Intraindividual Reproducibility of Postprandial and Orthostatic Blood Pressure Changes in Older Nursing‐Home Patients: Relationship with Chronic Use of Cardiovascular Medications

Jansen, René W. M. M.; Kelley-Gagnon, Margaret; Lipsitz, Lewis A.

doi:10.1111/j.1532-5415.1996.tb06406.x

Cited by 67 publications

(55 citation statements)

References 26 publications

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“…491,492,507,510 Several drug classes have been implicated in syncope, including diuretics, vasodilators, venodilators, negative chronotropes, and sedatives. [488][489][490]492,[507][508][509][510] Close supervision during adjustment of medications is frequently required because of potential worsening of preexisting supine hypertension or cardiac arrhythmias. [491][492][493]511 Other factors to consider include frailty, HF and/or cardiac dysfunction, and the use of a large number of medications causing adverse effects because of drug-drug interactions.…”

Section: -490492507-510mentioning

confidence: 99%

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

Sheldon²,

et al. 2017

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Section: -490492507-510mentioning

confidence: 99%

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

Sheldon²,

et al. 2017

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“…Although PPH has been reported to be more common than orthostatic hypotension, 18 a close relationship between the two conditions has also been reported. 19 Since we did not evaluate orthostatic hypotension in the present study, we could not exclude the possibility that our finding was a mere reflection of the higher prevalence of orthostatic hypotension in patients with advanced PPH.…”

Section: Discussionmentioning

confidence: 99%

Postprandial Hypotension Is Associated With Asymptomatic Cerebrovascular Damage in Essential Hypertensive Patients

et al. 1999

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Abstract-To elucidate the relationship between postprandial hypotension (PPH) and asymptomatic cerebrovascular damage, we evaluated changes in blood pressure after a meal by 24-hour blood pressure monitoring in 70 hospitalized essential hypertensive patients aged Ն50 years. They received a diet containing standard nutritional ingredients with 120 mmol (7 g) NaCl and were free from medication for at least 1 week. PPH was defined as the mean reduction of systolic blood pressure during 2 hours after a meal. Patients were divided into three groups according to mean values of PPH after 3 meals: PPH-1 (nϭ16, 5 mm HgՅPPHϽ10 mm Hg), PPH-2 (nϭ18, PPHՆ10 mm Hg), and normal (nϭ36, PPHϽ5 mm Hg). As asymptomatic cerebrovascular damage, lacunae and leukoaraiosis were evaluated by magnetic resonance imaging. PPH did not correlate with daytime or nighttime blood pressure or the nondipper phenomenon; however, PPH was significantly related to asymptomatic cerebrovascular damage. The prevalence of lacunae in the normal, PPH-1, and PPH-2 groups was 44%, 69%, and 83%, respectively ( 2 ϭ8.22, PϽ0.05). The number of lacunae in the normal, PPH-1, and PPH-2 groups was 1.0Ϯ1.3, 1.3Ϯ1.2, and 1.9Ϯ1.4, respectively (F[2,67]ϭ3.2, PϽ0.05). The prevalence of advanced leukoaraiosis in the normal, PPH-1, and PPH-2 groups was 44%, 50%, and 83%, respectively ( 2 ϭ7.63, PϽ0.05). Severity score of leukoaraiosis in the normal, PPH-1, and PPH-2 groups was 1.5Ϯ0.7, 1.7Ϯ0.8, and 2.1Ϯ0.7, respectively (F [2,67] has been shown to be related to several clinical abnormalities, including advanced end-organ damage, 1-3 secondary hypertension, 4 and autonomic nervous system dysfunction. 5 Several studies have demonstrated a linkage between asymptomatic brain damage and alteration of the diurnal change in BP. 2,6 -8 Recently, it has also been shown that dysregulation of postural change in BP is associated with advanced silent cerebrovascular damage in hypertension in the elderly. 9 Asymptomatic cerebrovascular damage, often found in elderly hypertensive individuals, is associated with cognitive dysfunction, 9 depression of mood, 10 and reduced capacity of the cerebral circulation. 11,12 It has also been shown that patients with asymptomatic lacunae have a significantly higher incidence of future stroke than normal subjects. 13 Postprandial hypotension (PPH) is a relatively common phenomenon frequently observed in elderly hypertensive patients. 14 However, only a few studies have investigated the effect of PPH on the diurnal change in BP in hypertensive patients. 15,16 In our previous study, 16 we evaluated PPH with ambulatory BP monitoring (ABPM) and showed that PPH contributed to the variability of BP in the daytime and the morning surge of BP, independent of the dipper and nondipper phenomena. Clinically, PPH can cause light-headedness, fainting, falls, or even transient ischemic attack. 14 Recently, it has also been shown that PPH is an independent risk factor for future mortality, coronary events, and stroke. 17 These findings suggest the relevance of PPH ...

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“…31 In another reproducibility study in elderly patients, intraclass correlation coefficients were somewhat higher for postural SBP changes (0.72) and pulse changes (0.69) compared with DBP changes (0.50). 32 In addition to possible measurement error introduced by instrumentation and study protocol, use of prescription antihypertensive medications may have also obscured normal physiological responses to the postural stressor in some individuals. Our ability to adequately account for possible medication effects is limited because Ͼ90% of participants in our study were current users of antihypertensive medications.…”

Section: Discussionmentioning

confidence: 99%

Possible Locus on Chromosome 18q Influencing Postural Systolic Blood Pressure Changes

et al. 2000

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Abstract-We conducted a genome-wide scan for quantitative trait loci influencing the systolic blood pressure, diastolic blood pressure, and pulse responses to a postural challenge in 498 white sibling-pairs from the Hypertension Genetic Epidemiology Network, a multicenter study of the genetic susceptibility to hypertension. All participants were hypertensive (systolic blood pressure Ն140 mm Hg, diastolic blood pressure Ն90 mm Hg, or on antihypertensive medications) with diagnosis before age 60. Blood pressure and pulse were measured by an oscillometric method after a 5-minute rest in a supine position and again immediately on standing. The genome scan included a total of 387 autosomal short-tandem-repeat polymorphisms typed by the National Heart, Lung, and Blood Institute Mammalian Genotyping Service at Marshfield. We used multipoint variance-components linkage analysis to identify possible quantitative trait loci influencing postural change phenotypes after adjusting for sex, age, and use of antihypertensive medications. There was suggestive evidence for linkage on chromosome 18q for the postural systolic blood pressure response (maximum logarithm of the odds scoreϭ2.6 at 80 centiMorgans). We also observed a maximum logarithm of the odds score of 1.9 for the systolic blood pressure response and 1.7 for the diastolic blood pressure response on chromosome 6p. The marker that demonstrated the strongest evidence for linkage for the systolic blood pressure response (D18S858) lies within 20 centiMorgans of a marker previously linked to rare familial orthostatic hypotensive syndrome. Our findings indicate that there may be 1 or more genes on chromosome 18q that regulate systolic blood pressure during the physiological recovery period after a postural stressor. Key Words: posture Ⅲ blood pressure Ⅲ heart rate Ⅲ hypertension Ⅲ linkage Ⅲ chromosome mapping T here is some evidence that blood pressure and heart rate responses to psychological and physical stressors are associated with adverse health outcomes. For example, prospective studies have found that a decrease in blood pressure on standing (orthostatic hypotension) is associated with increased coronary heart disease morbidity and mortality 1,2 and all-cause mortality. 3,4 Elderly individuals with postural hypotension accompanied by dizziness are also at greater risk of recurrent falls. 5 Family and twin studies suggest that blood pressure and heart rate responses to laboratory stressors such as a mental arithmetic or cold pressor test are partly under genetic control. 6 -12 By contrast, fewer studies have evaluated familial patterns of blood pressure or heart rate responses to postural stressors. A relatively severe form of orthostatic hypotension with an autosomal dominant mode of transmission has been described in 4 families. 13 Recently, a genome-wide scan in 2 of these families found significant evidence for linkage of this hypotensive trait in a region on chromosome 18q. 14 Unlike most other laboratory stressors designed to evaluate cardiovascular reactivity, ...

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Intraindividual Reproducibility of Postprandial and Orthostatic Blood Pressure Changes in Older Nursing‐Home Patients: Relationship with Chronic Use of Cardiovascular Medications

Cited by 67 publications

References 26 publications

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

Postprandial Hypotension Is Associated With Asymptomatic Cerebrovascular Damage in Essential Hypertensive Patients

Possible Locus on Chromosome 18q Influencing Postural Systolic Blood Pressure Changes

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