Prevalence Of Orthostatic Hypertension Research Articles

Prevalence of orthostatic hypertension and its association with cerebrovascular diagnoses in patients with suspected TIA and minor stroke

PurposeWe aimed to compare the rate of stroke, transient ischemic attack, and cerebrovascular disease diagnoses across groups of patients based on their orthostatic blood pressure response in a transients ischemic attack clinic setting.Materials and MethodsWe retrospectively analysed prospectively collected data from 3201 patients referred to a transient ischemic attack (TIA)/minor stroke outpatients clinic. Trained nurses measured supine and standing blood pressure using an automated blood pressure device and the patients were categorized based on their orthostatic blood pressure change into four groups: no orthostatic blood pressure rise, systolic orthostatic hypertension, diastolic orthostatic hypertension, and combined orthostatic hypertension. Then, four stroke physicians, who were unaware of patients' orthostatic BP response, assessed the patients and made diagnoses based on clinical and imaging data. We compared the rate of stroke, TIA, and cerebrovascular disease (either stroke or TIA) diagnoses across the study groups using Pearson's χ2 test. The effect of confounders was adjusted using a multivariate logistic regression analysis.ResultsCerebrovascular disease was significantly less common in patients with combined systolic and diastolic orthostatic hypertension compared to the "no rise" group [OR = 0.56 (95% CI 0.35–0.89]. The odds were even lower among the subgroups of patients with obesity [OR = 0.31 (0.12–0.80)], without history of smoking [OR 0.34 (0.15–0.80)], and without hypertension [OR = 0.42 (95% CI 0.19–0.92)]. We found no significant relationship between orthostatic blood pressure rise with the diagnosis of stroke. However, the odds of TIA were significantly lower in patients with diastolic [OR 0.82 (0.68–0.98)] and combined types of orthostatic hypertension [OR = 0.54 (0.32–0.93)]; especially in patients younger than 65 years [OR = 0.17 (0.04–0.73)] without a history of hypertension [OR = 0.34 (0.13–0.91)], and patients who did not take antihypertensive therapy [OR = 0.35 (0.14–0.86)].ConclusionOur data suggest that orthostatic hypertension may be a protective factor for TIA among younger and normotensive patients.

Time in range, as an emerging metric of glycemic control, is associated with orthostatic blood pressure changes in type 2 diabetes

AimsTo exlpore whether time in range(TIR) was associated with orthostatic blood pressure(BP) changes in type 2 diabetes(T2DM). MethodsA total of 342 T2DM patients were recruited. TIR was defined as the time percentage spent within the target range(3.9–10.0 mmol/L). Orthostatic hypotension(OH) and orthostatic hypertension(OHT) were defined as a decrease or an increase of at least 20 mmHg in SBP and/or 10 mmHg in DBP after standing for 3 min. ResultsCompared with orthostatic normotension group, patients with OH or OHT showed lower levels of TIR (P < 0.001). The prevalences of OH and OHT both decreased with ascending TIR tertiles (OH, P < 0.001; OHT, P = 0.019), and both absolute SBP and DBP changes were negatively correlated with TIR (r = -0.171, −0.190, P < 0.05). After stratifying by BMI, only the prevalence of OH in the lower layer and the prevalence of OHT in the higher layer remained significant difference among tertiles of TIR. Multivariate logistics regression revealed that lower TIR and lower BMI were risk factors for OH, whereas lower TIR but higher BMI were risk factors for OHT. ConclusionsWe find a differential correlation dependent of BMI milieus between TIR and orthostatic BP status.

Twenty-four-hour ambulatory blood pressure monitoring in very elderly patients: Comparison of in-hospital versus home follow-up results.

Elevated blood pressure (BP) is frequently diagnosed in very elderly hospitalized patients. Accurate diagnosis of hypertension is challenging in the hospital environment, due to the "white coat effect," and both overtreatment and undertreatment can adversely affect clinical outcome. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) has the potential to avoid the "white coat effect" and accurately guide the management of hypertension. However, effects of the hospital environment on ABPM are unknown in the very elderly. We set out to enroll 45 patients, age ≥70 years, with elevated conventional BP during hospitalization in this observational study. It was prespecified by protocol to assess initially the difference between 24-hour BP during hospital-admission and home follow-up. Subsequent analysis should investigate the change in anxiety (Hospital Anxiety and Depression Scale-A [HADS-A]) after discharge, the correlation with change in 24-hour BP after discharge, and the prevalence of orthostatic hypertension. Thirty-one patients were included in the final analysis (age 83.5 ± 4.4 years; 71% female). Twenty-four-hour BP decreased significantly after hospital discharge (systolic from 133.5 ± 15.6 to 126.2 ± 14.4 mm Hg [millimeter of mercury], P = .008; diastolic from 71.0 ± 9.0 to 68.3 ± 8.6 mm Hg, P = .046). Anxiety level (HADS-A) decreased significantly after discharge, from 7.5 (interquartile range [IQR]: 4.0-13.8) to 5.0 (IQR: 4.0-8.0, P = .012). The change in anxiety was a predictor of change in systolic BP after discharge (F[1,20] = 5.9, P = .025). Sixty-one percent of the patients had significant orthostatic hypotension during hospital stay. In conclusion, 24-hour BP in very elderly patients is lower in the home environment than during hospitalization. This phenomenon seems to be directly linked to a lower anxiety-level at home. Reassessing hypertension at home may decrease the need for (intensified) antihypertensive medical therapy in a substantial number of patients. This is particularly important in the very elderly, who have a high prevalence of symptomatic and asymptomatic orthostatic hypotension, making them prone to hazardous effects of antihypertensive therapy.

Prevalence of orthostatic hypertension in the very elderly and its relationship to all-cause mortality.

To investigate the association with mortality of orthostatic hypertension (OHYPER) amongst the oldest old. Two waves of community-dwelling residents born in 1920-1921 were examined at age of 85 (n = 1004) and 90 (n = 437). OHYPER, orthostatic hypotension (OHYPO), or orthostatic normotension (ONORMO) were so classified when difference of standing-sitting SBP either increased or decreased by at least 20 mmHg or not. Prevalence of OHYPO, ONORMO, and OHYPER was 5% (n = 48), 91% (n = 915), and 4% (n = 41) at age 85, and 9% (n = 39), 88% (n = 385), and 3% (n = 13) at age 90. There was a tendency for fewer men among OHYPER, and significantly more participants with financial hardship, higher weight, loneliness, and anemia (P < 0.05 for all) among the 85-year-olds, fewer with poor self-rated health, and more with anemia among the 90-year-olds. Sitting blood pressure was 157 ± 22/75 ± 11, 147 ± 21/74 ± 11, and 140 ± 16/74 ± 10 mmHg among OHYPO, ONORMO, and OHYPER at age 85 (P < 0.0001), and 166 ± 28/75 ± 10, 145 ± 23/69 ± 11, and 138 ± 23/74 ± 9 mmHg at age 90 (P < 0.0001). Ten-year survival were 27, 30, and 27%, respectively, at age 85 (log-rank P = 0.34). Five-year survival were 57, 67, and 55%, respectively, at age 90 (log-rank P = 0.14). In an adjusted Cox proportional hazards ratio model, OHYPER at age 85 was not associated with mortality (hazards ratio = 0.95, 95% confidence interval 0.65-1.39). The few OHYPER among 90-year-olds precluded modeling. OHYPER is quite uncommon among community-dwelling 85 and 90-year-olds and is not associated with increased mortality.

The association between orthostatic hypertension and all-cause mortality in hospitalized elderly persons.

BackgroundLittle is known about the prevalence of orthostatic hypertension (OHT) and its effect on long-term mortality in the elderly. We evaluated the prevalence of OHT and its effect on mortality in hospitalized elderly patients.MethodsOut of 1852 patients admitted between 31/12/1999 and 31/12/2000 to an acute geriatric ward, 474 patients (48% males) with a mean age of 81.5 ± 6.8 years were enrolled in this study. Blood pressure (BP) was measured three times during the day in a supine and standing position. Patients with at least one increase in systolic or diastolic BP levels upon standing were diagnosed with OHT. Medical history, physical examination and laboratory parameters were retrieved from the medical records. Mortality data until 18th June 2014 were retrieved from the computerized system of the Ministry of the Interior.ResultsFour hundred and seven patients (86%) were diagnosed with OHT. Those without OHT had a lower body mass index and were more likely males, smokers, had a higher rate of Parkinson's disease and less congestive heart failure compared with those with OHT. Patients with OHT had a better survival rate than those without OHT (P = 0.024). Hazard ratios (HRs) for mortality in those with OHT adjusted to age and multiple risk factors were: 0.67 [95% confidence interval (CI): 0.51−0.87] and 0.73 (95% CI: 0.55−0.97), respectively; a similar tendency was noticed in a sensitivity analysis by gender.ConclusionHospitalized elderly patients with OHT had a better survival rate than those without OHT.

Orthostatic hypotension and orthostatic hypertension in American veterans.

Abnormal blood pressure (BP) response to orthostatic maneuvers may predict adverse health outcomes. Orthostatic hypotension (OH) is defined as a fall in BP of ≥20/10 mmHg, and orthostatic hypertension (OHTN) is defined as an increase in systolic BP (SBP) of ≥20 mmHg, with standing. Herein, we document the prevalence of OH and OHTN in American veterans. The influence of demographic characteristics, life habits, co-incident medical conditions, and prescription medication use on these prevalence rates and associations between abnormal orthostatic BP responses and severity of self-reported symptoms of fatigue, dizziness, trouble concentrating, and head and neck discomfort were determined. 286 veterans participated; 14 % were classified with OH, 22 % with OHTN, and 64 % with normal BP responses to standing (reference group). An increased prevalence of the diagnosis of diabetes mellitus (27 %) and hypertension (63 %) was noted, which did not differ by orthostatic BP classification. Veterans with OH were older than the reference group and were prescribed more antihypertensive medications than the reference and OHTN groups. While the prevalence of OH increased with age, the prevalence of OHTN was comparable in young (20-30 years) and old (70+ years) veterans (17 vs. 19 %, respectively). The severity of fatigue and dizziness was increased in veterans with OH and OHTN compared to the reference group. These data suggest a relatively high prevalence of OH and OHTN, which is associated with increased self-reported severity of fatigue and dizziness in American veterans, findings which may adversely impact long-term health outcomes.

English

Orthostatic hypotension (OH) is a common orthostatic blood pressure (BP) regulation disorder. Orthostatic hypertension (OHT), on the other hand, is not so common but has positive relevance with autonomic neuropathy and diabetes. Orthostatic hypotension is prevalent in females and elder people, but prevalence of OHT by age and gender is poorly studied.

Prevalence of Orthostatic Hypertension in Elderly Patients with Type 2 Diabetes.

Background. The aim of the present study was to determine the prevalence of orthostatic hypertension (OHT) in elderly patients with type 2 diabetes and its relation to metabolic and echocardiographic parameters. Methods. This was an analytical cross-sectional study in 97 patients normotensive or hypertensive. OHT was defined as a ≥10 mmHg increase in systolic blood pressure after four minutes in the standing position. Results. The prevalence of OHT was 20.6%. The mean body mass index was significantly higher in patients with OHT than in those without it (29.80 ± 4.10 versus 27.51 ± 3.98 kg/m2; P = 0.026). There were no statistically significant differences between the two groups for other metabolic parameters. Among the 68 patients who had an echocardiographic examination 27% of those with OHT had an increase in their left atrial volume index (LAVi) compared with 75% of those who did not have OHT (P = 0.004). The mean LAVi of patients with OHT was significantly lower than that of those without OHT (26.27 ± 6.37 versus 32.65 ± 7.54, resp.; P = 0.011). Conclusion. We found a high prevalence of orthostatic hypertension and a lower left atrial volume indexed in the patients with orthostatic hypertension.

The Orthostatic Blood Pressure Change and Its Influence Factors in Young Students

To investigate orthostatic blood pressure (BP) changes and the influence factors in youth. Three hundred seventeen young students (165 males and 152 females, aged 21.5±1.0 years old) were recruited. BP was measured by automatic oscillometric devices after the subjects were in supine position for 10 minutes followed by standing for 3 minutes, and their difference was recorded as ΔBP. Orthostatic hypertension (OHT) was defined by ΔBP≥10-mm Hg and orthostatic hypotension (OH) by ΔBP≤−10-mm Hg. The association between ΔBP and age, sex, family history of hypertension, height, body mass, and body mass index was analyzed. The systolic and diastolic BP (SBP and DBP) were significantly increased in standing compared to supine position (P<0.05). The prevalence of OHT and OH in SBP was 16.4% and 3.8%, and that in DBP was 20.5% and 3.5%, respectively. The prevalence of OH was higher in females while the prevalence of OHT was higher in males. The OH group had the highest supine BP while the OHT group had the lowest supine BP. Linear regression analysis demonstrated a negative relationship between supine SBP and ΔSBP (r=−0.165, P<0.05), and between supine DBP and ΔDBP (r=−0.465, P<0.05). Multivariate analysis confirmed that both ΔSBP and ΔDBP correlated negatively with supine BP values and female gender. Gender and supine BP levels are associated with the prevalence of OHT and OH in young students.

Orthostatic hypertension in patients with type 2 diabetes.

The prevalence and clinical importance of orthostatic hypertension (OHT) in diabetic patients has not been elucidated, in contrast to orthostatic hypotension, which is occasionally found in diabetic patients with autonomic neuropathy. The prevalence and severity of orthostatic hypertension was investigated in 277 Japanese male patients with type 2 diabetes, including 90 hypertensive patients and 128 nondiabetic age-matched male subjects. Patients treated with antihypertensive drugs were excluded from the study. OHT was defined as an increase in diastolic blood pressure (DBP) from <90 to >or=90 mmHg and/or an increase in systolic blood pressure (SBP) from <140 to >or=140 mmHg after standing from supine position. Clinical profiles and several serum biochemical parameters were determined in addition to chest X-rays and electrocardiograms. The prevalence of OHT in normotensive and hypertensive diabetic patients was significantly higher than in control subjects (12.8 vs. 1.8%, P < 0.01, for normotensive patients; 12.6 vs. 11.1%, not significant, for hypertensive patients). Orthostasis induced a mean increase of 6.8 +/- 11.4 mmHg in SBP and 9.1 +/- 5.2 mmHg in DBP in diabetic patients with OHT compared with those without OHT (-1.0 +/- 9.0 and 3.8 +/- 6.6 mmHg, respectively). Vibration sensation in the lower limb was reduced in diabetic patients with OHT, but the percent coefficient of variation of RR interval, cardio-to-thoracic ratio on chest X-ray, and serum triglyceride levels were higher in these patients compared with normotensive diabetic patients without OHT. Orthostatic hypertension is a novel complication in normotensive diabetic patients and may associate with early stage neuropathy and development of sustained hypertension.

Prevalence of secondary hypertension and unusual aspects of the treatment of hypertension in elderly individuals

Although hypertension is very common in elderly subjects, there is little Published evidence on the effects of age on the Prevalence of ”secondary“ hypertension. Data derived from 2,880 untreated hypertensive subjects are Presented, showing that with increasing age from 70 years, the Prevalence of orthostatic hypertension falls from 17 to 4% while that of Primary aldosteronism, Cushing's syndrome and Pheochromocytoma changes very little and the Prevalence of hypertension due to hypothyroidism, renovascular stenosis and renal insufficiency increases Progressively, so that almost 10% of hypertensive Patients older than 60 years had renovascular hypertension or renal insufficiency. The SHEP study has shown that treatment of hypertension in the elderly significantly reduced cardiovascular but not total mortality. In secondary hypertension, specific, pathogenesis-related therapy is recommended and often effective. In elderly Patients with Primary hypertension, therapeutic decisions are influenced by the need to minimize side effects (such as orthostatic hypotension), the desirability of avoiding excessive reduction in (especially) diastolic Pressures, and the Possibility that in some situations treatment may actually reduce life expectancy.