Risk Factors for Orthostatic Hypotension: Differences Between Elderly Men and Women

Méndez, Andrea S; Melgarejo, Jesús D.; Mena, Luis J.; Chávez, Carlos; Gonzalez, A.; Boggia, José; Terwilliger, Joseph D.; Lee, Joseph H.; Maestre, Gladys E.

doi:10.1093/ajh/hpy050

Cited by 21 publications

(21 citation statements)

References 36 publications

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“…In previous studies, no relationship between occurrence of OH after spinal surgery and BMI has been reported. In Parkinson’s disease, low BMI is considered to be a risk factor for OH [ 24 , 25 ], which is consistent with a study on risk factors for OH in elder people [ 26 ]. This is considered with reduced autonomic function and lower leptin levels (a hormone produced by fat cells that possibly mediating the inhibition of sympathetic excitation).…”

Section: Discussionsupporting

confidence: 79%

Orthostatic hypotension following posterior spinal fusion surgeries for spinal deformity correction in adolescents: prevalence and risk factors

Yang

Chen

Tong

et al. 2021

BMC Musculoskelet Disord

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Study design Retrospective case series. Objectives This study aimed to determine the prevalence and risk factors for orthostatic hypotension (OH) in adolescents undergoing posterior spinal fusion for spinal deformity correction. Methods The data of 282 consecutive adolescents who underwent posterior spinal fusion for spinal deformity correction in our center over 12 months were retrieved. Patient characteristics, including whether laminectomy or osteotomy was performed during the surgery, the occurrence of postoperative nausea and vomiting (PONV), perioperative hemoglobin albumin changes, perioperative blood transfusion, length of bed rest, willingness to ambulate, length of postoperative exercises of the lower limbs, and length of hospital stay, were collected and compared statistically between patients who did and did not develop postoperative OH. Results Of 282 patients, 197 (69.86%) developed OH postoperatively, and all cases completely resolved 5 days after the first out-of-bed exercises. Significant differences in the incidence of PONV, the willingness to ambulate and the length of postoperative exercises of the lower limbs were observed. The mean length of hospital stay of the patients with OH was longer than that of the patients without OH. Conclusion Our study suggests that temporary OH is a common manifestation following posterior spinal fusion for spinal deformity correction in adolescents. Postoperative OH may increase the length of hospital stay in these patients. Patients with PONV, who are not willing to ambulate and who perform postoperative lower limb exercises for a shorter time are more likely to have OH.

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Section: Discussionsupporting

confidence: 79%

Orthostatic hypotension following posterior spinal fusion surgeries for spinal deformity correction in adolescents: prevalence and risk factors

Yang

Chen

Tong

et al. 2021

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…It is well known that orthostatic hypotension is more prevalent in the elderly and similarly in our cohort orthostatic patients were older ( p = 0.001) [ 18 ]. These patients had a lower BMI ( p = 0.045) as well which has also been reported in the general population [ 19 ]. Lower ambulatory diastolic blood pressure was associated with orthostatic hypotension in the univariate analysis ( p = 0.011) and a lower ambulatory systolic blood pressure in our multivariate analysis.…”

Section: Discussionsupporting

confidence: 72%

CD-19 CART therapy and orthostatic hypotension: a single center retrospective cohort study

et al. 2022

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Background Chimeric antigen receptor T-cell (CART) therapy is a form of cellular immunotherapy used to treat hematologic malignancies. Major adverse cardiovascular events have been seen in CART patients who have high grade CRS, higher baseline creatinine, and troponin elevation. However, the incidence and factors associated with orthostatic hypotension after CART therapy have not previously been reported in the literature. Methods We looked at patients who underwent CD-19 directed CART therapy at UPMC Shadyside hospital from April 1st 2018 to December 1st 2020. Patients were classified as having orthostatic hypotension if they had recorded orthostatic vital signs that were positive or provider notes indicated that vitals had been taken and were positive in the time period from discharge to 3 months post-CART. Data was analyzed with univariate and multivariate analysis using logistic regression. Results 79% of patients had orthostatic hypotension after discharge from their CART hospitalization and 64% of those patients were symptomatic. Older age, lower BMI, lower ambulatory diastolic blood pressure and grade 2 CRS were associated with orthostatic hypotension in the univariate analysis. Older age and lower ambulatory systolic blood pressure were associated with orthostatic hypotension in the multivariate analysis. Symptomatic orthostatic hypotension was associated with a history of hypertension in both the univariate and multivariate analysis. Patients with symptoms also had a higher pre-CART ejection fraction but this association was not seen in the regression model. Conclusion There is a high incidence of orthostatic hypotension after CART therapy even after discharge. Therefore, orthostatic vitals signs and associated symptoms should be assessed in both the inpatient and outpatient setting. Older patients and patients with lower BMIs, lower ambulatory blood pressures, grade 2 CRS, or a history of hypertension may need closer monitoring.

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“…Participants were non-smokers and free of any cardiorespiratory disease 20.0–90.0 BP was measured in the right arm using a mercury sphygmomanometer after 5 min of supine rest and at 1 and 3 min following standing. The average of two readings were taken to determine BP 8.9 Mendez 2018 [ 52 ] Male and female participants aged over 55 years, residing in Venezuela 66.7 BP was measured in the supine position and at 1 and 3 min after standing using the same oscillometric device (Dinamap 8100, Critikon Inc., Tampa, FL, USA) 19.3 Nguyen 2017 [ 53 ] Male and female participants, aged 60 years or older, able to communicate and sit and stand in 3 min, residing in Ben Tre, a Southern Province Vietnam 70.4 After at least 15 min of rest, two seated BP measurements were obtained, separated by 5 min. The mean of the two sitting BPs were used for analysis.…”

Section: Resultsmentioning

confidence: 99%

Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis

2021

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Background Postural hypotension (PH), the reduction in blood pressure when rising from sitting or lying 0to standing, is a risk factor for falls, cognitive decline and mortality. However, it is not often tested for in primary care. PH prevalence varies according to definition, population, care setting and measurement method. The aim of this study was to determine the prevalence of PH across different care settings and disease subgroups. Methods Systematic review, meta-analyses and meta-regression. We searched Medline and Embase to October 2019 for studies based in primary, community or institutional care settings reporting PH prevalence. Data and study level demographics were extracted independently by two reviewers. Pooled estimates for mean PH prevalence were compared between care settings and disease subgroups using random effects meta-analyses. Predictors of PH were explored using meta-regression. Quality assessment was undertaken using an adapted Newcastle-Ottawa Scale. Results One thousand eight hundred sixteen studies were identified; 61 contributed to analyses. Pooled prevalences for PH using the consensus definition were 17% (95% CI, 14–20%; I2 = 99%) for 34 community cohorts, 19% (15–25%; I2 = 98%) for 23 primary care cohorts and 31% (15–50%; I2 = 0%) for 3 residential care or nursing homes cohorts (P = 0.16 between groups). By condition, prevalences were 20% (16–23%; I2 = 98%) with hypertension (20 cohorts), 21% (16–26%; I2 = 92%) with diabetes (4 cohorts), 25% (18–33%; I2 = 88%) with Parkinson’s disease (7 cohorts) and 29% (25–33%, I2 = 0%) with dementia (3 cohorts), compared to 14% (12–17%, I2 = 99%) without these conditions (P < 0.01 between groups). Multivariable meta-regression modelling identified increasing age and diabetes as predictors of PH (P < 0.01, P = 0.13, respectively; R2 = 36%). PH prevalence was not affected by blood pressure measurement device (P = 0.65) or sitting or supine resting position (P = 0.24), however, when the definition of PH did not fulfil the consensus description, but fell within its parameters, prevalence was underestimated (P = 0.01) irrespective of study quality (P = 0.04). Conclusions PH prevalence in populations relevant to primary care is substantial and the definition of PH used is important. Our findings emphasise the importance of considering checking for PH, particularly in vulnerable populations, to enable interventions to manage it. These data should contribute to future guidelines relevant to the detection and treatment of PH. PROSPERO:CRD42017075423.

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Risk Factors for Orthostatic Hypotension: Differences Between Elderly Men and Women

Abstract: Although the prevalence of OH is similar in both sexes, there are different risk factors associated by sex. Systolic BP ≥140 mm Hg was associated with increased risk of OH only with women while BMI was a protective factor for OH in men and women.

Cited by 21 publications

References 36 publications

Orthostatic hypotension following posterior spinal fusion surgeries for spinal deformity correction in adolescents: prevalence and risk factors

Orthostatic hypotension following posterior spinal fusion surgeries for spinal deformity correction in adolescents: prevalence and risk factors

CD-19 CART therapy and orthostatic hypotension: a single center retrospective cohort study

Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis

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