Orthostatic Hypotension Group Research Articles

Effect of Postural Hypotension on Recurrent Stroke: Secondary Prevention of Small Subcortical Strokes (SPS3) Study

Background: Orthostatic hypotension (OH) has been independently associated with increased risk of stroke and other cardiovascular events. We sought to investigate the relationship between OH at follow-up and recurrent stroke risk in SPS3 (Secondary Prevention of Small Subcortical Strokes) trial patient cohort. This is a retrospective cohort analysis. Methods: We included all SPS3 trial participants with blood pressure measurements in both sitting and standing position per protocol at baseline, with at least 1 follow-up visit to establish the relationship between OH at follow-up and recurrent stroke risk (primary outcome). Secondary outcomes included major vascular events, myocardial infarction, all-cause mortality, and, ischemic and hemorrhagic stroke subtypes. Participants were classified as having OH at baseline and at each follow-up visit based on a systolic BP decline ≥20 mm Hg or a diastolic BP decline ≥10 mm Hg on position change from sitting to standing. We used Cox proportional hazards regression modeling to compare the risk of outcomes among those with and without OH. Results: A total of 2275 patients were included with a mean follow up time 3.2 years (standard deviation = 1.6 years). 39% (881/2275) had OH at some point during their follow-up. Of these, 41% (366/881) had orthostatic symptoms accompanying the BP drop. In a fully adjusted model, those with OH had a 1.8 times higher risk of recurrent stroke than those without OH (95% confidence interval: 1.1-3.0). The risk of ischemic stroke, major vascular events, and all-cause mortality was similarly elevated among the OH group. Conclusion: OH was associated with increased recurrent stroke risk, vascular events, and all-cause death in this large cohort of lacunar stroke patients. Whether minimizing OH in the management of poststroke hypertension in patients with lacunar stroke reduces recurrent stroke risk deserves further study.

Parkinson’s disease with orthostatic hypotension: analyses of clinical characteristics and influencing factors

ABSTRACTObjectives: This study was designed to investigate clinical symptoms and blood pressure (BP) characteristics in Parkinson’s disease (PD) with orthostatic hypotension (OH), and to figure out the influencing factors of PD with OH (PD-OH).Methods: Total 150 PD patients were divided into PD-OH and PD with no OH (PD-NOH) groups based on BP value. Series of scales were used to evaluate clinical symptoms. Twenty-four-hour ambulatory BP monitoring was adopted.Results: Total 49 PD patients (32.67%) were with OH. PD-OH group had significantly older age, longer disease duration, more diabetes cases, higher levels of fasting blood glucose, higher levels of hemoglobin A1c (HbA1c) and higher levodopa-equivalent daily doses (P < 0.05). Motor symptoms and non-motor symptoms, including autonomic dysfunction, fatigue and cognitive impairment indicated by significantly changed scores of related scales were found in PD-OH group (P < 0.05). PD-OH group had increased BP variability (BPV) and a higher proportion of non-dipper BP pattern (P < 0.05). Binary logistic regression analysis showed that age (B, 0.064; 95% CI, 1.007 ~ 1.128; P < 0.05), HbA1c (B, 1.091; 95% CI, 1.158 ~ 7.648; P < 0.05), and systolic BPV (B, 0.138; 95% CI, 1.004 ~ 1.312; P < 0.05) were independent related factors for PD-OH group. The PD-OH group had significantly compromised daily activities and quality of life (P < 0.05).Conclusion: Older age, higher levels of HbA1c and increased systolic BPV were the influencing factors of PD-OH patients. Daily activities and quality of life of PD-OH patients were fairly compromised.

Malnutrition and Malnutrition Risk Can Be Associated with Systolic Orthostatic Hypotension in Older Adults.

Malnutrition and orthostatic hypotension(OH) are the two important geriatric syndromes, which have similar negative outcomes such as falls. The aim of the study is to detect whether there is any relation between malnutrition and OH. 862 geriatric patients, who had undergone comprehensive geriatric assessment (CGA),were included in the retrospective study. OH was identified as 20 and/or 10 mmHg dropped for systolic and/or diastolic blood pressures with the active standing test when patients got up from supine to standing position. Nutritional status was checked according to Mini Nutritional Assesment-Short Form(MNA-SF). The mean age of the patients was 74±8.05, and %66.3 of them were female. The prevalence of malnutrition, malnutrition-risk and OH were detected as 7.7%, 26.9 % and 21.2%, respectively. When OH, systolic OH, diastolic OH and control group were compared with CGA parameters and the effects of age and gender were removed, the frequency of falls and Timed-Up and Go Test were higher, activity daily living indexes and TINETTI-Balance scores were lower in systolic OH than without it (p<0.05).Systolic OH was more frequent in malnutrition-risk and malnutrition group than control group (p<0.002 and p<0.05, respectively). Diastolic OH was not associated with nutritional status (p>0.05).OH was only higher in malnutrition-risk group than robust (p<0.05). Our findings suggest that not only malnutrition but also malnutrition-risk may be associated with systolic OH, which leads to many negative outcomes in older adults. Because malnutrition/ malnutrition risk is preventable and reversible, nutritional status should be checked during the evaluation of OH patients.

Subthalamic nucleus stimulation and levodopa modulate cardiovascular autonomic function in Parkinson\u2019s disease

We aimed to explore the effects of bilateral subthalamic nucleus stimulation and levodopa on cardiovascular autonomic function in Parkinson’s disease. Twenty-six Parkinson’s disease patients with bilateral subthalamic nucleus stimulation in a stable state were tested under stimulation off and dopaminergic medication off (OFF-OFF), stimulation on and dopaminergic medication off (ON-OFF), and stimulation on and medication (levodopa) on (ON-ON) conditions by recording continuously blood pressure, ECG, and respiration at rest, during metronomic deep breathing, and head-up tilt test. Thirteen patients were diagnosed as orthostatic hypotension by head-up tilt test. Baroreflex sensitivity and spectral analyses were performed by trigonometric regressive spectral analysis. Subthalamic nucleus stimulation and levodopa had multiple influences. (1) Systolic blood pressure during tilt-up was reduced by subthalamic nucleus stimulation, and then further by levodopa. (2) Subthalamic nucleus stimulation and levodopa had different effects on sympathetic and parasympathetic regulations in Parkinson’s disease. (3) Levodopa decreased baroreflex sensitivity and RR interval only in the orthostatic hypotension group, and had opposite effects on the non-orthostatic hypotension group. These findings indicate that subthalamic nucleus stimulation and levodopa have different effects on cardiovascular autonomic function in Parkinson’s disease, which are modulated by the presence of orthostatic hypotension as well.

Patients with Orthostatic Intolerance: Relationship to Autonomic Function Tests results and Reproducibility of Symptoms on Tilt

This study was designed to investigate the frequency and pattern of orthostatic symptoms during head-up tilt (HUT) in patients with orthostatic intolerance during daily life, and to identify the relationship between the orthostatic symptoms during HUT and autonomic parameters. We prospectively collected autonomic data from 464 patients with orthostatic symptoms. Adrenergic and cardiovagal function tests including HUT were performed. Based on HUT results, we divided patients into orthostatic hypotension (OH), postural tachycardia syndrome (POTS), or normal HUT groups. We also investigated orthostatic symptoms during HUT. Only 25% of the patients reported orthostatic symptoms during HUT and 75% were asymptomatic. Typical orthostatic symptoms such as orthostatic dizziness and blurred vision, and atypical symptoms like chest tightness and headache occurred in 86% and 66%, respectively. Patients with POTS had symptoms more frequently than patients with OH during HUT. There were no differences in degrees of BP or HR changes between symptomatic and asymptomatic groups within the OH and POTS groups. HUT fails to reproduce symptoms of orthostatic intolerance in the majority of patients. Clinicians need to be aware that most patients with OH are asymptomatic during HUT and patients with POTS are more likely to be symptomatic than patients with OH.

Blood pressure circadian rhythms and adverse outcomes in type 2 diabetes patients diagnosed with orthostatic hypotension.

Aims/IntroductionPatients with diabetes frequently develop orthostatic hypotension (OH). The present study was designed to examine the relationship of blood pressure (BP) circadian rhythms and outcomes in diabetes with OH.Materials and MethodsIn the present study, 173 inpatients with type 2 diabetes were enrolled. Patients were divided into an OH group and a non‐OH group according to the BP changes detected in the supine and standing position. Then, 24‐h ambulatory BP was monitored. Patients were followed up for an average of 45 ± 10 months post‐discharge. Outcomes – death and major adverse cardiac and cerebrovascular events, including heart failure, myocardial infarction and stroke – were recorded.ResultsThere were 61 patients (35.26%) in the OH group and 112 patients (64.74%) in the non‐OH group. In the OH group, the night‐time systolic BP and night‐time diastolic BP were higher, the blood BP rhythms were predominantly of the riser type (67.21%). OH was as an independent marker of riser type circadian rhythm (adjusted odds ratio 4.532, 95% confidence interval 2.579–7.966). In the OH group, the incidence rates of mortality, and major adverse cardiac and cerebrovascular events were increased significantly compared with those in the non‐OH group (11.48 vs 2.68%, P = 0.014; 37.70 vs 8.93%, P < 0.01).ConclusionsIn patients who had type 2 diabetes diagnosed with OH, the BP circadian rhythm usually showed riser patterns, and they had increased rates of mortality, and major adverse cardiac and cerebrovascular events.

Orthostatic dizziness in Parkinson's disease is attributed to cerebral hypoperfusion: A transcranial doppler study.

Orthostatic hypotension (OH) is controversially regarded as the cause of orthostatic dizziness in Parkinson's disease (PD). We sought to evaluate whether cerebral autoregulation is an alternative cause for orthostatic dizziness in PD patients, using transcranial Doppler monitoring during head-up tilting. Forty-five PD patients with dizziness, 13 PD patients without dizziness, and 10 age-matched healthy controls were enrolled. Participants were divided into the following four groups: patients with dizziness and OH (group 1, n = 22), patients with dizziness but no OH (n = 23, group 2), patients without dizziness (n = 11, group 3), and age-matched healthy controls (n = 10, group 4). All participants underwent transcranial Doppler and blood pressure monitoring for 10 minutes during the head-up tilt test. Changes in the cerebral blood flow velocity (CBFV) in the middle cerebral artery and the mean blood pressure (mBP) within 3 minutes after head-up tilting were compared between groups. Group 1 showed a significantly higher change in mBP (-16.3 ± 10.8 mmHg) than groups 2 (-2.6 ± 4.9), 3 (-2.2 ± 3.6), or 4 (1.8 ± 6.0) (p < 0.001). However, groups 3 (4.6 ± 3.0 cm/s) and 4 (-4.2 ± 2.5) showed a significantly smaller change in CBFV than groups 1 (-9.0 ± 4.2) and 2 (-8.1 ± 5.1) (p < 0.01). Our results suggest that cerebral hypoperfusion contributes to dizziness in PD patients despite a lack of OH. Transcranial Doppler monitoring during head-up tilting may be a useful tool for evaluating dizziness in PD patients with or without OH. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:337-342, 2017.

Orthostatic Hypotension Predicts Cognitive Impairment in the Elderly: Findings from a Cohort Study.

Orthostatic hypotension (OH) is a known risk factor for cerebral ischemia, but its correlation with cognitive impairment (CI) is not well established. The aim of this study is to explore the relationship between OH and CI in the elderly. The study group consisted of 44 OH patients who presented with drowsiness, vertigo, and fatigue between January 2009 and December 2011 (OH group). Eighty-eight healthy elderly were paired with those in the OH group in a 1:2 based on their education levels (NOH group). Baseline sociodemographic information and cognition-related measures were collected for both groups. Cognitive function was assessed 4 years later using MMSE. The overall incidence of CI was 14.0% among the 114 subjects who completed the follow-up assessment. There was a significant difference in the incidence of CI between the OH group (23.7%) and the NOH group (9.2%) (χ2 = 4.399, P = 0.036). After excluding the influence of age (OR = 1.199, 95% CI: 1.072-1.340, P = 0.001) and education years (OR = 0.568, 95% CI: 0.371-0.869, P = 0.009), OH (OR = 4.047, 95% CI: 1.144-14.313, P = 0.030) became an independent risk factor for CI. OH can lead to CI. We suggest that future studies, with a larger sample size, use OH exposure time instead of OH exposure population to verify the conclusion of this study.

Clinical analysis on the relationship of orthostatic hypotension in elderly hypertensive patients with left ventricular structure and function

Objectives To explore the relationship of orthostatic hypotension in elderly hypertensive patients with left ventricular structure and function. Methods 101 cases of elderly patients with hypertension were selected from July 2013 to June 2015.After blood pressure measurement in vertical and decubitus position, all patients were divided into non-orthostatic hypotension and orthostatic hypotension groups, received the echocardiography and the accurate calculation of left ventricular mass index. Results Compared with non-orthostatic hypotension, orthostatic hypotension in patients with left ventricular diastolic diameter, left ventricular posterior wall thinckness and interventricular septum thickness.Left ventricular mass index significantly increased(48.13±5.54)mm vs.(52.45±1.48)mm in left ventricular diastolic diameter, (10.08±1.87)mm vs.(11.29±1.98)mm in left ventricular posterior wall thickness, (10.18±1.88)mm vs.(11.61±1.66)mm in interventricular septum thickness, and(114.59±22.72)g/m2 vs.(131.98±23.43)g/m2 〔t=4.386、2.985、4.397、8.672, in left ventricular mass index(BMI), all P<0.05〕. Left heart ventricular ejection fraction and mitral peak early/late diastolic blood flow decreased〔(60.81±4.73)vs.(53.60±2.58)and(0.93±0.23)vs(0.76±0.26)t=4.298、3.654, all P<0.05〕. Conclusions There is relationship of orthostatic hypotension with left ventricular structure and function in elderly hypertension patients, and it is essential not only to control blood pressure effectively, but also to focus on controlling orthostatic hypotension. Key words: Elderly hypertension; Orthostatic hypotension; Left ventricular structure

Orthostatic hypertension: An underestimated cause of orthostatic intolerance

To investigate the frequency and mechanism of orthostatic hypertension (OHT) in patients with orthostatic intolerance. We retrospectively reviewed 1033 consecutive case series of orthostatic intolerance that underwent autonomic function tests including a head-up tilt test. OHT was defined as a paradoxical orthostatic increase in systolic blood pressure (BP) of at least 20 mmHg during the tilt. We collected autonomic parameters during the standardized autonomic function tests, which included the beat-to-beat derived hemodynamic parameters during the tilt table test and compared them with age and sex-matched normal controls and the orthostatic hypotension (OH) group with orthostatic symptoms. We identified 38 (3.7%) patients who showed OHT during the tilt. The increase in mean systolic BP during the tilt was 26.5 mmHg. Approximately 87% (33/38) of the OHT patients showed an increase in total peripheral resistance during the tilt. The mean increase in total peripheral resistance from a supine baseline was significantly higher in OHT patients compared to normal controls, but the OH group showed a decrease in mean total peripheral resistance during the tilt. A select few patients with orthostatic dizziness can show OHT during the tilt and they have signs of increased peripheral resistance. OHT may be considered in the differential diagnosis of orthostatic intolerance.

Distinct neurohumoral biomarker profiles in children with hemodynamically defined orthostatic intolerance may predict treatment options.

Studies of adults with orthostatic intolerance (OI) have revealed altered neurohumoral responses to orthostasis, which provide mechanistic insights into the dysregulation of blood pressure control. Similar studies in children with OI providing a thorough neurohumoral profile are lacking. The objective of the present study was to determine the cardiovascular and neurohumoral profile in adolescent subjects presenting with OI. Subjects at 10-18 yr of age were prospectively recruited if they exhibited two or more traditional OI symptoms and were referred for head-up tilt (HUT) testing. Circulating catecholamines, vasopressin, aldosterone, renin, and angiotensins were measured in the supine position and after 15 min of 70° tilt. Heart rate and blood pressure were continuously measured. Of the 48 patients, 30 patients had an abnormal tilt. Subjects with an abnormal tilt had lower systolic, diastolic, and mean arterial blood pressures during tilt, significantly higher levels of vasopressin during HUT, and relatively higher catecholamines and ANG II during HUT than subjects with a normal tilt. Distinct neurohumoral profiles were observed when OI subjects were placed into the following groups defined by the hemodynamic response: postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension (OH), syncope, and POTS/syncope. Key characteristics included higher HUT-induced norepinephrine in POTS subjects, higher vasopressin in OH and syncope subjects, and higher supine and HUT aldosterone in OH subjects. In conclusion, children with OI and an abnormal response to tilt exhibit distinct neurohumoral profiles associated with the type of the hemodynamic response during orthostatic challenge. Elevated arginine vasopressin levels in syncope and OH groups are likely an exaggerated response to decreased blood flow not compensated by higher norepinephrine levels, as observed in POTS subjects. These different compensatory mechanisms support the role of measuring neurohumoral profiles toward the goal of selecting more focused and mechanistic-based treatment options for pediatric patients with OI.

Orthostatic hypotension in acute cerebellar infarction.

To investigate the frequency and pattern of orthostatic hypotension (OH) associated with acute isolated cerebellar infarction, and to identify the cerebellar structure(s) potentially responsible for OH, 29 patients (mean age 60.0) with acute isolated cerebellar infarction performed a standard battery of autonomic function tests including the head up tilt test using Finapres for recording of the beat-to-beat BP response during the acute period. Cerebellar infarction related OH was defined as fall in BP (>20 mmHg systolic BP) on tilting in patients without any disease(s) that could potentially cause autonomic dysfunction, or in patients who had a potential cause of autonomic dysfunction, but showed the absence of OH during a follow-up test. The severity and distribution of autonomic dysfunction were measured by the composite autonomic severity score (CASS). Nine patients (31 %) had OH (range 24-53 mmHg) on tilting during the acute period. Most patients (7/9) had a remarkable decrement in systolic BP immediately upon tilting, but OH rapidly normalized. Mean of maximal decrease in systolic BP during head up tilt test was 37.0 mmHg. The OH group showed mild autonomic dysfunctions (CASS, 3.7) with adrenergic sympathetic dysfunction appearing as the most common abnormality. Lesion subtraction analyses revealed that damage to the medial part of the superior semilunar lobule (Crus I) and tonsil was more frequent in OH group compared to non-OH group. Cerebellar infarction may cause a brief episode of OH. The medial part of the superior semilunar lobule and tonsil may participate in regulating the early BP response during orthostasis.

Cerebral hemodynamics in orthostatic intolerance with normal head-up tilt test.

Orthostatic hypotension (OH) and postural orthostatic tachycardia syndrome (POTS) are well-known causes of orthostatic intolerance (OI). In addition, there are OI patients who are characterized by the symptoms of OI and lack of abnormal findings in head-up tilt (HUT) test. The aim of this study was to determine the cerebral hemodynamic changes in HUT test of OI patients with normal HUT (OINH). Two hundred and sixty-one OI patients and 50 healthy controls were enrolled in this study. All subjects underwent transcranial Doppler test while performing the HUT test. Forty-five patients had OH, 33 patients had POTS, and 183 patients had OINH. Blood pressures, heart rate, cerebral blood flow velocities (CBFVs), end-tidal carbon dioxide (ET-PCO2 ), cerebral critical closing pressure (CCP), cerebral perfusion pressure (CPP), and cerebral vascular resistance (CVR) were measured during HUT test. We compared the hemodynamic parameters of OINH with those of OH, POTS, and healthy controls. Reduced CBFVs, CPP, and ET-PCO2 and elevated CCP were observed in the HUT test of all four groups. CVR was reduced in three OI patients. The drops in systolic CBFV, CPP, and CVR of OINH patients were greater than those of healthy controls. The changes in parameters in the HUT test of OINH group were not different from those of OH and POTS groups except prominent decrements of CPP and CVR in OH group. Our findings suggest that OINH is true OI sharing the common pathomechanism of OH and POTS.

PP.18.07

Objective: The aim of the study was to investigate the interrelations between orthostatic hypotension (OH) and target organs damage in middle aged hypertensive (HTN) patients. Design and method: We examined 85 men with HTN (mean age 45.69.7). Head-up tilt test by Westminster protocol was performed. The prevalence of OH were determined. In patients with OH the target organ damage signs were evaluated in comparison to HTN patients without OH.± Results: Tilt-induced OH was registered in 16 HTN patients (18.8%). In persons with OH (Group 1), in comparison to those without it (Group 2), the left ventricular mass index was higher (104.2(94–112) vs 88.5(81–105) g/m respectively, p = 0.009) and left atrium dimension was larger (33(31–34) and 31(29–33) mm, p = 0.03). Patients with OH were characterized by greater intimae-media thickness (0.6(0.05–1.0) vs 1.3(0.7–2.0) mm, p = 0.02) and more often detection of atherosclerotic plaque/intimae-media thickening (50.0% and 18.8%, p = 0.009). In the Group 1 as compared with Group 2 mean central aortic systolic pressure was higher (128(123–136) and 121(114–125) mmHg, p = 0.04) as well as carotid-femoral pulse wave velocity > 10 m/s occurred more often (22.2% and 3.1%, p = 0.05). At the same time the glomerular filtration rate and urinary albumin concentration did not differ.2 Conclusions: In middle-aged hypertensive men the orthostatic hypertension diagnosed by head-up tilt test was associated with more pronounced myocardial and vascular damage.

Uncontrolled hypertension and orthostatic hypotension in relation to standing balance in elderly hypertensive patients.

ObjectiveTo investigate the associations among uncontrolled hypertension, orthostatic hypotension (OH), and standing balance impairment in the elderly hypertensive patients referred to comprehensive geriatric assessment (CGA).MethodsIn a cross-sectional study, a total of 176 elderly hypertensive patients who underwent CGA were divided into OH group (n=36) and non-OH group (n=140) according to blood pressure measurement in the supine position, after immediate standing up, and after 1 minute and 3 minutes of standing position. Uncontrolled hypertension was defined as blood pressure of ≥140/90 mmHg if accompanied by diabetes mellitus (DM) or chronic kidney disease (CKD), or ≥150/90 mmHg if no DM and no CKD. Standing balance, including immediate standing balance and prolonged standing balance, was assessed in side-by-side and tandem stance.ResultsNeither uncontrolled hypertension nor OH was associated with prolonged standing balance impairment in elderly hypertensive patients (P>0.05). Blood pressure decrease after postural change was significantly associated with immediate standing balance impairment in side-by-side and tandem stance (P<0.05). Patients with OH were at greater risk of immediate standing balance impairment in both side-by-side and tandem stance than those without OH (odds ratio [OR] 3.44, 95% confidence interval [CI] 1.26–9.33, P<0.05; OR 3.14, 95% CI 1.14–8.64, P<0.01). Furthermore, uncontrolled hypertension was associated with immediate standing balance impairment in side-by-side stance (OR 2.96, 95% CI 1.31–6.68, P<0.05).ConclusionUncontrolled hypertension, OH, and blood pressure decrease after postural change were associated with immediate standing balance impairment, and therefore, a better understanding of the underlying associations might have major clinical value.

Uncontrolled hypertension and orthostatic hypotension in relation to standing balance in&amp;nbsp;elderly hypertensive patients

Uncontrolled hypertension and orthostatic hypotension in relation to standing balance in&nbsp;elderly hypertensive patients Shanshan Shen,1 Ting He,1 Jiaojiao Chu,1 Jin He,2 Xujiao Chen1 1Department of Geriatrics, Zhejiang Hospital, Hangzhou, 2Department of Neurology, Fuyuan Hospital of Yiwu, Jinhua, People&rsquo;s Republic of China Objective: To investigate the associations among uncontrolled hypertension, orthostatic hypotension (OH), and standing balance impairment in the elderly hypertensive patients referred to comprehensive geriatric assessment (CGA).Methods: In a cross-sectional study, a total of 176 elderly hypertensive patients who underwent CGA were divided into OH group (n=36) and non-OH group (n=140) according to blood pressure measurement in the supine position, after immediate standing up, and after 1&nbsp;minute and 3&nbsp;minutes of standing position. Uncontrolled hypertension was defined as blood pressure of&nbsp;&ge;140/90&nbsp;mmHg if accompanied by diabetes mellitus (DM) or chronic kidney disease (CKD), or &ge;150/90&nbsp;mmHg if no DM and no CKD. Standing balance, including immediate standing balance and prolonged standing balance, was assessed in side-by-side and tandem stance.Results: Neither uncontrolled hypertension nor OH was associated with prolonged standing balance impairment in elderly hypertensive patients (P&gt;0.05). Blood pressure decrease after postural change was significantly associated with immediate standing balance impairment in side-by-side and tandem stance (P&lt;0.05). Patients with OH were at greater risk of immediate standing balance impairment in both side-by-side and tandem stance than those without OH (odds ratio [OR] 3.44, 95% confidence interval [CI] 1.26&ndash;9.33, P&lt;0.05; OR 3.14, 95% CI 1.14&ndash;8.64, P&lt;0.01). Furthermore, uncontrolled hypertension was associated with immediate standing balance impairment in side-by-side stance (OR 2.96, 95% CI 1.31&ndash;6.68, P&lt;0.05).Conclusion: Uncontrolled hypertension, OH, and blood pressure decrease after postural change were associated with immediate standing balance impairment, and therefore, a better understanding of the underlying associations might have major clinical value. Keywords: hypertension, orthostatic hypotension, balance, elderly

Neurogenic hyperadrenergic orthostatic hypotension: a newly recognized variant of orthostatic hypotension in older adults with elevated norepinephrine (noradrenaline).

Patients with neurogenic orthostatic hypotension (OH) typically have impaired sympathetic nervous system tone and therefore low levels of upright plasma norepinephrine (NE) (noradrenaline). We report a subset of patients who clinically have typical neurogenic OH but who paradoxically have elevated upright levels of plasma NE. We retrospectively studied 83 OH patients evaluated at the Vanderbilt Autonomic Dysfunction Center between August 2007 and May 2013. Based on standing NE, patients were dichotomized into a hyperadrenergic OH group [hyperOH: upright NE ≥ 3.55 nmol/l (600 pg/ml), n=19] or a non-hyperadrenergic OH group [nOH: upright NE < 3.55 nmol/l (600 pg/ml), n=64]. Medical history and data from autonomic testing, including the Valsalva manoeuvre (VM), were analysed. HyperOH patients had profound orthostatic falls in blood pressure (BP), but less severe than in nOH [change in SBP (systolic blood pressure): -53 ± 31 mmHg compared with -68 ± 33 mmHg, P=0.050; change in DBP (diastolic blood pressure): -18 ± 23 mmHg compared with -30 ± 17 mmHg, P=0.01]. The expected compensatory increase in standing heart rate (HR) was similarly blunted in both hyperOH and nOH groups [84 ± 15 beats per minute (bpm) compared with 82 ± 14 bpm; P=0.6]. HyperOH patients had less severe sympathetic failure as evidenced by smaller falls in DBP during phase 2 of VM and a shorter VM phase 4 BP recovery time (16.5 ± 8.9 s compared with 31.6 ± 16.6 s; P<0.001) than nOH patients. Neurogenic hyperOH patients have severe neurogenic OH, but have less severe adrenergic dysfunction than nOH patients. Further work is required to understand whether hyperOH patients will progress to nOH or whether this represents a different disorder.

Orthostatic hypotension and cognitive impairment in de novo patients with Parkinson's disease.

Orthostatic hypotension and cognitive impairment in de novo patients with Parkinson's disease.

Reduced cerebral autoregulation as the genesis of symptoms in orthostatic intolerance in elderly (1069.3)

Background: The prevalence of orthostatic hypotension (OH) increases with age and affects over 50% of elderly visiting a falls and syncope outpatient clinic. OH may be symptomatic or asymptomatic. Surprisingly little is known why serious symptoms as dizziness, falling and syncope occur. A possible cause of symptom development may be cerebral hypoperfusion due to loss of cerebral autoregulation (CA). The purpose of this study is to compare CA in elderly with symptomatic and asymptomatic OH and a control group without OH.Methods: Dynamic CA is assessed in 20 elderly with symptomatic OH, 20 with asymptomatic OH and 20 age‐matched healthy subjects without OH using transfer function analysis (TFA) on blood pressure (BP) and cerebral blood flow velocity (CBFV). Single supine to standing measurements is used to assess time domain changes in BP, CBFV and heart rate. Patient inclusion continues until March 2014.Results: TFA provides outputs gain and phase of the relation between BP and CBFV to assess CA. Time domain analyses will be used to report time to peak and nadir, and time and amount of recovery.Conclusions : This study characterizes CA in symptomatic and asymptomatic OH. The yet preliminary conclusion is that a reduced CA performance is related to the subject group with symptomatic OH in comparison to the asymptomatic OH group.

GW24-e0234 Influencing factors of orthostatic hypotension in hospitalised patients of cardiology

ObjectivesThe aim is to determine the influencing factors of orthostatic hypotension (OH) in inpatients of cardiology.MethodsA total of 200 patients hospitalised in cardiology of Peking University People’s Hospital from July...