The Influence of Age and Blood Pressure on the Hemodynamic and Humoral Response to Head‐Up Tilt

Abstract

It has been reported that postural hypotension in the elderly is common. However, these studies included institutionalized and more or less disabled persons. Furthermore, postural hypotension may be related to baseline blood pressure. In this study, the influence of age and blood pressure on the hemodynamic and plasma catecholamine responses to orthostatic stress was investigated in young and old normotensive and hypertensive healthy subjects. In normotensive and hypertensive elderly persons, the percentage blood pressure responses during tilt were not significantly different from that seen in young normotensives. We measured a slight decrease of systolic blood pressure and a slight increase of diastolic blood pressure. The hypertensive young patients showed an enhanced diastolic blood pressure response with no fall in systolic blood pressure, in contrast to the normotensive young subjects. Both elderly groups had a lower increase of heart rate than the young subjects. The percentage increase in norepinephrine after tilting was significantly lower in elderly hypertensives than in elderly normotensives and young hypertensives. The presence of hypertension was associated with a decrease in blood pressure, but age had no influence on the change in blood pressure during tilt. In this group of healthy elderly subjects, there was no significant orthostatic hypotension when the blood pressure course of the entire tilt test was taken into account.

Intraindividual Reproducibility of Postprandial and Orthostatic Blood Pressure Changes in Older Nursing‐Home Patients: Relationship with Chronic Use of Cardiovascular Medications

“…In contrast, when cardiovascular medications were given, systolic BP remained stable during the 10‐minute period of standing, whereas when no medication was administered, there was an initial decline followed by an increase in systolic BP. This difference may be explained by a small but nonsignificant difference in baseline BP inasmuch as it has been demonstrated that higher supine BPs are associated with greater declines after standing 15,20,26 …”

Aging and Arterial Blood Pressure Variability during Orthostatic Challenge

“…Since aging has been reported to be associated with decreases in leg venous compliance [21,23], the exacerbated ABP instability in the older subjects is probably not due to greater LBNPinduced peripheral venous pooling [31]. On the other hand, it has been demonstrated that increases in blood plasma norepinephrine concentrations are not significantly different between older and younger healthy subjects in response to either head-up tilt [6,11] or LBNP [34], despite the finding that muscle sympathetic nerve responses to LBNP appear to be augmented in older subjects [3]. However, it has been established that aging is associated with a decrease in ·-adrenoceptor sensitivity [3,9].…”

Cerebral oxygenation responses to standing in elderly patients with predominantly diastolic dysfunction

“…In 40–50% of elderly patients, heart failure is caused by left ventricular diastolic dysfunction as a result of increased interstitial connective tissue depositions, decreased cardiovascular compliance and compensatory left ventricular hypertrophy (Rich, 1997; Tresch, 1997). Because standing results in a decreased pre‐load by a reduced venous return and in an increased afterload by higher peripheral resistance, diminished ventricular function may increase the risk of orthostatic cerebral symptoms (Levine et al , 1983; Jansen et al , 1989; Wei, 1992; Raiha et al , 1995; van Kraaij et al , 2000).…”