When should orthostatic blood pressure changes be evaluated in elderly: 1st, 3rd or 5th minute?

Soysal, Pınar; Aydın, Ali Ekrem; Okudur, Saadet Koç; Işık, Ahmet Turan

doi:10.1016/j.archger.2016.03.022

Cited by 24 publications

(14 citation statements)

References 27 publications

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“…There is, however, no consensus regarding the best moment within this period. In order to determine the most appropriate moment, one study 25 evaluated 407 elderly patients (average age of 78.7 ± 7.8 for patients with OH and 74.1 ± 8.6 for patients without OH at 3 minutes) 1, 3, and 5 minutes after standing. The prevalences were 21.86%, 21.37%, and 19.90%, respectively, and the parameters associated with OH were the same during the three moments.…”

Section: Discussionmentioning

confidence: 99%

A Prevalência da Hipotensão Ortostática e a Distribuição da Variação Pressórica no Estudo Longitudinal da Saúde do Adulto

Velten¹,

Benseñor²,

Lotufo³

et al. 2020

Arquivos Brasileiros De Cardiologia

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Background: Orthostatic hypotension (OH) has been neglected in clinical practice, and there are no studies on its prevalence in the Brazilian population. Objective: To determine the prevalence of OH and blood pressure (BP) changes after the postural change maneuver in participants of the Longitudinal Study of Adult Health. Methods: In this descriptive study of baseline data (N = 14,833 adults, ages 35-74 years), participants remained lying down for 20 minutes and subsequently stood up actively. BP measurements were taken while the participants were supine and at 2, 3, and 5 minutes after standing. OH was defined as a reduction of ≥ 20 mmHg in systolic BP and/or a reduction of ≥ 10 mmHg in diastolic BP at 3 minutes, and its prevalence was determined with a 95% confidence interval (CI). The distribution of BP variation after the postural change maneuver was determined in a subsample (N = 8,011) obtained by removing patients with cardiovascular morbidity and/or diabetes. Results: The prevalence of OH was 2.0% (95% CI: 1.8-2.3), increasing with age. If the criterion applied were a BP reduction during any measurement, the prevalence would increase to 4.3% (95% CI: 4.0-4.7). Symptoms (dizziness, scotoma, nausea, etc.) were reported by 19.7% of participants (95% CI: 15.6-24.6) with OH and 1.4% (95% CI: 1.2-1.6) of participants without OH. The −2 Z-scores of BP variation before and after the postural change maneuver in the subsample were −14.1 mmHg for systolic BP and −5.4 mmHg for diastolic BP. Conclusion: Prevalence of OH varies depending on when BP is measured. Current cutoff points may underestimate the actual occurrence of OH in the population.

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Section: Discussionmentioning

confidence: 99%

A Prevalência da Hipotensão Ortostática e a Distribuição da Variação Pressórica no Estudo Longitudinal da Saúde do Adulto

Velten¹,

Benseñor²,

Lotufo³

et al. 2020

Arquivos Brasileiros De Cardiologia

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“…Appendix E provides the forest plots showing individual study data, stratified by study population, for each physical functioning category. OH was significantly associated with objective or self-reported balance impairment in all populations ( 2014) and four studies reported subjective balance measures (overall OR 0.83, 95% CI 0.71-0.97) (Mader et al, 1987;Oishi et al, 2016;Rutan et al, 1992;Soysal et al, 2016). OH was not associated with gait characteristics, mobility, walking speed, TUG, HGS, physical frailty and physical activity (Figs.…”

Section: Meta-analysismentioning

confidence: 95%

“…Outcome measures of studies included in and excluded from the meta-analyses, per physical functioning category. Oishi et al, 2016;Rutan et al, 1992;Soysal et al, 2016 Gray Gaxatte et al, 2017;Merola et al, 2016Bendini et al, 2007Siennicki-Lantz et al, 1999 Insufficient…”

Section: Table D1mentioning

confidence: 99%

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Orthostatic hypotension and physical functioning in older adults: A systematic review and meta-analysis

Mol

Reijnierse

Hoang

et al. 2018

Ageing Research Reviews

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Background: Orthostatic hypotension (OH) may negatively affect physical functioning and aggravate morbidities, but existing evidence is contradictory. Methods: MEDLINE (from 1946), PubMed (from 1966) and EMBASE databases (from 1947) were systematically searched for studies on the association of OH and physical functioning in older adults, categorized as: balance, gait characteristics, walking speed, Timed Up and Go time, handgrip strength (HGS), physical frailty, exercise tolerance, physical activity, activities of daily living (ADL), and performance on the Hoehn and Yahr scale (HY) and Unified Parkinson's Disease Rating Scale (UPDRS). Study quality was assessed using the Newcastle Ottawa Scale. Results: Forty-two studies were included in the systematic review (29,421 individuals) and 29 studies in the meta-analyses (23,879 individuals). Sixteen out of 42 studies reported a significant association of OH with worse physical functioning. Meta-analysis showed a significant association of OH with impaired balance, ADL performance and HY/UPDRS III performance, but not with gait characteristics, mobility, walking speed, TUG, HGS, physical frailty, exercise tolerance, physical activity and UPDRS II performance. Conclusions: OH was associated with impaired balance, ADL performance and HY/UPDRS III performance, but not with other physical functioning categories. The results suggest that OH interventions could potentially improve some aspects of physical functioning.

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“…The HUT was used for the diagnosis of OH, as stated in our previous studies [4, 14, 19]. The diagnosis of OH was made in the event of a 20 mm Hg or higher decrease in systolic blood pressure and/or a 10 mm Hg or higher decrease in diastolic blood pressure during the transition from the supine position to the upright position within 3 min during the HUT [20].…”

Section: Methodsmentioning

confidence: 99%

The Relationship between the Most Common Subtypes of Dementia and Orthostatic Hypotension in Older Adults

Işık

Koçyiğit²,

Kaya

et al. 2020

Dement Geriatr Cogn Disord

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Background: It is crucial to evaluate the causes of morbidity and mortality in elderly patients with dementia, such as orthostatic hypotension (OH), which may affect their daily life activities, reduce the quality of life, and increase the caregiver burden. Objective: We aimed to investigate the relationship between OH and the most common subtypes of dementia in detail. Methods: A total of 268 older adults with dementia diagnosed with Alzheimer’s disease (AD), dementia with Lewy bodies (DLB), vascular dementia (VaD), and behavioral variant frontotemporal dementia (bvFTD), and 539 older adults without dementia were included in this prospective study. Comprehensive geriatric assessment including comorbidity, medication evaluation, and the head-up tilt test was also performed. Results: Of the participants, 13.8, 8.3, 6.4, and 4.8% had AD, DLB, bvFTD, and VaD, respectively. After adjusting for age, gender, the presence of comorbidities, and usage of OH-induced drugs; AD, DLB, and VaD were associated with OH (odds ratio [OR]: 2.23 confidence interval [CI] 95% 1.31–3.80; p = 0.003; OR: 3.68 CI 95% 1.98–6.83; p < 0.001, and OR: 3.56 CI 95% 1.46–8.69; p = 0.005, respectively). Furthermore, VaD was independently related to diastolic OH (OR: 4.19 CI 95% 1.66–10.57; p = 0.002), whereas AD and DLB were not. Conclusions: This study shows that elderly patients with DLB, AD, and VaD often have OH, a disabling autonomic dysfunction feature. Moreover, diastolic OH may play a role in the development of VaD. Therefore, considering potential complications of OH, it is essential to evaluate OH in the follow-up and management of those patients.

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When should orthostatic blood pressure changes be evaluated in elderly: 1st, 3rd or 5th minute?

Cited by 24 publications

References 27 publications

A Prevalência da Hipotensão Ortostática e a Distribuição da Variação Pressórica no Estudo Longitudinal da Saúde do Adulto

A Prevalência da Hipotensão Ortostática e a Distribuição da Variação Pressórica no Estudo Longitudinal da Saúde do Adulto

Orthostatic hypotension and physical functioning in older adults: A systematic review and meta-analysis

The Relationship between the Most Common Subtypes of Dementia and Orthostatic Hypotension in Older Adults

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