Hypotension Unawareness in Profound Orthostatic Hypotension

Arbogast, S D; Alshekhlee, Amer; Hussain, Zulfiqar; McNeeley, Kevin; Chelimsky, Thomas C.

doi:10.1016/j.amjmed.2008.10.040

Cited by 109 publications

(66 citation statements)

References 16 publications

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“…Previous studies have found similar results that suggested that only 30% to 40% of patients with OH would manifest typical symptoms while the others remained asymptomatic or had atypical symptoms. [2][3][4] This makes the diagnosis of OH difficult, and thus routine measurements are required to vigilantly detect cases.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence, Associations and Risk Factors for Orthostatic Hypotension in Medical, Surgical and Trauma Inpatients: An Observational Cohort Study

Aung

Corcoran

Nagalingam

et al. 2011

Heart, Lung and Circulation

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Background: Orthostatic hypotension (OH) is prevalent in hospitalized elderly patients. It is defined as a reduction in systolic blood pressure (SBP) of at least 20 mmHg and/or diastolic blood pressure (DBP) of at least 10 mmHg within 3 minutes of standing from a lying position. This observational cohort study describes the prevalence, association with symptoms, and risk factors for OH in medical, surgical, and trauma wards in a tertiary hospital and the differences in hemodynamic behaviors between OH-positive (OHP) and OH-negative (OHN) patients. Methods: All 76 patients who were hemodynamically stable and able to stand from 4 hospital wards had noninvasive supine and orthostatic blood pressures (BPs) and pulse rates (PRs) measured over 4 days. Results: Mean age of the 76 patients included in the study was 67.8 6 19.6 years. Overall prevalence of OH was 23.7% (95% CI: 14.7%-34.8%) with 21.2% (95% CI: 9.0%-38.9%) in medical, 31.8% (95% CI: 13.9%-54.9%) in surgical, and 19.0% (95% CI: 5.4%-41.9%) in trauma wards. OH had no association with symptoms (P 5 .53). We found no differences in age, number of comorbidities, and medication use between the OHN and OHP groups.The two groups displayed very different hemodynamic responses. The OHN group demonstrated a statistically significant compensatory rise in BP and PR over time to orthostatic

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Section: Discussionmentioning

confidence: 99%

“…1 It is a physical sign and is not always associated with symptoms. [2][3][4] The reported prevalence of OH ranges from 6% in healthy elderly community dwellers to 68% in hospitalized geriatric patients. 5 The prevalence of OH across emergency department presentations is about 3% to 25%.…”

Section: Introductionmentioning

confidence: 99%

Prevalence, Associations and Risk Factors for Orthostatic Hypotension in Medical, Surgical and Trauma Inpatients: An Observational Cohort Study

Aung

Corcoran

Nagalingam

et al. 2011

Heart, Lung and Circulation

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show abstract

“…In a study that enrolled 205 subjects of mean age 71, 33 % of the subjects were asymptomatic despite profound falls in blood pressure during the head-up tilt table test. 4 Accordingly, although the raw rate of falls was comparable in the intensively treated subjects vs, the standard treatment group, 1 what we need to know is whether or not orthostatic hypotension (and its severity) might have contributed to falls in either group.…”

mentioning

confidence: 95%

Intensive BP Control Falls and Fractures

Jolobe¹

2015

J GEN INTERN MED

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“…Acute causes of OH include dehydration or deconditioning, but chronic OH may be caused by neurodegenerative disorders such as Parkinson's disease or autonomic failure. OH can cause people to feel dizzy, lightheaded and have blurred vision and blackouts, but some people with OH have few symptoms and cognitive impairment may affect their ability to report symptoms (Passant et al 1996, Arbogast et al 2009. OH in such patients who experience few symptoms may still contribute to the risk of falling.…”

Section: Peer Reviewmentioning

confidence: 99%

Measurement of lying and standing blood pressure in hospital

O'Riordan

Vasilakis

Hussain

et al. 2017

Nursing Older People

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Measuring lying and standing blood pressure (BP) is an important clinical observation in older hospital inpatients. This is because a drop in BP on standing, known as orthostatic hypotension (OH) is common in older people and in acute illness and, therefore, in hospital patients. OH increases the risk of a fall in hospital. Simple measures such as changes in medication or rehydration can reduce this drop in BP and reduce the risk of falls.In a recent snapshot audit in England and Wales of 179 acute hospitals and 4,846 patients aged 65 years and over admitted with an acute illness, only 16% had a lying and standing BP recorded within 48 hours.A review of the literature showed that existing advice on how to measure and interpret lying and standing BP was often not appropriate for use on the ward with frail and unwell inpatients. An online survey of 275 clinicians' usual practice highlighted variation and the need for clarity and pragmatism. In the light of the survey findings, a clinical guide has been developed on when to measure lying and standing BP, how to measure it and what is considered a significant result.

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Hypotension Unawareness in Profound Orthostatic Hypotension

Cited by 109 publications

References 16 publications

Prevalence, Associations and Risk Factors for Orthostatic Hypotension in Medical, Surgical and Trauma Inpatients: An Observational Cohort Study

Prevalence, Associations and Risk Factors for Orthostatic Hypotension in Medical, Surgical and Trauma Inpatients: An Observational Cohort Study

Intensive BP Control Falls and Fractures

Measurement of lying and standing blood pressure in hospital

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