Standing Up Slowly Antagonises Initial Blood Pressure Decrease in Older Adults with Orthostatic Hypotension

Abstract

Background: Orthostatic hypotension (OH) is common in older adults and associated with increased morbidity and mortality, loss of independence and high health-care costs. Standing up slowly is a recommended non-pharmacological intervention. However, the effectiveness of this advice has not been well studied. Objectives: The aim of this study was to investigate whether standing up slowly antagonises posture-related blood pressure (BP) decrease in a clinically relevant population of geriatric outpatients. Methods: In this cross-sectional study, 24 community-dwelling older adults referred to a geriatric outpatient clinic and diagnosed with OH were included. BP was measured continuously during 3 consecutive transitions from supine to standing position during normal, slow and fast transition. Results: The relative BP decrease at 0-15 s after slow transition was significantly lower than after normal transition (p = 0.003 for both systolic BP and diastolic BP) and fast transition (p = 0.045 for systolic BP; diastolic BP: non-significant). The relative diastolic BP decrease at 60-180 s after normal transition was significantly lower than after fast transition (p = 0.029). Conclusion: Standing up slowly antagonises BP decrease predominantly during the first 15 s of standing up in a clinically relevant population of geriatric outpatients diagnosed with OH. Results support the non-pharmacological intervention in clinical practice to counteract OH.

Orthostatic Intolerance in Older Persons: Etiology and Countermeasures

“…Some other countermeasures that could potentially prevent orthostatic intolerance include standing up slowly (de Bruïne et al, 2017 ). Standing up slowly in older persons with histories of orthostatic hypotension has been shown to antagonize the blood pressure decreases within the first 15 sec of changes in posture/ standing (de Bruïne et al, 2017 ).…”

“…For instance, orthostatic tolerance has been shown to be improved by exercise (Howden et al, 2004 ), water drinking (Schroeder et al, 2002 ), and mental arithmetic (Goswami et al, 2012a ). Other countermeasures that could potentially prevent or mitigate orthostatic intolerance can include simple measures such as standing up slowly (de Bruïne et al, 2017 ) and/or compression of abdominal region (Figueroa et al, 2010 ). For bed confined persons, countermeasures can include cognitive training (Goswami et al, 2015 ) and nutritional supplementation (Muscaritoli et al, 2017 )—with and without physical activity—in mitigating orthostatic intolerance.…”

Multimodal Monitoring of Cardiovascular Responses to Postural Changes

“…Orthostatic hypotension (OH), defined as a blood pressure (BP) drop of at least 20 mm Hg systolic and/or >10 mm Hg diastolic after postural change (Freeman et al, 2011), is highly prevalent in older adults (Cooke et al, 2013;Frewen et al, 2014;Timmermans et al, 2018), whereas the effectiveness of non-pharmacological interventions are limited (De Bruïne et al, 2017). OH may be accompanied by clinical symptoms, e.g., lightheadedness and dizziness (Juraschek et al, 2017(Juraschek et al, , 2018, and is associated with poor clinical outcome such as impaired physical performance (Pasma et al, 2014;de Bruïne et al, 2018;Mol et al, 2018b), falls (Saedon et al, 2016;Mol et al, 2018a), cognition (Iseli et al, 2019), cardiovascular diseases (Verwoert et al, 2008;Ricci et al, 2015) and mortality (Verwoert et al, 2008;Lagro et al, 2012;Rockwood et al, 2012;Ricci et al, 2015;Frith et al, 2016).…”

Functional Analysis of Continuous, High-Resolution Measures in Aging Research: A Demonstration Using Cerebral Oxygenation Data From the Irish Longitudinal Study on Aging

“…The study of the orthostatic response to standing from supine is of interest in older adults given its relationship with falls, depression and mortality (McCrory et al, 2016 ; Finucane et al, 2017 ; Briggs et al, 2019 ). Given the range in older adult mobility, the speed at which the transition is completed is an important source of variation that is associated with both timing and magnitude of hemeodynamic parameters (de Bruïne et al, 2017 ; Mol et al, 2019 ; O’Connor et al, 2020 ). The musculoskeletal effort of standing causes vasodilation in the lower limbs (as evidenced by larger changes during active vs. passive stand; van Wijnen et al, 2017 ).…”

“…Whereas TCD measures the CBF in the basal arteries of the brain, near-infrared spectroscopy (NIRS) may be used to measure cerebral oxygenation levels (Colier et al, 1997 ; Mehagnoul-Schipper et al, 2000 ; Kawaguchi et al, 2001 ; Kim et al, 2018 ; Mol et al, 2019 ). Although sit-to-stand or supine-to-stand tests are suitable for older adults, the speed of postural transition is heterogeneous and the hemeodynamic response is influenced by standing speed (de Bruïne et al, 2017 ; Mol et al, 2019 ; O’Connor et al, 2020 ). This is not unexpected given that much of the physiological response to standing is driven by muscle activation in the lower limbs (van Wijnen et al, 2017 ).…”