Orthostatic Hypertension

Robertson, David L.

doi:10.1161/hypertensionaha.110.163485

Cited by 37 publications

(24 citation statements)

References 12 publications

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“…9 Clinicians are encouraged to check on orthostatic reductions in BP, particularly in older patients, 10 and are generally relieved when the BP does not fall in the upright position in the clinical encounter. However, the impact of an increase in BP on standing may represent a different set of physiologic adaptations whose overcompensation could be a significant contributor to future cardiovascular events.…”

Section: Introductionmentioning

confidence: 99%

Orthostatic changes in systolic blood pressure among SPRINT participants at baseline

Townsend

Chang

Cohen

et al. 2016

Journal of the American Society of Hypertension

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Orthostatic changes in systolic blood pressure (SBP) impact cardiovascular outcomes. In this study, we aimed to determine the pattern of orthostatic systolic pressure changes in participants enrolled in the SBP Intervention Trial (SPRINT) at their baseline visit before randomization and sought to understand clinical factors predictive of these changes. Of the 9323 participants enrolled in SPRINT, 8662 had complete data for these analyses. The SBP after 1 minute of standing was subtracted from the mean value of the three preceding seated SBP values. At the baseline visit, medical history, medications, anthropometric measures, and standard laboratory testing were undertaken. The mean age of SPRINT participants was 68 years, two-thirds were male, with 30% black, 11% Hispanic, and 55% Caucasian. The spectrum of SBP changes on standing demonstrated that increases in SBP were as common as declines, and about 5% of participants had an increase, and 5% had a decrease of >20 mm Hg in SBP upon standing. Female sex, taller height, more advanced kidney disease, current smoking, and several drug classes were associated with larger declines in BP upon standing, while black race, higher blood levels of glucose and sodium, and heavier weight were associated with more positive values of the change in BP upon standing. Our cross-sectional results show a significant spectrum of orthostatic SBP changes, reflecting known (eg, age) and less well-known (eg, kidney function) relationships that may be important considerations in determining the optimal target blood pressure in long-term outcomes of older hypertensive patients.

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Section: Introductionmentioning

confidence: 99%

Orthostatic changes in systolic blood pressure among SPRINT participants at baseline

Townsend

Chang

Cohen

et al. 2016

Journal of the American Society of Hypertension

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“…Some authors found orthostatic hypotension unassociated with CI or CD in geriatric patients, 11,12 whereas others reported a significant link. 13,14 Meanwhile, the possible relationship between orthostatic hypertension and cognitive status has never been considered, though this condition is a risk factor for several other negative outcomes in the elderly, such as cardiovascular diseases, essential hypertension, and mortality. 11,15 We hypothesized that both orthostatic hypotension and orthostatic hypertension might carry a risk of being associated with cognitive deterioration.…”

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confidence: 99%

Orthostatic Changes in Blood Pressure and Cognitive Status in the Elderly

et al. 2016

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Abstract-We studied a cohort of 1408 older subjects to explore whether postural changes in blood pressure (BP; defined as orthostatic hypo-or hypertension) can predict the onset of cognitive deterioration. Orthostatic hypotension was defined as a drop of 20 mm Hg in systolic or 10 mm Hg in diastolic BP and orthostatic hypertension as a rise of 20 mm Hg in systolic BP. Orthostatic BP values were grouped into quintiles for secondary analyses. Two cognitive assessments were considered:(1) cognitive impairment, that is, Mini-Mental State Examination scores ≤24/30, and (2) cognitive decline (CD), that is, a 3-point decrease in Mini-Mental State Examination score from the baseline to the follow-up. At the baseline, the prevalence of orthostatic hypotension and hypertension was 18.3% and 10.9%, respectively. At the follow-up (4.4±1.2 years), 286 participants were found cognitively impaired and 138 had a CD. Using logistic regression analysis adjusted for potential baseline confounders, participants with orthostatic hypertension were at significantly higher risk of CD (odds ratio =1.50; 95% confidence intervals =1.26-1.78). Neither orthostatic hypotension nor orthostatic hypertension raised the risk of developing a cognitive impairment. Using quintiles of orthostatic BP values, we found that both decreases and increases in systolic and diastolic BP raised the risk of CD, but not of cognitive impairment. In conclusion, we found that orthostatic hypertension predicts the onset of CD, but not of cognitive impairment in the elderly, whereas orthostatic hypotension predicts neither of these conditions. Further studies are needed to confirm our findings. Correspondence to Nicola Veronese, Department of Medicine-DIMED, Geriatrics Division, University of Padova, Via Giustiniani, 2-35128, Padova, Italy. E-mail ilmannato@gmail.com or Chiara Curreri, Department of Medicine-DIMED, Geriatrics Division, University of Padova, Via Giustiniani, 2-35128 Padova, Italy. E-mail chiaracurreri@icloud.com Orthostatic Changes in Blood Pressure and Cognitive Status in the ElderlyThe Progetto Veneto Anziani Study Methods Data Source and SubjectsThis work was based on data obtained for the Progetto Veneto Anziani (Pro.V.A.) study, an observational cohort study of communitydwelling subjects aged ≥65 years residing in Camposampiero and Rovigo (2 towns in northern Italy), who were enrolled without any specific exclusion criteria. 16 Baseline visits were conducted between October 1995 and November 1997. To avoid any sampling bias, the initial sample was randomly divided into 3 (Camposampiero) and 4 (Rovigo) mutually exclusive subsets that were balanced for age and sex distribution. A random sample was selected from the first subset, and the remaining subsets were set aside. As part of the sampling strategy, age and sex were stratified to maintain a male-to-female ratio of 2:3, to oversample the oldest subjects and thereby obtain reliable estimates of conditions with low prevalence rates, and to recruit a sizable proportion of disabled individuals. Th...

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“…[7][8][9] On the contrary orthostatic hypertension, has been less thoroughly analyzed. 10 It seems to affect about 10% of older people, but its reported prevalence varies because different criteria have been adopted to define it. 11 Recent researches point to orthostatic hypertension as an emerging hemodynamic cardiovascular risk factor, particularly in older people with essential hypertension.…”

Section: Original Articlementioning

confidence: 99%

“…11 Recent researches point to orthostatic hypertension as an emerging hemodynamic cardiovascular risk factor, particularly in older people with essential hypertension. 10,12 The condition seems to be associated with more severe organ damage and a greater risk of clinical and subclinical CVD events. 11,12 To the best of our knowledge, no published data are available on the association between orthostatic hypertension and mortality.…”

mentioning

confidence: 99%

Treatment of Neurogenic Orthostatic Hypotension

Byun¹,

Kim²

2017

Res Vestib Sci

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Orthostatic blood pressure dysregulation is common among older people owing to the aging process itself as well as to dysautonomia due to comorbidities such as Parkinson's disease, cardiovascular diseases (CVD) or diabetes, and the use of medication (such as antihypertensive agents and benzodiazepines).The most often studied orthostatic blood pressure dysregulation is orthostatic hypotension, which is identified in approximately 20-30% of individuals over 65 years of age 1,2 and is associated with an increase CVD unrelated mortality. [3][4][5][6] Extensive research has also tended (with some exceptions) to support a role for orthostatic hypotension as a risk factor for CVD in the elderly. 7-9 On the contrary orthostatic hypertension, has been less thoroughly analyzed. 10 It seems to affect about 10% of older people, but its reported prevalence varies because different criteria have been adopted to define it. 11 Recent researches point to orthostatic hypertension as an emerging hemodynamic cardiovascular risk factor, particularly in older people with essential hypertension. 10,12 The condition seems to be associated with more severe organ damage and a greater risk of clinical and subclinical CVD events. 11,12 To the best of our knowledge, no published data are available on the association between orthostatic hypertension and mortality.Based on these premises, we hypothesized that not only orthostatic hypotension, but also orthostatic hypertension may be associated to a higher risk of mortality. Orthostatic Changes in Blood Pressure BACKGROUNDAn extensive, albeit contrasting literature has suggested a possible role for orthostatic hypotension as a risk factor for cardiovascular (CVD) and non-CVD mortality, while no data are available for orthostatic hypertension. We investigated whether orthostatic changes in blood pressure (BP) were associated with any increased risk of all-cause, CVD or non-CVD mortality in a group of elderly people.

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Orthostatic Hypertension

Cited by 37 publications

References 12 publications

Orthostatic changes in systolic blood pressure among SPRINT participants at baseline

Orthostatic changes in systolic blood pressure among SPRINT participants at baseline

Orthostatic Changes in Blood Pressure and Cognitive Status in the Elderly

Treatment of Neurogenic Orthostatic Hypotension

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