Physical countermeasures to increase orthostatic tolerance

Wieling, Wouter; Dijk, Nynke van; Thijs, Roland D.; Lange, Frederik J. de; Krediet, C. T. Paul; Halliwill, John R.

doi:10.1111/joim.12249

Cited by 81 publications

(58 citation statements)

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“…4) [9, 10, 22]. The effect of buttock clenching on complaints during long-term follow-up can thereby be used as the reference that the diagnosis of IOH is correct [23–25].…”

Section: Discussionmentioning

confidence: 99%

“…The effect of buttock clenching on complaints during long-term follow-up can thereby be used as the reference that the diagnosis of IOH is correct [23–25]. This emphasizes an important aspect of laboratory testing, namely the effects of physical counterpressure maneuvers can be demonstrated to the patient on a video screen [22]. An additional advantage to use squatting for instructions to patients is that it can be demonstrated that squatting itself increases BP instantaneously and thereby can be used as an emergency measure to abort an impending syncope [9–11].…”

Section: Discussionmentioning

confidence: 99%

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Initial orthostatic hypotension in teenagers and young adults

et al. 2016

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ObjectiveTo assess: (1) the frequency of an abnormally large fall in blood pressure (BP) upon standing from supine in patients with initial orthostatic hypotension (IOH); (2) the underlying hemodynamic mechanisms of this fall in BP upon standing from supine and from squatting.MethodsIn a retrospective study of 371 patients (≤30 years) visiting the syncope unit, the hemodynamic response to standing and squatting were studied in 26 patients who were diagnosed clinically with IOH, based on history taking only. In six patients changes in cardiac output (CO) and systemic vascular resistance (SVR) were determined, and the underlying hemodynamics were analyzed.Results15/26 (58 %) patients with IOH had an abnormally large initial fall in systolic BP (≥40 mmHg). There was a large scatter in CO and SVR response after arising from supine [ΔCO at BP nadir median −8 % (range −37, +27 %); ΔSVR at BP nadir median −31 % (range −46, +10 %)]. The hemodynamic response after squatting showed a more consistent pattern, with a fall in SVR in all six patients [ΔCO at BP nadir median +23 % (range −12, +31 %); ΔSVR at BP nadir median −42 %, (range −52, −35 %)].InterpretationThe clinical diagnosis of IOH is based on history taking, as an abnormally large fall in systolic BP can only be documented in 58 %. For IOH upon standing after supine rest, the hemodynamic mechanism can be either a large fall in CO or in SVR. For IOH upon arising from squatting a large fall in SVR is a consistent finding.

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“…4) [9, 10, 22]. The effect of buttock clenching on complaints during long-term follow-up can thereby be used as the reference that the diagnosis of IOH is correct [23–25].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Initial orthostatic hypotension in teenagers and young adults

et al. 2016

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“…30 Considering the literature in human studies, very few authors have reported an association between hypovitaminosis D and OH. [8][9][10][11][12] Altogether these studies suggested that participants with OH had significantly lower serum 25OHD levels and that after the correction for potential confounders the association remain significant, although the number and kind of covariates included seem to be important to explain this association.…”

Section: A C C E P T E D Accepted Manuscript 12mentioning

confidence: 99%

Hypovitaminosis D predicts the onset of orthostatic hypotension in older adults

Veronese

Trevisan

Bolzetta

et al. 2016

Journal of the American Society of Hypertension

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A number of small cross sectional studies have demonstrated that hypovitaminosis D (represented by low 25 hydroxyvitamin D (25OHD) levels) is associated with orthostatic hypotension (OH). We investigated if hypovitaminosis D is associated with the onset of OH in older adults over a followup of 4.4 years. 25OHD was categorized using sex specific quartiles; OH was defined as a drop of ≤20 mm Hg in systolic or ≤10 mm Hg in diastolic blood pressure <3 minutes of standing. Among 1,308 elderly without OH at baseline, using an adjusted logistic regression analysis and taking those with higher baseline serum 25OHD as reference, there was a significant increase in the onset of OH in those with lower serum 25OHD levels. The association was significant only in women when we stratified by sex. In conclusion, hypovitaminosis D predicts the onset of OH in older adults, particularly in women.

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“…More pronounced splanchnic pooling during orthostasis may result in more stimulation of vascular subdiaphramatic receptors that are postulated to play a role in orthostatic adjustment by causing vasoconstriction and augmentation of the carotid baroreflex (Doe et al, 1996). Other obvious differences with LBNP are that during free standing the carotid baroreceptors are always above the heart and the static increase in skeletal muscle tone during active standing opposes pooling of blood in limb veins (Wieling and van Lieshout, 2008; Wieling et al, 2014). Increases in skeletal muscle tone are a key factor in orthostatic adjustment.…”

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confidence: 99%