Orthostatic Hypotension In Older Adults Research Articles

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 in older adults with dementia.

Orthostatic hypotension (OH) in older adults with dementia is associated with increased confusion, dizziness, syncope, and falls. These problems may result in a negative, downward spiral accompanied by high morbidity and mortality. The literature supports that nonpharmacological interventions are effective in the reduction of symptoms and prevention of orthostasis. The purpose of this quality improvement project was to increase staff knowledge and skill in the assessment, documentation, and care of residents with OH in dementia care units within a continuing care retirement community. An in-service program using a protocol based on clinical practice guidelines was presented to RNs, licensed practical nurses, therapists, and unlicensed caregivers. Assessments, documentation of assessments, and interventions for residents with OH increased following the in-service program. As staff continue to apply their knowledge in care routines, it is expected that this evidence-based practice will reduce symptoms of OH and increase safety and quality of life within this specific population.

Supine Exercises for Orthostatic Hypotension in Older Adults

For patients with symptomatic neurogenic orthostatic hypotension (e.g., related to neuropathy or to central disorders such as Parkinson disease),

Counteracting Effect of Supine Leg Resistance Exercise on Systolic Orthostatic Hypotension in Older Adults

To assess the efficacy of a leg exercise performed in supine position to prevent orthostatic hypotension (OH) in older adults. Case-control study. Division of Physical Medicine and Rehabilitation, Salvatore Maugeri Foundation, Scientific Institute of Veruno, Veruno, Italy. Individuals aged 65 and older admitted with degenerative joint disease screened (n = 90) and found positive for OH (n = 42). Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded using an automatic oscillometric device in the supine position after 10 minutes of bed rest; immediately upon standing up; and after 1, 3 and 5 minutes standing. In 42 participants, a fall in SBP of 20 mmHg or more within 3 minutes of standing was found. Participants with OH were alternately assigned to the control or exercise group. The following day, both groups were reassessed as above. In the exercise group, before standing up, participants were required to perform 10 full extensions of the lower limbs, starting from 60° flexion of hip and 90° flexion of knee and ankle joints, against the resistance of an elastic band. In both participant groups, SBP, DBP, and HR were similar in the supine position. When standing, the same decrease in SBP and DBP and increase in HR occurred over a similar time-course in both participant groups. The next day, the reduction in SBP was significantly smaller at each time interval after standing up in the exercise than in the control group, but no difference between the exercise and control groups was observed in DBP or HR. Supine leg exercise is effective in reducing an initial fall in SBP when passing from a supine to an upright position in older adults. The duration of the effect requires further investigation.

Pharmacological options in the management of orthostatic hypotension in older adults

Orthostatic hypotension (OH) is a common disorder in older adults with potentially serious clinical consequences. Understanding the key underlying pathophysiological processes that predispose individuals to OH is essential when making treatment decisions for this group of patients. In this article, we discuss the key antihypotensive agents used in the management of OH in older adults. Commonly, midodrine is used as a first-line agent, given its supportive data in randomized, controlled trials. Fludrocortisone has been evaluated in open-label trials and has long-established usage in clinical practice. Other agents are available and in clinical use, either alone or in combination, but larger randomized trial evaluations are yet to be published. It is important to bear in mind that a patient may be taking medications that predispose to or exacerbate the symptoms of OH. Withdrawal of such medications, where possible, should be considered before commencing other pharmacological agents that attenuate the symptoms of OH.

Treatment of combined hypertension and orthostatic hypotension in older adults: more questions than answers still remain

Treatment of combined hypertension and orthostatic hypotension in older adults: more questions than answers still remain

Postural Tachycardia Syndrome

When a person stands up, he or she assumes that the body will automatically make any changes necessary to compensate for the increased gravitational stress this change of position brings. Indeed, standing causes gravity to try to pull nearly one quarter of the body’s blood downward toward the lower arms, legs, and abdomen, reducing the amount of blood available to keep the brain supplied with oxygen. To maintain a constant oxygen supply to the brain and upper body, standing is normally accompanied by an automatic increase in heart rate and the force with which the heart contracts and, most important, a tightening of the blood vessels in the lower part of the body. The combination of these 3 actions pushes blood upward against the force of gravity, thereby maintaining an uninterrupted flow of blood to the brain. The aspect of the nervous system that governs these …

Arterial stiffness as the candidate underlying mechanism for postural blood pressure changes and orthostatic hypotension in older adults: the Rotterdam Study

To investigate whether arterial stiffening, one of the characteristics of the aging vascular system, is associated with orthostatic hypotension. Cross-sectional data of a cohort study in elderly men and women. We investigated the relationship between arterial stiffness and orthostatic hypotension within the framework of the Rotterdam Study, a population-based study in individuals aged 55 and older. The present study included 3362 subjects participating in the third examination phase. The carotid-femoral pulse wave velocity was used as measure of arterial stiffness. Orthostatic hypotension was assessed with blood pressure measurements in supine and standing position. Odds ratios for orthostatic hypotension increased through quartiles of pulse wave velocity; the age, gender and mean arterial pressure adjusted odds ratio in the last quartile of pulse wave velocity was 1.45 (95% confidence interval, 1.09-1.93) when compared with the first quartile (reference). In fully adjusted models estimates remained statistically significant. In subjects with higher stiffness we observed a higher drop in blood pressure but no significant change of heart rate. Arterial stiffness is independently associated with orthostatic hypotension. The drop in blood pressure levels and the contemporary attenuated response of heart rate to orthostatic challenge in subjects with stiffer arteries support the hypothesis that arterial stiffness may explain, at least in part, the reduced baroreflex observed in older adults.

Effect of strength training on orthostatic hypotension in older adults.

This preliminary study attempted to identify the frequency of orthostatic hypotension (OH) in community dwelling older adults who volunteered to participate in an 8-week, heavy-resistance, strength-training program. It also assessed the effect of the strength-training program on OH. From a larger study (n = 53) on high-resistance strength training in older adults (mean age 71.4 +/- 6.6 years), a subset of subjects (n = 24), mean age 71.0 +/- 5.8 years, was evaluated who met at least one criterion for OH. All subjects were tested for resting blood pressures (BP) and heart rates (HR) in the supine, sitting, and standing positions. Also noted was their response to orthostatism in rising from a cot after 10 minutes and rising from a chair after 5 minutes. The subset was not different from the overall group in gender ratio, age, or effect of medication on BP. The treatment was an 8-week strength-training program at 80% of their one repetition maximum. Significant changes (P < 0.05) were shown in supine diastolic BP (+3.2 mm Hg), sitting systolic BP (-3.9), and standing HR (+4.9 beats per minute). In response to the orthostatic challenge, significant (P < 0.05) improvements were shown in systolic BP (+9.7 mm Hg), diastolic BP (+4.7), and HR (+3.2 beats per minute) for the rise from chair, and in diastolic BP (+6.7 mm Hg) rise from the cot. These data show that OH is not uncommon (45%) in community dwelling older adults. A strength training program in older adults has little effect on resting BP, but elicits a positive adaptation to an orthostatic challenge.

Effect of Strength Training on Orthostatic Hypotension in Older Adults.

Effect of Strength Training on Orthostatic Hypotension in Older Adults.

Orthostatic hypotension in older adults. The Cardiovascular Health Study. CHS Collaborative Research Group.

The purpose of the present study was to assess the prevalence of orthostatic hypotension and its associations with demographic characteristics, cardiovascular risk factors and symptomatology, prevalent cardiovascular disease, and selected clinical measurements in the Cardiovascular Health Study, a multicenter, observational, longitudinal study enrolling 5,201 men and women aged 65 years and older at initial examination. Blood pressure measurements were obtained with the subjects in a supine position and after they had been standing for 3 minutes. The prevalence of asymptomatic orthostatic hypotension, defined as 20 mm Hg or greater decrease in systolic or 10 mm Hg or greater decrease in diastolic blood pressure, was 16.2%. This prevalence increased to 18.2% when the definition also included those in whom the procedure was aborted due to dizziness upon standing. The prevalence was higher at successive ages. Orthostatic hypotension was associated significantly with difficulty walking (odds ratio, 1.23; 95% confidence interval, 1.02, 1.46), frequent falls (odds ratio, 1.52; confidence interval, 1.04, 2.22), and histories of myocardial infarction (odds ratio, 1.24; confidence interval, 1.02, 1.50) and transient ischemic attacks (odds ratio, 1.68; confidence interval, 1.12, 2.51). History of stroke, angina pectoris, and diabetes mellitus were not associated significantly with orthostatic hypotension. In addition, orthostatic hypotension was associated with isolated systolic hypertension (odds ratio, 1.35; confidence interval, 1.09, 1.68), major electrocardiographic abnormalities (odds ratio, 1.21; confidence interval, 1.03, 1.42), and the presence of carotid artery stenosis based on ultrasonography (odds ratio, 1.67; confidence interval, 1.23, 2.26). Orthostatic hypotension was negatively associated with weight. We conclude that orthostatic hypotension is common in the elderly and increases with advancing age. It is associated with cardiovascular disease, particularly those manifestations measured objectively, such as carotid stenosis. It is associated also with general neurological symptoms, but this link may not be causal. Differences in prevalence of and associations with orthostatic hypotension in the present study compared with others are largely attributed to differences in population characteristics and methodology.

Systolic Hypertension in the Elderly Program (SHEP). Part 5: Baseline blood pressure and pulse rate measurements.

HomeHypertensionVol. 17, No. 3_supplementSystolic Hypertension in the Elderly Program (SHEP). Part 5: Baseline blood pressure and pulse rate measurements. Free AccessAbstractPDF/EPUBAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessAbstractPDF/EPUBSystolic Hypertension in the Elderly Program (SHEP). Part 5: Baseline blood pressure and pulse rate measurements. D R Labarthe, M D Blaufox, W M Smith, C R Lacy, H Schnaper, F LaBaw, S Mascioli, J Davey and E Lakatos D R LabartheD R Labarthe Search for more papers by this author , M D BlaufoxM D Blaufox Search for more papers by this author , W M SmithW M Smith Search for more papers by this author , C R LacyC R Lacy Search for more papers by this author , H SchnaperH Schnaper Search for more papers by this author , F LaBawF LaBaw Search for more papers by this author , S MascioliS Mascioli Search for more papers by this author , J DaveyJ Davey Search for more papers by this author and E LakatosE Lakatos Search for more papers by this author Originally published1 Mar 1991https://doi.org/10.1161/01.HYP.17.3_Suppl.II62Hypertension. 1991;17 Previous Back to top Next FiguresReferencesRelatedDetailsCited By Drawz P and Ix J (2017) BP Measurement in Clinical Practice: Time to SPRINT to Guideline-Recommended Protocols, Journal of the American Society of Nephrology, 10.1681/ASN.2017070753, 29:2, (383-388), Online publication date: 1-Feb-2018. Ice G, Yogo J, Heh V and Juma E (2009) The Impact of Caregiving on the Health and Well-being of Kenyan Luo Grandparents, Research on Aging, 10.1177/0164027509348128, 32:1, (40-66), Online publication date: 1-Jan-2010. Horwitz S, Yogo J, Juma E and Ice G (2009) Caregiving and cardiovascular disease risk factors in male and female Luo elders from Kenya, Annals of Human Biology, 10.1080/03014460902845720, 36:4, (400-410), Online publication date: 1-Jan-2009. Ice G, Zidron A and Juma E (2008) Health and Health Perceptions Among Kenyan Grandparents, Journal of Cross-Cultural Gerontology, 10.1007/s10823-008-9063-9, 23:2, (111-129), Online publication date: 1-Jun-2008. Kario K, Tobin J, Wolfson L, Whipple R, Derby C, Singh D, Marantz P and Wassertheil-Smoller S (2001) Lower standing systolic blood pressure as a predictor of falls in the elderly: a community-based prospective study, Journal of the American College of Cardiology, 10.1016/S0735-1097(01)01327-4, 38:1, (246-252), Online publication date: 1-Jul-2001. Crews D and Harper G (1998) Renin, ANP, ACE polymorphisms, blood pressure and age in American Samoans: Preliminary data, American Journal of Human Biology, 10.1002/(SICI)1520-6300(1998)10:4<439::AID-AJHB4>3.0.CO;2-B, 10:4, (439-449), . Rutan G, Hermanson B, Bild D, Kittner S, LaBaw F and Tell G (1992) Orthostatic hypotension in older adults. The Cardiovascular Health Study. CHS Collaborative Research Group., Hypertension, 19:6_pt_1, (508-519), Online publication date: 1-Jun-1992.Black H, Unger D, Burlando A, Wright J, Pressel S, Allen R, McDonald R and Surath H (1991) Systolic Hypertension in the Elderly Program (SHEP). Part 6: Baseline physical examination findings., Hypertension, 17:3_supplement, (II77), Online publication date: 1-Mar-1991. March 1991Vol 17, Issue 3_supplementArticle InformationMetrics Copyright © 1991 by American Heart Associationhttps://doi.org/10.1161/01.HYP.17.3_Suppl.II62PMID: 1999376 Originally publishedMarch 1, 1991 PDF download Advertisement