Arterial Stiffness, Central Pulsatile Hemodynamic Load, and Orthostatic Hypotension

Wang, Si; Wan, Shang; Zhou, Yufei; Pan, Pei; Wen, Bo; Zhang, Xin; Liao, Hang; Shi, Dai; Shi, Rui; Chen, Xiaoping; Jangala, Tulasiram

doi:10.1111/jch.12726

Cited by 12 publications

(9 citation statements)

References 44 publications

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“…We have previously associated interarm difference with white coat effects, which can confound detection of postural hypotension. 50 51 Arterial stiffness is a postulated cause of interarm difference 52 and is also associated with postural hypotension 53 54 ; thus interarm difference as a proxy measure of arterial stiffness might account for the observed association. Hypotension on ambulatory monitoring and elevated pulse wave velocity are both associated with cognitive decline, lending further support to the association of interarm difference, arterial stiffness and postural hypotension.…”

Section: Discussionmentioning

confidence: 99%

Detecting Risk Of Postural hypotension (DROP): derivation and validation of a prediction score for primary care

et al. 2018

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ObjectivesFalls are a common problem in older people. Postural hypotension contributes to falls but is often asymptomatic. In the absence of symptoms, postural hypotension is only infrequently checked for in clinical practice. We undertook this study to derive, validate and explore the prospective associations of a prediction tool to identify people likely to have unrecognised postural hypotension.Design and settingCross-sectional and prospective multivariable cohort analysis.Participants1317 participants of the Invecchiare in Chianti study, a population-based cohort representative of the older Italian population.Primary outcome measuresPredictive value of score to suggest presence of postural hypotension.MethodsSubjects were randomised 1:1 to derivation or validation cohorts. Within the derivation cohort, univariable associations for candidate predictors of postural hypotension were tested. Variables with p<0.1 entered multivariable linear regression models. Factors retaining multivariable significance were incorporated into unweighted and weighted Detecting Risk Of Postural hypotension (DROP) scores. These scores were tested in the validation cohort against prediction of postural hypotension, cognitive decline and mortality over 9 years of follow-up.ResultsPostural hypotension was present in 203 (15.4%) of participants. Factors predicting postural hypotension were: digoxin use, Parkinson’s disease, hypertension, stroke or cardiovascular disease and an interarm systolic blood pressure difference. Area under the curve was consistent at 0.65 for all models, with significant ORs of 1.8 to 2.4 per unit increase in score for predicting postural hypotension. For a DROP score ≥1, five cases need to be tested to identify one with postural hypotension.Increasing DROP scores predicted mortality (OR 1.8 to 2.8 per unit rise) and increasing rates of decline of Mini Mental State Examination score (analysis of variance p<0.001) over 9 years of follow-up.ConclusionsThe DROP score provides a simple method to identify people likely to have postural hypotension and increased risks to health who require further evaluation.

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Section: Discussionmentioning

confidence: 99%

Detecting Risk Of Postural hypotension (DROP): derivation and validation of a prediction score for primary care

et al. 2018

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“…In total, 11 studies ( Mattace-Raso et al, 2006 ; Protogerou et al, 2008 ; Aso et al, 2012 ; Lu et al, 2014 ; Meng et al, 2014 ; Sung et al, 2014 ; Liu et al, 2016 ; Chi et al, 2019 ; Cremer et al, 2020 ; Kirkham et al, 2020 ; Li et al, 2021 ) were included in the systematic review and meta-analysis ( Figure 1 ). Of the included studies, six were prospective longitudinal studies, ( Mattace-Raso et al, 2006 ; Protogerou et al, 2008 ; Lu et al, 2014 ; Sung et al, 2014 ; Chi et al, 2019 ; Kirkham et al, 2020 ), and five were cross-sectional studies.…”

Section: Resultsmentioning

confidence: 99%

Association between arterial stiffness and orthostatic hypotension: A systematic review and meta-analysis

Saz‐Lara¹,

Cavero‐Redondo²,

Martínez‐Vizcaíno³

et al. 2023

Front. Physiol.

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Background: Orthostatic hypotension, defined as a decrease in blood pressure on standing, is associated with an increased risk of mortality and cardiovascular events in the general population. In addition, it has recently been suggested that arterial stiffness is independently associated with orthostatic hypotension, which may be due to a loss of the buffering effect of the ascending aorta and an early return of pressure waves. However, the specific mechanisms underlying this association remain unclear. Thus, we aimed to evaluate the association between orthostatic hypotension and arterial stiffness in the adult population.Methods: PubMed, Scopus, Web of Science, and Cochrane Library databases were searched from inception to 31 January 2022. The DerSimonian and Laird method was used to calculate pooled odds ratio (OR) estimates and their respective 95% confidence intervals (95% CI) for the association between orthostatic hypotension and arterial stiffness.Results: Overall, 11 studies were included, with a total of 10,611 subjects. Our results showed that increased arterial stiffness raises the risk of orthostatic hypotension (OR: 1.40, 95% CI: 1.28–1.54), with a stronger association at central arterial stiffness (OR: 1.50, 95% CI: 1.34–1.68) than at peripheral arterial stiffness (OR: 1.29, 95% CI: 1.17–1.43).Conclusion: Our findings showed that increased arterial stiffness raises the risk of orthostatic hypotension by 40% among the adult population. Considering that orthostatic hypotension, which is usually a consequence of antihypertensive treatment, has been widely associated with the risk of cardiovascular events, appropriate control of arterial stiffness could be a clinical strategy to prevent cardiovascular morbidity and mortality.

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“…Less documented is the link between OH and cardiovascular events, even though data available in literature suggest a positive association with heart failure, myocardial infarction, and stroke in the general population [ 25 , 43 , 44 ]. A positive association has also been found with aortic stiffness, while the relationship with central systolic pressures has not been completely clarified [ 45 , 46 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Epidemiology of Systolic and Diastolic Orthostatic Hypotension in Patients on Peritoneal Dialysis

Torino

Tripepi

Versace

et al. 2021

JCM

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Blood pressure changes upon standing reflect a hemodynamic response, which depends on the baroreflex system and euvolemia. Dysautonomia and fluctuations in blood volume are hallmarks in kidney failure requiring replacement therapy. Orthostatic hypotension has been associated with mortality in hemodialysis patients, but neither this relationship nor the impact of changes in blood pressure has been tested in patients on peritoneal dialysis. We investigated both these relationships in a cohort of 137 PD patients. The response to orthostasis was assessed according to a standardized protocol. Twenty-five patients (18%) had systolic orthostatic hypotension, and 17 patients (12%) had diastolic hypotension. The magnitude of systolic and diastolic BP changes was inversely related to the value of the corresponding supine BP component (r = −0.16, p = 0.056 (systolic) and r = −0.25, p = 0.003 (diastolic), respectively). Orthostatic changes in diastolic, but not in systolic, BP were linearly related to the death risk (HR (1 mmHg reduction): 1.04, 95% CI 1.01–1.07, p = 0.006), and this was also true for CV death (HR: 1.08, 95% CI 1.03–1.12, p = 0.001). The strength of this association was not affected by further data adjustment (p ≤ 0.05). These findings suggest that independent of the formal diagnosis of orthostatic hypotension, even minor orthostatic reductions in diastolic BP bear an excess death risk in this population.

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Arterial Stiffness, Central Pulsatile Hemodynamic Load, and Orthostatic Hypotension

Cited by 12 publications

References 44 publications

Detecting Risk Of Postural hypotension (DROP): derivation and validation of a prediction score for primary care

Detecting Risk Of Postural hypotension (DROP): derivation and validation of a prediction score for primary care

Association between arterial stiffness and orthostatic hypotension: A systematic review and meta-analysis

Clinical Epidemiology of Systolic and Diastolic Orthostatic Hypotension in Patients on Peritoneal Dialysis

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