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

Mattace-Raso, Francesco; Cammen, Tischa J. M. van der; Knetsch, A; Meiracker, Anton H. van den; Schalekamp, M. A. D. H.; Hofman, Albert; Witteman, Jacqueline C. M.

doi:10.1097/01.hjh.0000202816.25706.64

Cited by 120 publications

(73 citation statements)

References 19 publications

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“…In our sample, the overall proportion of subjects with documented history of hypertension was 42.4%, 39.1% in the asymptomatic group and 51.6% in the symptomatic group, with a trend pointing towards more burden of hypertension in the symptomatic group (v 2 = 2.852, P = 0.091). Chronic hypertension is a risk factor for arterial stiffness (AS), and the latter is an independent risk factor for OH [16]. In our study, we did not have independent measures of AS (e.g.…”

Section: Discussionmentioning

confidence: 86%

Intolerance to initial orthostasis relates to systolic BP changes in elders

et al. 2009

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Section: Discussionmentioning

confidence: 86%

Intolerance to initial orthostasis relates to systolic BP changes in elders

et al. 2009

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“…This association may exist because OH indicates earlier (before midlife) risk factor exposures that contributed to both OH and impaired cognition in midlife. Also, OH may reflect atherosclerotic disease [38] and, thus, be a marker of cerebrovascular burden. Although our findings do not Poor cognitive function defined as performance in the lowest quintile on the test.…”

Section: Discussionmentioning

confidence: 99%

Orthostatic Hypotension and Cognitive Function: The Atherosclerosis Risk in Communities Study

Rose¹,

Couper

Eigenbrodt

et al. 2009

Neuroepidemiology

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Background: To examine the association between orthostatic hypotension (OH) and cognitive function in middle-aged adults. Methods: Participants were 12,702 men and women from the Atherosclerosis Risk in Communities Study. OH was defined as decrease in systolic blood pressure (BP) by ≧20 mm Hg or diastolic BP by ≧10 mm Hg upon standing. At the 2nd and the 4th follow-up examinations, cognitive function was assessed using the Delayed Word Recall Test, Digit Symbol Substitution Test (DSST) and Word Fluency Test (WFT). Results: After age adjustment, those with OH were more likely to be in the lowest quintile of the DSST (OR = 1.34, 95% CI = 1.12–1.62) and WFT (OR = 1.25, 95% CI = 1.03–1.51) than were those without OH. After adjustment for sociodemographic and cardiovascular risk factors, associations were no longer significant. In age-adjusted models only, OH was associated with increased odds of being in the greatest quintile of decline in DSST score between visits 2 and 4 (OR = 1.28, 95% CI = 1.04–1.58). Conclusions: OH was associated with less favorable cognitive function, but this association was largely attributable to demographic and cardiovascular risk factors. Episodic asymptomatic hypotension in middle age may not be an independent cause of cognitive decline. Further study, including emphasis on neuroimaging, is needed.

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“…OH is also associated with adverse cardiovascular health outcomes in middle-age and older adults, including elevated risk for all-cause and cardiovascular mortality and cardiovascular disease (Rose et al, 2006,Verwoert et al, 2008,Masaki et al, 1998, myocardial infarction, transient ischemic attack (Fedorowski et al, 2010) and arterial stiffness (Mattace-Raso et al, 2006). It has been identified as a risk factor for ischemic stroke (Eigenbrodt et al, 2000).…”

Section: Introductionmentioning

confidence: 99%

Application of the Sit-Up Test for orthostatic hypotension in individuals with stroke

Tang

Eng

Krassioukov

2012

Autonomic Neuroscience

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Orthostatic hypotension (OH) is an important consideration for individuals with stroke, given the shared occurrence of mobility limitations, fall risk and association with adverse cardiovascular outcomes. This study aimed to 1) establish the application of a simple bedside test of orthostatic challenge to identify OH after stroke, 2) examine differences in characteristics between those with and without OH and 3) determine cardiovascular correlates with hemodynamic responses. Fortynine participants (n=29 men, mean±SD age 66±7 years, time post-stroke 4.5±3.1 years) performed an orthostatic challenge (Sit-Up Test). Eleven (22%) of the 49 participants presented with OH (n=7, of which 5 were asymptomatic) or symptoms of cerebral hypoperfusion with position change (n=4). Compared to participants without OH, those with OH had higher total:high-density lipoprotein cholesterol ratios (4.2 ± 0.9 vs. 3.3 ± 0.8, P=0.009) and triglyceride levels (2.2 ± 0.8 vs. 1.4 ± 0.5 mmol/L, P=0.001). Multivariate linear regression revealed that high-density lipoprotein cholesterol and triglyceride levels explained 20% of the variance of the change in systolic blood pressure from the Sit-Up Test (F(2,45)=5.68, P=0.006). In conclusion, we used a simple bedside test of orthostatic tolerance to identify that over 20% of individuals with stroke presented with OH or symptoms of hypoperfusion. They also had more impaired cardiovascular risk profiles relative to those without OH. These individuals may be at even higher risk for mobility limitations and falls beyond that associated with stroke-related deficits alone.

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

Cited by 120 publications

References 19 publications

Intolerance to initial orthostasis relates to systolic BP changes in elders

Intolerance to initial orthostasis relates to systolic BP changes in elders

Orthostatic Hypotension and Cognitive Function: The Atherosclerosis Risk in Communities Study

Application of the Sit-Up Test for orthostatic hypotension in individuals with stroke

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