home BP according to relevant guidelines. During a median follow-up of 5.0 years (interquartile range 3.6-5.2), 231 major cardiovascular events occurred. After adjustment for age, sitting office systolic BP, and other covariates, a 1-unit increase in CAVI (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.01-1.24) and a 0.1-unit decrease in ABI (HR 1.41, 95% CI 1.18-1.68) were significantly associated with cardiovascular event risk; risk was greatest when CAVI was ≥8.0 and ABI was ≤1.10. Uncontrolled supine hypertension (≥140/90 mmHg) was also significantly associated with adjusted cardiovascular event risk (HR 1.36, 95% CI 1.02-1.81); seated office BP control was not significantly associated with cardiovascular event risk. Increased arterial stiffness, mildly lower ABI, and supine hypertension are risk factors for cardiovascular events during standard clinical practice. Supine evaluation of BP and vascular biomarkers has highlighted a blind spot in current hypertension management (Clinical trial registration: University Hospital Medical Information Network Clinical Trials Registry, UMIN000018474).

Acupuncture at stellate ganglion combined with western medication for orthostatic hypotension in Parkinson's disease: a randomized controlled trial

To observe the effect of acupuncture at stellate ganglion on orthostatic hypotension (OH) in Parkinson's disease (PD), and explore its action mechanism. A total of 68 patients with OH in PD were randomly divided into a combination group (34 cases, 2 cases dropped out, 1 case was eliminated) and a western medication group (34 cases, 1 case was eliminated). Both groups received stable dose anti-PD western medication, the western medication group received oral midodrine hydrochloride tablets, 2.5 mg each time, 2 times a day. The combination group was treated with acupuncture at bilateral stellate ganglion on the basis of the western medication group, without retaining needles, once a day, 5 times a week. Both groups were treated for 2 weeks. Supine and orthostatic blood pressure, orthostatic hypotension questionnaire (OHQ) score, TCM syndrome score, unified Parkinson's disease rating scale (UPDRS) score before and after treatment in the two groups were observed, the level of serum norepinephrine (NE) was detected, and the clinical effect was evaluated. After treatment, orthostatic systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the combination group were increased compared with those before treatment (P<0.01), OHQ score, TCM syndrome score, UPDRS score were decreased compared with those before treatment (P<0.01); supine SBP in the western medication group was increased compared with that before treatment (P<0.05), OHQ score was decreased compared with that before treatment (P<0.05); the levels of serum NE in both groups were increased compared with those before treatment (P<0.01). After treatment, orthostatic SBP, orthostatic DBP and the level of serum NE in the combination group were higher than those in the western medication group (P<0.01, P<0.05), the OHQ score, TCM syndrome score, UPDRS score were lower than those in the western medication group (P<0.05, P<0.01). The total effective rate was 87.1% (27/31) in the combination group, which was higher than 63.6% (21/32) in the western medication group (P<0.05). Acupuncture at stellate ganglion can increase the orthostatic blood pressure in patients with OH in PD , improve clinical symptoms, and the mechanism may be related to the up-regulation of NE.

Orthostatic hypotension and cerebral small vessel disease: A systematic review.

Orthostatic hypotension(OH) is highly prevalent in ageing populations and may contribute to cognitive decline through cerebral small vessel disease(CSVD). Research on the association between OH and CSVD is fragmented and inconsistent. We systematically reviewed the literature for studies assessing the association between OH and CSVD, published until December 1st 2023 in MEDLINE, PubMed or Web of Science. We included studies with populations aged ≥60, that assessed OH in relation to CSVD including white matter hyperintensities(WMH), lacunes and cerebral microbleeds. Modified JBI checklist was used to assess risk of bias. A narrative synthesis of the results was presented. Of 3180 identified studies, eighteen were included. Fifteen studies reported on WMH, four on lacunes, seven on microbleeds. Six of fifteen studies on WMH found that OH was related to an increased burden of WMH, neither longitudinal studies found associations with WMH progression. Findings were inconsistent across studies concerning lacunes and microbleeds. Across outcomes, adequate adjustment for systolic blood pressure tended to coincide with smaller effect estimates. Current evidence on the OH-CSVD association originates mostly from cross-sectional studies, providing inconsistent and inconclusive results. Longitudinal studies using standardized and fine-grained assessment of OH and CSVD and adequate adjustment for supine blood pressure are warranted.

Effects of Blood Flow Restriction Resistance Training on Autonomic and Endothelial Function in Persons with Parkinson's Disease.

Autonomic dysfunction precedes endothelial dysfunction in Parkinson's disease (PD) and causes blood pressure and circulation abnormalities that are highly disruptive to one's quality of life. While exercise interventions have proven helpful for motor symptoms of PD, improving associated non-motor symptoms is limited. Low-intensity resistance training with blood flow restriction (LIRT-BFR) improves autonomic dysfunction in non-PD patients and high-intensity resistance training (HIRT) is recommended for motor symptom improvements for people with PD (PwPD). To determine the effects of LIRT-BFR and HIRT on homocysteine and autonomic and endothelial function in PwPD and to determine the hemodynamic loads during LIRT-BFR and HIRT in PwPD using a novel exercise protocol. Thirty-eight PwPD were assigned LIRT-BFR, HIRT or to a control (CNTRL) group. The LIRT-BFR and HIRT groups exercised three days per week for four weeks. The LIRT-BFR protocol used 60% limb occlusion pressure (LOP) and performed three sets of 20 repetitions at 20% of the one-repetition maximum (1RM). The HIRT group performed three sets of eight repetitions at 80% 1RM. The CNTRL group was asked to continue their normal daily routines. LIRT-BFR significantly improved orthostatic hypotension (p = 0.026), homocysteine levels (p < 0.001), peripheral circulation (p = 0.003), supine blood pressure (p = 0.028) and heart rate variability (p = 0.041); LIRT-BFR improved homocysteine levels (p < 0.018), peripheral circulation (p = 0.005), supine blood pressure (p = 0.007) and heart rate variability (p = 0.047) more than HIRT; and hemodynamic loads for LIRT-BFR and HIRT were similar. LIRT-BFR may be more effective than HIRT for autonomic and endothelial function improvements in PwPD and hemodynamic loads may be lessened in LIRT-BFR protocols using single-joint exercises with intermittent blood flow restriction. Further research is needed to determine if non-motor symptoms improve over time and if results are sustainable.

Impact of Smokeless Tobacco on Cardiovascular Disease Risk in a Nigerian Metropolitan City.

The use of smokeless tobacco products (STP) as a substitute for tobacco smoking is driving increasing consumption of these products especially in developing countries. The study sought to make comparison of cardiovascular risk profile between chronic STP users and suitably matched tobacco-naïve controls. This is a preliminary report from the cross sectional part of a two-arm prospective study of Smokeless Tobacco Products Composition and Exposure Outcome in Enugu metropolis, Nigeria. Consecutively recruited current Smokeless tobacco users, who had no history of cigarette smoking, aged 18years and above, residing in selected communities in Enugu metropolis, Nigeria were recruited for the study from October 2022 to July 2023. Age and sex matched non-tobacco users from same localities as the study subjects served as controls. Written informed consent to participate in the study was obtained from all study participants. All participants were screened by the investigators, using the study case report forms, to obtain data on medical history, demographic, clinical, laboratory, and electrocardiographic evaluation. Data from 54 STP-users and 54 non-STP-users (mean age 56.58 ± 8.15years) were analyzed. Anthropometric parameters were similar in both groups. Smokeless tobacco users had higher erect and supine blood pressure indices as well asgreater postural drop in systolic blood pressure. The occurrence of diabetes mellitus (20.37% versus 5.56%) and hypertension (25.93%; 11.11%) was significantly higher in the STP-users than in the non-user population, (p = 0.02192 and 0.04751 respectively). Electrocardiographic evaluation showed significantly increased QTc and dispersions of P-wave, QRS and QT intervals as well as reduced PR interval in STP users. Electrocardiographic abnormalities observed in STP users include left ventricular hypertrophy, left atrial enlargement, ST-segment elevation, short PR interval and long QTc. Use of smokeless tobacco products is associated with increased risk burden of diabetes mellitus and hypertensive heart disease. Electrocardiographic findings linked to STP-use in this study are features consistent with arrhythmia, ventricular repolarization abnormality, myocardial hypertrophy and ischaemia, suggesting that smokeless tobacco products are not safe substitutes for tobacco smoking.

IMPROVEMENT OF RENAL HAEMODYNAMICS AND ECHOCARDIOGRAPHIC PARAMETERS IN PHARMACOLOGICAL CONTROLLED HYPERTENSIVES

Objective: A study was carried out to evaluate the influence of blood pressure lowering treatment with combined doses of olmesartan plus amplodipina compared with those of either drug at a single dose level. Design and method: By double-blind, three-way crossover study (balanced Latin square design) in 102 subjects (mean age 51.9 +/- 7.42 years) with essential hypertension we used Olmesartan 40 mg plus Amplodine 5 mg compared with those of either drug at a single and higher dose level (40 or 10 mg daily, respectively). Left ventricular mass and function were evaluated by M-B mode echocardiography, renal function by glomerular filtration rate (GFR) and by serum and 24-h urinary Na+ and K+ during wash-out period and after 24 weeks of treatment. Results: The supine blood pressure for subjects given placebo was 171/103 mmHg. After 24 weeks of treatment, systolic and diastolic supine blood pressure were significantly lower with 40 mg iolmesartan plus 5 mg amplodipine (134/84 mmHg) than with 10 mg amplodipine (137/84 mmHg) or with 40 mg olmesartan (144/85 mmHg). Left ventricular posterior wall and septal thickness were significantly and similarly reduced in all groups. Left ventricular systolic and diastolic end diameters were not significantly changed. Left ventricular mass (LVM) was significantly reduced in Olmesartan plus Amplodipine group and Olmesartan group. GFR was not significantly altered. The 24-h urinary Na+ significantly increased with olmesartan, more so than amplodipine. The combination was tolerated better than either monotherapy. We observed no clinically significant changes in laboratory variables including blood lipoproteins. Conclusions: The combination of olmesartan plus amplodipina reduced blood pressure more effectively and was better tolerated than other drug alone. All three groups showed similar changes in echocardiographic indices and no change in renal function.

INFLUENCES OF BEDREST DECONDITIONING ON ORTHOSTATIC HYPERTENSION RISK

Objective: Orthostatic hypertension defined as systolic blood pressure (SBP) increase of more than 20 mmHg when standing up with hypertensive upright SBP heralds increased cardiovascular risk. The phenomenon is caused by sympathetic overactivation and occurs in conditions associated with poor cardiopulmonary fitness or hypovolemia. We hypothesized that head-down tilt bedrest, which induces cardiopulmonary deconditioning, hypovolemia, and sympathetic activation increases the likelihood of experiencing orthostatic hypertension. Design and method: We pooled data from two strict head-down tilt bedrest studies, the 60 days AGBRESA study (n=24, 8 women/ 16 men, 33.3±9 years) and the 30 days SANS countermeasure study (n=47, 20 women/ 27 men, 35±9 years), which both included healthy persons on no medications. In both studies, participants were on controlled sodium diets and caloric intake was adjusted to maintain body weight. Before and immediately after bedrest, we measured supine and upright blood pressure and heart rate during head-up tilt testing. We measured plasma volume using carbon monoxide rebreathing before and after bedrest. Results: Supine SBP was 128±9 mmHg before and 133±10 mmHg after bedrest (p&lt;0.0001). While 5 minutes standing, SBP changed 2±8 mmHg before and 3±8 mmHg after bedrest (p=0.5825). 1 out of 67 participants fulfilled diagnostic criteria of orthostatic hypertension before and 3 out of 57 after bedrest. Supine heart rate was 69±11 bpm before and 79±15 bpm after bedrest (p&lt;0.0001). With standing, heart rate increased 21±12 bpm before and 39±16 bpm after bedrest (p&lt;0.0001). Plasma volume decreased by 367±348 ml with bedrest (p&lt;0.0001). Conclusions: We conclude that in most healthy persons, cardiovascular deconditioning and volume loss associated with long-term bedrest are not sufficient to elicit orthostatic hypertension. There may be a smaller subgroup of susceptible individuals.

Blood Pressure and Central Arterial Stiffness before and after a 161-km Ultra-Endurance Race

BACKGROUND: Competing in ultra-endurance running events (&gt;42.2 km) is a tremendous physiological stressor. Training for and competing in these events may be detrimental to cardiovascular (CV) health. However, previous findings on acute changes in key CV health measures like blood pressure (BP) and central arterial stiffness after a race remain equivocal. Therefore, we aimed to characterize the acute CV response to an ultra-endurance race. We hypothesized that BP would decrease while central arterial stiffness would increase following the race. Methods: We measured supine BP with an automated brachial cuff and carotid-to-femoral pulse wave velocity (cfPWV - index of central arterial stiffness) with applanation tonometry (SphygmoCor XCEL, AtCor Medical) among 41 finishers (9F/32M; Age: 44 ± 10 years; BMI: 22.7 ± 1.8 kg/m2) of the 2023 161-km Western States Endurance Run (WSER). Measures were taken 1–3 days before (pre) and ≤1 hour after race completion (post). We present data as mean ± SD after confirming normality using Shapiro-Wilk tests (α ≥ 0.05). We assessed differences between pre- and post- systolic BP (SBP), mean BP (MBP), diastolic BP (DBP), cfPWV, and cfPWV normalized to MBP using paired, two-tailed t-tests (α &lt; 0.05). The magnitude of the difference between time points was represented as Cohen’s d ( d) effect sizes. Results: After the race, there was a significant decrease in SBP (129 ± 9 vs. 122 ± 10 mmHg, P &lt; 0.001, d = 0.78), MBP (94 ± 7 vs. 89 ± 10 mmHg, P &lt; 0.001, d = 0.58), and DBP (77 ± 7 vs. 74 ± 8, P = 0.02, d = 0.38) but no change in cfPWV (6.4 ± 1.0 vs. 6.2 ± 0.8 m/s, P = 0.10, d = 0.26) or cfPWV normalized to MBP (0.07 ± 0.01 vs. 0.07 ± 0.01 (m/s)/mmHg, P = 0.83, d = 0.00). CONCLUSION: We found that systolic, mean, and diastolic pressure were all lower after the 161-km WSER, but cfPWV did not change. These findings suggest that running a 161-km ultra-marathon race acutely lowers BP but does not affect central arterial stiffness. Further research is needed to understand the effect of chronic ultra-endurance training and competition on cardiovascular health. FUNDING INFORMATION: Western States Endurance Run Medical Research Program (GJG), National Institutes of Health K01HL160772 (JCW), American Heart Association 23CDA1037938 (JCW). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Abstract P316: Orthostatic Hypertension, Standing Hypertension, and Risk of Cardiovascular Disease

Background: There is substantial controversy over how to define orthostatic hypertension (OHTN), an increase in blood pressure (BP) after standing. Recent consensus statements combine both orthostatic and standing hypertension. This could be problematic if their individual associations with cardiovascular disease (CVD) differed as one phenotype would subsume the risk attributes of the other. Objectives: To compare the association between OHTN or standing HTN with CVD. Methods: The Atherosclerosis Risk in Communities Study measured supine and standing BP during visit 1 (1987-1989). OHTN was defined as a rise in SBP ≥20 mm Hg or DBP ≥10 mm Hg (standing minus supine BP). We also examined a new consensus statement definition of a rise of ≥20 mm Hg in SBP (systolic OHTN) and standing SBP of ≥140 mm Hg. We excluded participants with a history of CVD. We determined risk associations with incident CHD, heart failure, stroke, fatal CHD, and all-cause mortality using Cox models adjusted for CVD risk factors (see Table footnote). Results: Of 11,369 participants (56% female, 25% Black adults, mean age 54 years), 10% had OHTN, 20% had standing systolic HTN, and 1% had systolic OHTN with standing SBP ≥140 mm Hg. Over a range of 25-28 years of follow-up, OHTN was not significantly associated with any of the outcomes, while standing systolic HTN was significantly associated with all outcomes. In joint models comparing systolic OHTN and standing HTN, standing HTN was significantly associated with CVD and associations differed significantly from systolic OHTN (Table). Conclusions: Unlike OHTN, standing HTN was strongly associated with CVD and death. These differences in CVD risk raise important concerns about combining OHTN and standing HTN in a consensus definition.

Subclinical vascular composites predict clinical cardiovascular disease, stroke, and dementia: The Multi-Ethnic Study of Atherosclerosis (MESA)

Background and aimsSubclinical cardiovascular disease (CVD) measures may reflect biological pathways that contribute to increased risk for coronary heart disease (CHD) events, stroke, and dementia beyond conventional risk scores. MethodsThe Multi-Ethnic Study of Atherosclerosis (MESA) followed 6814 participants (45–84 years of age) from baseline in 2000–2002 to 2018 over 6 clinical examinations and annual follow-up interviews. MESA baseline subclinical CVD procedures included: seated and supineblood pressure, coronary calcium scan, radial artery tonometry, and carotid ultrasound. Baseline subclinical CVD measures were transformed into z-scores before factor analysis to derive composite factor scores. Time to clinical event for all-cause CVD, CHD, stroke and ICD code-based dementia events were modeled using Cox proportional hazards models reported as area under the curve (AUC) with 95% Confidence Intervals (95%CI) at 10 and 15 years of follow-up. All models included all factor scores together, and adjustment for conventional risk scores for global CVD, stroke, and dementia. ResultsAfter factor selection, 24 subclinical measures aggregated into four distinct factors representing: blood pressure, atherosclerosis, arteriosclerosis, and cardiac factors. Each factor significantly predicted time to CVD events and dementia at 10 and 15 years independent of each other and conventional risk scores. Subclinical vascular composites of atherosclerosis and arteriosclerosis best predicted time to clinical events of CVD, CHD, stroke, and dementia. These results were consistent across sex and racial and ethnic groups. ConclusionsSubclinical vascular composites of atherosclerosis and arteriosclerosis may be useful biomarkers to inform the vascular pathways contributing to events of CVD, CHD, stroke, and dementia.

Study protocol for the Heads-Up trial: a phase II randomized controlled trial investigating head-up tilt sleeping to alleviate orthostatic intolerance in Parkinson’s Disease and parkinsonism

BackgroundIn persons with Parkinson’s Disease (PD) or certain forms of atypical parkinsonism, orthostatic hypotension is common and disabling, yet often underrecognized and undertreated. About half of affected individuals also exhibit supine hypertension. This common co-occurrence of both orthostatic hypotension and supine hypertension complicates pharmacological treatments as the treatment of the one can aggravate the other. Whole-body head-up tilt sleeping (HUTS) is the only known intervention that may improve both. Evidence on its effectiveness and tolerability is, however, lacking, and little is known about the implementability.MethodsIn this double-blind multicenter randomized controlled trial (phase II) we will test the efficacy and tolerability of HUTS at different angles in 50 people with PD or parkinsonism who have both symptomatic orthostatic hypotension and supine hypertension. All participants start with one week of horizontal sleeping and subsequently sleep at three different angles, each maintained for two weeks. The exact intervention will vary between the randomly allocated groups. Specifically, the intervention group will consecutively sleep at 6°, 12° and 18°, while the delayed treatment group starts with a placebo angle (1°), followed by 6° and 12°. We will evaluate tolerability using questionnaires and compliance to the study protocol. The primary endpoint is the change in average overnight blood pressure measured by a 24-hour ambulatory blood pressure recording. Secondary outcomes include orthostatic blood pressure, orthostatic tolerance, supine blood pressure, nocturia and various other motor and non-motor tests and questionnaires.DiscussionWe hypothesize that HUTS can simultaneously alleviate orthostatic hypotension and supine hypertension, and that higher angles of HUTS are more effective but less tolerable. The Heads-Up trial will help to clarify the effectiveness, tolerability, and feasibility of this intervention at home and can guide at-home implementation.Trial registrationClinicalTrials.gov NCT05551377; Date of registration: September 22, 2022.

Prospective association of occupational and leisure-time physical activity with orthostatic blood pressure changes in older adults

Orthostatic hypotension (OH) is common in older people. We examined the influence of self-reported occupational-related physical activity (PA) and leisure-time physical exercise (PE) on orthostatic response in a sample of older people over a 2 year period. Supine and orthostatic systolic blood pressure (sBP), diastolic blood pressure (dBP), and mean blood pressure (mBP) were assessed in response to Active Stand (AS) test in 205 older subjects (> 60 years old) at baseline and 2-year follow-up. OH was found in 24 subjects (11.71%) at baseline and 20 subjects (9.76%) after 2 years, with a significant degree of variability in the occurrence of OH after 2 years. Twenty-two subjects who had OH at baseline were free of it after 2 years, two subjects had persistent OH at baseline and after 2 years. After 2 years, adults with occupational PA showed no significant decrease of blood pressure in response to AS test, while lack of undertaking an occupation-related PA was significantly related with a greater decrease in sBP and mBP in response to AS testing in the 1st min. Occupation-related PA and leisure-time-related PE were related to an increase in the response of BP on AS in change between baseline and after 2 years. High between-subjects variance in OH over 2 years was noted. Occupations that involved continuous physical activity and leisure-time physical exercise in middle age were both protective for BP decline on orthostatic stress test within 2 years.

Insult of Ultraendurance Events on Blood Pressure: A Systematic Review and Meta-Analysis.

The rise of ultraendurance sports in the past two decades warrants evaluation of the impact on the heart and vessels of a growing number of athletes participating. Bloodpressure is a simple, inexpensive method to evaluate one dimension of an athlete's cardiovascular health. No systematic review or meta-analysis to date has chronicled and delineated the effects of ultraendurance races, such as ultramarathons, marathons, half-marathons, and Ironman triathlon events, specifically on heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and mean arterial pressure (MAP) measurements in supine and standing positions before and after the event. This meta-analysis reviews the effects of ultraendurance events on positional and calculated hemodynamic values. Data were extracted from 38 studies and analyzed using a random effects model with a total of 1,645 total blood pressure measurements. Of these, 326 values were obtained from astanding position, and 1,319 blood pressures were taken supine. Pre-race andpost-race measurements were evaluated for clinical significance using established standards of hypotensionand orthostasis. HR and calculated BP features, such as PP and MAP, were evaluated. Across all included studies, the mean supine post-race HR increased by 21±8 beats per minute (bpm) compared to pre-race values. The mean standing post-race HR increased by 23±14 bpm when compared with pre-race HR. Overall, there was a mean SBP decrease of 19±9 mmHgand a DBP decrease of 9±5 mmHgpost-race versus pre-race values. MAP variations reflected SBP and DBP changes. The mean supine and standing pre-race blood pressures across studies were systolic (126±7; 124±14) and diastolic (76±6; 75±12), suggesting that some athletes may enter races with existing hypertension. The post-race increasein the mean HR and decline in mean blood pressure across examined studies suggestthat during long-term events, ultramarathon athletes perform with relatively asymptomatic hypotension.

Relationship of blood pressure measured in the calf with arm blood pressure and arterial stiffness: a general population study.

Leg blood pressure (BP) measurement is needed when arm BP evaluation is not feasible, and calf BP, especially when measured in standing position, may have greater association with cardiovascular remodeling than arm BP. This study evaluated the relationship between calf and arm BP, and investigated whether calf BP would be superior to arm BP in predicting increased arterial stiffness [pulse wave velocity (PWV) > 10 m/s]. We evaluated clinical and laboratory characteristics, BP measurements, and PWV in 1397 individuals resident in Baependi, Brazil, between 2017 and 2019. Arm BP was measured in the seated and supine positions while calf BP was measured in supine and standing positions using digital oscillometric devices. Carotid-femoral PWV was measured using a noninvasive mechanotransducer. The sample had 62.7% females, age = 48.1 ± 15.4 years and 8.4% with PWV >10 m/s. Results of linear regression analysis showed that BP values of 140/90 mmHg measured in the arm in supine and seated position were equivalent to calf supine BP values of 164/81 mmHg and 166/78 mmHg and calf standing BP values of 217/137 mmHg and 221/137 mmHg, respectively. Calf-arm BP differences were associated with age, glomerular filtration rate, body mass index, smoking, low-density lipoprotein-cholesterol, diabetes and height. Furthermore, stepwise logistic regression analysis revealed that arm supine systolic BP, but not calf BP measurements, was independently associated with increased arterial stiffness. Thresholds of ≈165/80 mmHg and ≈220/135 mmHg could be used for diagnosing hypertension when only calf measurements in supine and standing positions, respectively, are available. Conversely, calf BP was not superior to arm BP in predicting increased arterial stiffness.

Levodopa-induced orthostatic hypotension in parkinsonism: A red flag of autonomic failure.

Levodopa (LD) is the main treatment for parkinsonism, but its use may be limited by a potential hypotensive effect. We evaluated the cardiovascular effect of LD performing head-up tilt test (HUTT) before and 60 min after 100/25 mg LD/dopa-decarboxylase inhibitor (pre-LD vs. post-LD HUTT) in 164 patients with parkinsonism on chronic LD treatment. Features predictive of LD-induced orthostatic hypotension (OH) were assessed by logistic regression analysis. Basal supine blood pressure (BP) and heart rate (HR) decreased after LD. During post-LD HUTT, BP drop and HR increase were significantly greater than at pre-LD HUTT. Thirty-eight percent of patients had OH at post-LD HUTT compared to 22% of patients presenting OH at pre-LD HUTT (p < 0.001). Risk factors for LD-induced/worsened OH were pre-LD OH (odds ratio [OR] = 36, 95% confidence interval [CI] = 10-131), absence of overshoot at Valsalva maneuver (OR = 9, 95% CI = 4-20), and pathological Valsalva ratio (OR = 6, 95% CI = 2-15). LD administration caused/worsened hypotension in both supine and orthostatic conditions. Patients with cardiovascular autonomic failure had a higher risk of developing LD-induced OH. In clinical practice, LD-induced OH could represent a red flag for cardiovascular autonomic failure.

Abstract 058: Factors Contributing To Postprandial Hypotension In Neurogenic Orthostatic Hypotension

Postprandial hypotension (PPH) is defined as a sudden and substantial decrease (&gt;20 mmHg or &gt;10 mmHg) in blood pressure (BP) within two hours post meal intake; This condition is highly prevalent in neurogenic orthostatic hypotension (nOH) and is associated with pre-syncopal symptoms and postprandial syncope. We studied factors contributing to PPH in nOH. Patients were admitted at the Vanderbilt clinical research center and placed on a sodium-controlled diet. Autonomic function testing, including continuous recording of BP and heart rate (HR) during head up tilt, sinus arrhythmia, and Valsalva Maneuver, was performed. Subjects took a high-carbohydrate meal (~500 Kcal). Hemodynamic parameters were monitored every 5 mins for 30 minutes before and up to 120 minutes afterwards. Results: We recruited 13 patients with peripheral autonomic failure (Parkinson’s Disease), 62% males, 73±9.08 y.o. and 13 with central autonomic failure (Multiple System Atrophy), 69% males, 62±8.23 y.o. All subjects had a substantial SBP (-42.9 ±27.90 mmHg) and DBP (-20.8 ±15.2 mmHg) decrease within 3 mins of standing, without compensatory HR increase (11.64 ± 5.97 bpm). The orthostatic increase in HR adjusted by decrease in SBP was abnormal (0.4±0.43, normal&gt;0.5), sinus arrhythmia ratio was abnormal (1.05±0.04, normal&gt;1.2). Pressor response in Valsalva Maneuver showed impaired sympathetic vasoconstriction. Postprandial hemodynamic changes were analyzed with area under the curve (AUC) and at 30-min timepoint post meal, which was the nadir. PD had a larger DBP increase (907±214.83 mmHg vs.1209±277.68 mmHg MSA, P=0.016), MSA had a higher HR increase (1102±236 mmHg vs. 1318±199.82 mmHg, P=0.029). No difference was found in AUC SBP, however at 30-min post-meal, SBP was lower in PD (-25±24.19 mmHg vs. -3.3±15.05 mmHg MSA, P=0.026). Only supine SBP predicted the postprandial decrease in SBP at 30 min (r=-0.5, P=0.04). Conclusion: PPH is more severe in peripheral autonomic failure; supine BP was associated with PPH.

Abstract P408: Treatment Of Orthostatic Hypotension With Pyridostigmine: Relevance To Supine Hypertension

Supine hypertension, a common comorbidity in patients with orthostatic hypotension (OH), creates a management challenge because the treatment of one condition can worsen the other. Treatment of OH with the acetylcholinesterase inhibitor pyridostigmine has the advantage of preferentially increasing upright blood pressure (BP) by facilitating autonomic ganglia neurotransmission. We did a retrospective analysis of 37 patients with neurogenic OH (65±2 yr, 21 men) to study the efficacy of pyridostigmine 60 mg (defined as the increase in upright systolic BP [SBP] 1-hr postdrug) and determine clinical predictors of efficacy. Pyridostigmine increased upright SBP by 4 (-6 to 11 mmHg, median, IQR). Pyridostigmine efficacy was inversely correlated with the severity of OH (the SBP drop on standing, r 2 =0.4, p=0.022) and with the magnitude of autonomic impairment, the ratio of the increase in heart rate on standing divided by the drop in SBP, (r 2 =0.32, p=0.044) only in patients with central autonomic failure and intact efferent sympathetic pathways (multiple system atrophy, MSA; n=13), but not in patients with pure autonomic failure (PAF; n=24). Pyridostigmine efficacy was negatively correlated to supine BP (r 2 =0.20, p=0.006; Figure). In conclusion, pyridostigmine was less effective in patients with severe autonomic impairment and those with supine hypertension, who are most likely to benefit from the preferential increase in upright BP produced by the drug. PAF patients had severe OH (-74±6 vs. -56±8 mmHg in MSA), and our results may not reflect patients with milder OH.

Myocardial Work in Middle-Aged Adults with Overweight and Obesity: Associations with Sex and Central Arterial Stiffness.

We explored global myocardial work index (GWI), a novel measure of myocardial function that integrates left ventricular (LV) hemodynamic load, in relation to sex and increased body mass index (BMI). We used data from 467 individuals (61% women, average age 47 ± 9 years and BMI 31.2 kg/m2) without known cardiac disease. Central arterial function was analysed by applanation tonometry. GWI was calculated from global longitudinal strain (GLS) and post-echocardiography supine blood pressure (BP). Covariables of GWI were identified in linear regression analyses. Women had higher BMI, aortic augmentation pressure (12 ± 7 vs. 8 ± 6 mmHg), LV GLS (20.0 ± 2.8 vs. 18.8 ± 2.8%), and GWI (2126 ± 385 vs. 2047 ± 389 mmHg%) than men (all p < 0.05). In univariable analyses, higher GWI was associated with female sex, higher age, systolic BP, LV wall stress, LV ejection fraction, left atrial size, LV ejection time, and with lower waist circumference (all p < 0.05). In multivariable analysis, adjusting for these correlates, female sex remained independently associated with higher GWI (β = 0.13, p = 0.007). After additional adjustment for aortic augmentation pressure or central pulse pressure, this association became non-significant. In conclusion, the higher GWI in women compared to men was mainly explained by increased LV workload due to higher aortic augmentation pressure in women.