Failure of cerebral autoregulation as a cause of brain dysfunction in the elderly.

Wollner, L.; McCarthy, S. T.; Soper, Nigel; Macy, Dorothy

doi:10.1136/bmj.1.6171.1117

Cited by 118 publications

(60 citation statements)

References 14 publications

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“…There is no direct relationship between the magnitude of a change in systolic blood pressure and symptoms. Failure of cerebral blood flow autoregulation may be the major factor determining whether modest falls in blood pressure give rise to symptoms (Wollner et al, 1979 (Floras, 1988). Further studies in frail elderly subjects are necessary to investigate these hypotheses.…”

Section: Resultsmentioning

confidence: 99%

Effect of temazepam on blood pressure regulation in healthy elderly subjects.

Ford

Hoffman

Blaschke

1990

Brit J Clinical Pharma

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1. Blood pressure regulation was studied in 12 healthy elderly subjects after double‐blind randomised administration of placebo, 15 mg and 30 mg temazepam at 10.00 h and 22.00 h. 2. Supine and standing heart rate and blood pressure were measured after daytime administration and supine measurements were obtained during sleep. 3. Temazepam caused a fall in systolic blood pressure and an increase in heart rate after morning administration. These changes were greater in the standing position and were dose‐dependent; for standing blood pressure and heart rate 1 h after administration there was a 7 mm Hg fall and 6 beats min‐ 1 increase after 15 mg temazepam and a 10 mm Hg fall and 8 beats min‐1 increase after 30 mg temazepam. Temazepam magnified the fall in systolic blood pressure and increase in heart rate that occurred with standing. Temazepam enhanced the fall in systolic blood pressure that occurred during sleep (mean +/‐ s.d.; placebo: ‐23 +/‐ 10 mm Hg, 15 mg temazepam: ‐31 +/‐ 13 mm Hg, 30 mg temazepam: ‐36 +/‐ 14 mm Hg). 4. These changes in blood pressure regulation caused by temazepam may have clinical importance in some elderly individuals.

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Section: Resultsmentioning

confidence: 99%

Effect of temazepam on blood pressure regulation in healthy elderly subjects.

Ford

Hoffman

Blaschke

1990

Brit J Clinical Pharma

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“…In fact, it has been suggested that impairment in CA associated with aging may contribute to increased rates of syncope in the elderly. 26 However, the results of several studies have shown that dynamic CA is maintained in healthy aging. 11,27,28 This may be related to the fact that some data have demonstrated that cerebral vessels may not show the same stiffening effects as peripheral vessels.…”

Section: Deegan Et Al Sex Differences In Cerebral Autoregulationmentioning

confidence: 99%

Elderly Women Regulate Brain Blood Flow Better Than Men Do

Deegan

Sorond

Galica

et al. 2011

Stroke

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Background and Purpose-Orthostatic intolerance and falls differ between sexes and change with age. However, it remains unclear what role cerebral autoregulation may play in this response. This study was designed to determine whether cerebral autoregulation, assessed using transcranial Doppler ultrasound, is more effective in elderly females than in males. Methods-We used transcranial Doppler ultrasound to evaluate cerebral autoregulation in 544 (236 male) subjects older than age 70 years recruited as part of the MOBILIZE Boston study. The MOBILIZE Boston study is a prospective cohort study of a unique set of risk factors for falls in seniors in the Boston area. We assessed CO 2 reactivity and transfer function gain, phase, and coherence during 5 minutes of quiet sitting and autoregulatory index during sit-to-stand tests. Pϭ0.002) in the autoregulatory band, implying less effective cerebral autoregulation. However, reduced autoregulation in males was not below the normal range, indicating autoregulation was intact but less effective. Conclusions-Female subjects were better able to maintain cerebral flow velocities during postural changes and demonstrated better cerebral autoregulation. The mechanisms of sex-based differences in autoregulation remain unclear but may partially explain the higher rates of orthostatic hypotension-related hospitalizations in elderly men. (Stroke.

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“…This is particularly of concern in older hypertensive patients with impaired cerebral autoregulation. 38 However, it remains uncertain whether or not nocturnal extreme BP dipping itself could be a trigger for ischemic stroke onset or heart attack during sleep in older hypertensives. 31 Recent studies have shown a close association between natural extreme dipping and mild cognitive impairment without reaching definitive dementia in community-dwelling older persons (mean age, 68 years), 39 indicating that extreme dipping may be associated with reduced quality of life in older persons.…”

Section: Nocturnal Blood Pressure and Cardiovascular Risk Y Yano And mentioning

confidence: 99%

Nocturnal blood pressure and cardiovascular disease: a review of recent advances

2012

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The accurate measurement, prediction and treatment of high blood pressure (BP) are essential issues in the management of hypertension. Ambulatory blood pressure monitoring (ABPM) has been shown to be superior to clinic BP measurements as ABPM can provide the following important information: (i) the mean BP levels, (ii) the diurnal variation in BP and (iii) the short-term BP variability. Among these parameters, there is increasing evidence that the mean nocturnal BP level is the most sensitive predictor of cardiovascular morbidity and mortality. Furthermore, several studies have shown that less nocturnal BP dipping, defined as less nocturnal BP decline relative to daytime BP, or a high night-day BP ratio was associated with poor prognosis irrespective of the 24-hour BP levels. These findings can be interpreted in at least two ways: namely, high nocturnal BP or less nocturnal BP dipping might be not only a potent risk factor for cardiovascular disease (CVD), but also a marker of pre-existing or concurrent diseases that can lead to nocturnal BP elevation. In this review, we consider the clinical utility of ABPM and in particular focus on the nocturnal BP levels or nocturnal BP dipping as a potent risk factor for CVD. In addition, the clinical management of high nocturnal BP and blunted nocturnal BP dipping with antihypertensive medications is discussed.

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Failure of cerebral autoregulation as a cause of brain dysfunction in the elderly.

Cited by 118 publications

References 14 publications

Effect of temazepam on blood pressure regulation in healthy elderly subjects.

Effect of temazepam on blood pressure regulation in healthy elderly subjects.

Elderly Women Regulate Brain Blood Flow Better Than Men Do

Nocturnal blood pressure and cardiovascular disease: a review of recent advances

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