Skip to main content

Advertisement

SpringerLink
Log in

Intolerance to initial orthostasis relates to systolic BP changes in elders

  • Research Article
  • Published:
Clinical Autonomic Research Aims and scope Submit manuscript

Abstract

Objectives

To explore the association of early symptoms of orthostatic intolerance (OI) with systolic (SBP), diastolic (DBP) and mean arterial (MAP) blood pressure changes in a sample of community-dwelling older people undergoing an active stand test; and to establish whether SBP and DBP changes have different symptomatic correlates during early orthostasis.

Methods

A total of 224 community-dwelling older subjects (mean age 72.6 years, 68.8% females) were included. All had a Mini-Mental State Examination score ≥23 and no risk factors for autonomic neuropathy. Subjects were monitored with the Finometer™ Pro device. Variables reflecting blood pressure changes (absolute low: nadir, magnitude of drop: delta, and speed of recovery) were extracted for SBP, DBP and MAP with the BeatScope™ software (5-s averages method), and correlated with self-reported OI during active stand.

Results

Of the 224 subjects, 62 (27.7%) reported OI. SBP changes had strong bivariate associations with OI, but not DBP changes. A logistic regression model suggested that the rate of recovery of SBP during the first 30 s following active stand is more important as a determinant of OI than SBP nadir or delta. Subjects who recovered at least 80% of their baseline SBP within 30 s post-stand were very unlikely to report OI.

Interpretation

Our study suggests that orthostatic SBP changes may be more important than DBP changes as determinants of early OI during active stand. The crucial importance of the quick recovery of SBP in order to avoid OI is biologically plausible and is discussed in the context of initial OH pathophysiology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. (1996) Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Neurology 46:1470

  2. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ (2003) The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 289:2560–2572

    Article  CAS  PubMed  Google Scholar 

  3. Craig GM (1994) Clinical presentation of orthostatic hypotension in the elderly. Postgrad Med J 70:638–642

    Article  CAS  PubMed  Google Scholar 

  4. Cullen B, Fahy S, Cunningham CJ, Coen RF, Bruce I, Greene E, Coakley D, Walsh JB, Lawlor BA (2005) Screening for dementia in an Irish community sample using MMSE: a comparison of norm-adjusted versus fixed cut-points. Int J Geriatr Psychiatry 20:371–376

    Article  PubMed  Google Scholar 

  5. Duron E, Lenoir H, Pequignot R, Lefevre M, Rigaud AS, Hanon O (2007) What is the most relevant definition of orthostatic hypotension: systolic blood pressure drop, diastolic blood pressure drop, or both? Arch Mal Coeur Vaiss 100:689–694

    CAS  PubMed  Google Scholar 

  6. Eysenck HJ, Eysenck SBG (1984) Manual of the Eysenck personality inventory. Hodder and Stoughton Limited, Sevenoaks

    Google Scholar 

  7. Eysenck HJ, Eysenck SBG (1991) Manual of the Eysenck Personality Scales (EPS Adult). Hodder & Stoughton, London

    Google Scholar 

  8. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–M156

    CAS  PubMed  Google Scholar 

  9. Guelen I, Westerhof BE, Van Der Sar GL, Van Montfrans GA, Kiemeneij F, Wesseling KH, Bos WJ (2003) Finometer, finger pressure measurements with the possibility to reconstruct brachial pressure. Blood Press Monit 8:27–30

    Article  PubMed  Google Scholar 

  10. Hiitola P, Enlund H, Kettunen R, Sulkava R, Hartikainen S (2009) Postural changes in blood pressure and the prevalence of orthostatic hypotension among home-dwelling elderly aged 75 years or older. J Hum Hypertens 23:33–39

    Article  CAS  PubMed  Google Scholar 

  11. Hoad A, Spickett G, Elliott J, Newton J (2008) Postural orthostatic tachycardia syndrome is an under-recognized condition in chronic fatigue syndrome. QJM 101:961–965

    Article  CAS  PubMed  Google Scholar 

  12. Lang TA, Secic M (2006) How to report statistics in medicine: annotated guidelines for authors, editors, and reviewers. American College of Physicians, Philadelphia

    Google Scholar 

  13. Low PA (2008) Prevalence of orthostatic hypotension. Clin Auton Res 18(Suppl 1):8–13

    Article  PubMed  Google Scholar 

  14. Luukinen H, Koski K, Laippala P, Kivela SL (1999) Prognosis of diastolic and systolic orthostatic hypotension in older persons. Arch Intern Med 159:273–280

    Article  CAS  PubMed  Google Scholar 

  15. Masaki KH, Schatz IJ, Burchfiel CM, Sharp DS, Chiu D, Foley D, Curb JD (1998) Orthostatic hypotension predicts mortality in elderly men: the Honolulu Heart Program. Circulation 98:2290–2295

    CAS  PubMed  Google Scholar 

  16. Mattace-Raso FU, van der Cammen TJ, Knetsch AM, van den Meiracker AH, Schalekamp MA, Hofman A, Witteman JC (2006) Arterial stiffness as the candidate underlying mechanism for postural blood pressure changes and orthostatic hypotension in older adults: the Rotterdam Study. J Hypertens 24:339–344

    Article  CAS  PubMed  Google Scholar 

  17. McDonald M, Hertz RP, Unger AN, Lustik MB (2009) Prevalence, awareness, and management of hypertension, dyslipidemia, and diabetes among United States adults aged 65 and older. J Gerontol A Biol Sci Med Sci 64:256–263

    PubMed  Google Scholar 

  18. Naschitz JE, Rosner I (2007) Orthostatic hypotension: framework of the syndrome. Postgrad Med J 83:568–574

    Article  PubMed  Google Scholar 

  19. Novak V, Novak P, Spies JM, Low PA (1998) Autoregulation of cerebral blood flow in orthostatic hypotension. Stroke 29:104–111

    CAS  PubMed  Google Scholar 

  20. Nozawa I, Imamura S, Hashimoto K, Nakayama H, Murakami Y (1997) The relationship between orthostatic dizziness and hypotension in male medical students. Auris Nasus Larynx 24:53–58

    Article  CAS  PubMed  Google Scholar 

  21. Passant U, Warkentin S, Karlson S, Nilsson K, Edvinsson L, Gustafson L (1996) Orthostatic hypotension in organic dementia: relationship between blood pressure, cortical blood flow and symptoms. Clin Auton Res 6:29–36

    Article  CAS  PubMed  Google Scholar 

  22. Ram CV, Meese R, Kaplan NM, Devous MD Sr, Bonte FJ, Forland SC, Cutler RE (1987) Antihypertensive therapy in the elderly. Effects on blood pressure and cerebral blood flow. Am J Med 82:53–57

    Article  CAS  PubMed  Google Scholar 

  23. Sahni M, Lowenthal DT, Meuleman J (2005) A clinical, physiology and pharmacology evaluation of orthostatic hypotension in the elderly. Int Urol Nephrol 37:669–674

    Article  PubMed  Google Scholar 

  24. Shibao C, Grijalva CG, Raj SR, Biaggioni I, Griffin MR (2007) Orthostatic hypotension-related hospitalizations in the United States. Am J Med 120:975–980

    Article  PubMed  Google Scholar 

  25. Siennicki-Lantz A, Lilja B, Rosen I, Elmstahl S (1998) Cerebral blood flow in white matter is correlated with systolic blood pressure and EEG in senile dementia of the Alzheimer type. Dement Geriatr Cogn Disord 9:29–38

    Article  CAS  PubMed  Google Scholar 

  26. Staud R (2008) Autonomic dysfunction in fibromyalgia syndrome: postural orthostatic tachycardia. Curr Rheumatol Rep 10:463–466

    Article  PubMed  Google Scholar 

  27. Traub YM, Shapiro AP, Dujovny M, Nelson D (1982) Cerebral blood flow changes with diuretic therapy in elderly subjects with systolic hypertension. Clin Exp Hypertens A 4:1193–1201

    Article  CAS  PubMed  Google Scholar 

  28. van der Velde N, van den Meiracker AH, Stricker BH, van der Cammen TJ (2007) Measuring orthostatic hypotension with the Finometer device: is a blood pressure drop of one heartbeat clinically relevant? Blood Press Monit 12:167–171

    Article  PubMed  Google Scholar 

  29. van Osch MJ, Jansen PA, Vingerhoets RW, van der Grond J (2005) Association between supine cerebral perfusion and symptomatic orthostatic hypotension. Neuroimage 27:789–794

    Article  PubMed  Google Scholar 

  30. Wieling W, Krediet CT, van Dijk N, Linzer M, Tschakovsky ME (2007) Initial orthostatic hypotension: review of a forgotten condition. Clin Sci (Lond) 112:157–165

    Article  Google Scholar 

Download references

Acknowledgments

The Technology Research for Independent Living (TRIL) Centre focuses on the research of new technologies to enable people to live independent lives for as long as possible in the environment of their choosing. The Centre is a joint initiative between Intel and the Industrial Development Agency (IDA) Ireland. The Centre is an active research collaboration between industry and academic partners including Intel, Trinity College Dublin, University College Dublin, and the National University of Ireland Galway and represents a multidisciplinary team of up to 70 researchers including Ethnographers Designers, Clinicians, Economists and a range of Scientists and Technologists. The authors would also like to acknowledge Dr Kathleen Bennett, medical statistician at the Department of Pharmacology and Therapeutics (Trinity College Dublin), for her statistical advice. The TRIL Clinic is funded by Intel Corporation and the Industrial Development Agency (IDA) Ireland, with operational support from St James’s Hospital Dublin. The financial sponsors played no role in the design, execution, analysis and interpretation of data, or writing of the study.

Author information

Authors and Affiliations

  1. TRIL Clinic, Trinity College Dublin, Hospital 4, Top Floor, St James’s Hospital, James’s Street, Dublin 8, Ireland

    Roman Romero-Ortuno, Lisa Cogan & Chie Wei Fan

  2. Department of Medical Gerontology, Trinity College Dublin, Trinity Centre for Health Sciences, St James’s Hospital, James’s Street, Dublin 8, Ireland

    Rose Anne Kenny

Authors
  1. Roman Romero-Ortuno
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lisa Cogan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chie Wei Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rose Anne Kenny
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roman Romero-Ortuno.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Romero-Ortuno, R., Cogan, L., Fan, C.W. et al. Intolerance to initial orthostasis relates to systolic BP changes in elders. Clin Auton Res 20, 39–45 (2010). https://doi.org/10.1007/s10286-009-0040-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10286-009-0040-3

Keywords

Search

Navigation