Postural hypotension

Gilani, Artaza; Juraschek, Stephen P; Belanger, Matthew J; Wannamethee, S. Goya

doi:10.1136/bmj.n922

Cited by 14 publications

(26 citation statements)

References 43 publications

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“…Patients should be screened for etiologies of OH, such as neurodegenerative diseases, diabetes, B12 deficiency, renal failure, rheumatologic or autoimmune conditions, dehydration, prolonged recumbency, deconditioning, and medications. 19,57 Evaluation for whether medications that contribute to orthostasis can be withdrawn or replaced is warranted. The medications most strongly associated with OH include alpha blockers, beta-blockers, tricyclic antidepressants, nitrates, phosphodiesterase-5 inhibitors, and antipsychotics.…”

Section: Management Traditional Approachesmentioning

confidence: 99%

“…The medications most strongly associated with OH include alpha blockers, beta-blockers, tricyclic antidepressants, nitrates, phosphodiesterase-5 inhibitors, and antipsychotics. 19,23,58,59 Several nonpharmacological interventions may improve orthostatic symptoms, including advising patients to change position slowly, maintaining adequate hydration, and avoiding alcohol and large meals. 19 Countermeasure maneuvers such as crossing legs while standing have evidence for improving orthostasis in a placebo-controlled cross-over study.…”

Section: Managementmentioning

confidence: 99%

“…OH is defined by various guidelines as a decrease in SBP by ≥20 mm Hg or a decrease in diastolic BP by ≥10 mm Hg when an individual stands from a seated or supine position. [17][18][19] During the normal physiological response to standing, baroreceptors in the carotid sinus and the aortic arch sense the sudden decrease in BP due to venous pooling and respond by increasing sympathetic tone and decreasing parasympathetic tone. The influx of sympathetic tone results in increased peripheral vascular resistance leading to an increase in venous return and BP augmentation.…”

Section: Oh As a Clinical Assessment Predicting Hypotensive Events An...mentioning

confidence: 99%

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Orthostatic Hypotension in Hypertensive Adults: Harry Goldblatt Award for Early Career Investigators 2021

et al. 2022

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Orthostatic hypotension affects roughly 10% of individuals with hypertension and is associated with several adverse health outcomes, including dementia, cardiovascular disease, stroke, and death. Among adults with hypertension, orthostatic hypotension has also been shown to predict patterns of blood pressure dysregulation that may not be appreciated in the office setting, including nocturnal nondipping. Individuals with uncontrolled hypertension are at particular risk of orthostatic hypotension and may meet diagnostic criteria for the condition with a smaller relative reduction in blood pressure compared with normotensive individuals. Antihypertensive medications are commonly de-prescribed to address orthostatic hypotension; however, this approach may worsen supine or seated hypertension, which may be an important driver of adverse events in this population. There is significant variability between guidelines for the diagnosis of orthostatic hypotension with regards to timing and position of blood pressure measurements. Clinically relevant orthostatic hypotension may be missed when standing measurements are delayed or when taken after a seated rather than supine position. The treatment of orthostatic hypotension in patients with hypertension poses a significant management challenge for clinicians; however, recent evidence suggests that intensive blood pressure control may reduce the risk of orthostatic hypotension. A detailed characterization of blood pressure variability is essential to tailoring a treatment plan and can be accomplished using both in-office and out-of-office monitoring.

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Section: Management Traditional Approachesmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Section: Oh As a Clinical Assessment Predicting Hypotensive Events An...mentioning

confidence: 99%

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Orthostatic Hypotension in Hypertensive Adults: Harry Goldblatt Award for Early Career Investigators 2021

et al. 2022

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“…Por otra parte, en las personas mayores con hipertensión tratada, al problema de la propia HTA y su control adecuado se puede añadir el problema de una excesiva reducción de la PA (sea de manera episódica o mantenida), que puede llevar a cifras de presión posiblemente inseguras (6,16,(18)(19)(20). Por lo tanto, en estas personas es especialmente importante lograr un equilibrio entre eficacia y seguridad en cuanto a las cifras de PA a alcanzar.…”

Section: Hipotensión En Hipertensos Mayores Tratadosunclassified

“…Los principales patrones de hipotensión ambulatoria son: la hipotensión espontánea, la postural (u ortostática [HO]), la postprandial y la inducida por fármacos (20). La hipotensión "episódica" más conocida y frecuente es la HO, o bajada ≥20 mmHg de la PA sistólica (PAS) o ≥10 mmHg de la PA diastólica (PAD), entre 1 y 3 minutos tras pasar de la posición sentada a bipedestación (6,18). Pero la HO inicial también puede ocurrir <1 minuto tras estar de pie, o puede ser diferida más allá de los 3 minutos, y puede ser difícil de detectar con técnicas convencionales en el momento de la consulta médica (7).…”

Section: Hipotensión En Hipertensos Mayores Tratadosunclassified

Hypotension in Older Treated Hypertensive Patients. Epidemiological Burden and Detection Efficiency

Banegas¹

2022

an. ranm

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Hypertension (systolic/diastolic blood pressure [SBP/DBP] ≥140 and/or ≥90 mmHg) is a very common condition in older people (prevalence >60%) and one of the leading causes of death and disability worldwide. The cardiovascular, cerebrovascular, and renal benefits of treating it properly are abundantly supported by clinical trials. However, an excessive reduction in BP (e.g., postural or pharmacological), especially if it is sustained over time, is less known but apparently more frequent than expected and clinically-efficient to detect (e.g., with ambulatory monitoring [ABPM] or home-BP self-measurement). Some studies have associated hypotension with a greater risk of fatigue, dizziness, imbalance, falls, cardiovascular disease, kidney damage, and dementia. In older and frail patients with treated hypertension, some proposed safety margins are SBP/DBP of 130-139 (if tolerated)/70-79 mmHg and, in general, BP should not be reduced below these values. Orthostatic hypotension (>20/10 mmHg fall in SBP/DBP within 3 minutes of erect standing) and ambulatory hypotension (mean daytime BP <110/70 mmHg) can be detected measuring standing BP in the office and with 24-hour ABPM, respectively. Several studies suggest that there may not be a single treatment goal for all patients because the BP/outcome relation seems to be modified by the patient’s age, co-morbidities, drugs, etc., and ignorance of this can lead to hypotension and other deleterious effects. The balance between efficacy and safety of the drug treatment of hypertension can be reasonably achieved by the good doctor practicing personalized medicine, individualizing the treatment of each of his older patients (who are genetic, demographic, physiological, metabolic, psychological, and culturally different), combining the updated scientific evidence, his/her experience and comprehensive knowledge of the patient (age, co-morbidities, etc), and the preferences of the patient or their caregiver. Most of this review is supported by some recent clinical practice guidelines.

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Regulation of Cardiac and Vascular Function

Greaney¹,

Kucia²

2022

Cardiac Care

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Postural hypotension

Cited by 14 publications

References 43 publications

Orthostatic Hypotension in Hypertensive Adults: Harry Goldblatt Award for Early Career Investigators 2021

Orthostatic Hypotension in Hypertensive Adults: Harry Goldblatt Award for Early Career Investigators 2021

Hypotension in Older Treated Hypertensive Patients. Epidemiological Burden and Detection Efficiency

Regulation of Cardiac and Vascular Function

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