A review of orthostatic blood pressure regulation and its association with mood and cognition.

AIMS: This paper will review literature that examines the psychological and neuropsychological correlates of orthostatic blood pressure regulation. RESULTS: The pattern of change in systolic blood pressure in response to the shift from supine to upright posture reflects the adequacy of orthostatic regulation. Orthostatic integrity involves the skeletal muscle pump, neurovascular compensation, neurohumoral effects and cerebral flow regulation. Various physiological states and disease conditions may disrupt these mechanisms. Clinical and subclinical orthostatic hypotension has been associated with impaired cognitive function, decreased effort, reduced motivation and increased hopelessness as well as dementia, diabetes mellitus, and Parkinson's disease. Furthermore, inadequate blood pressure regulation in response to orthostasis has been linked to increased depression and anxiety as well as to intergenerational behavioral sequalae. CONCLUSIONS: Identifying possible causes and consequences of subclinical and clinical OH are critical in improving quality of life for both children and older adults.

Subsyndromal orthostatic blood pressure regulation correlates with motor skills in head start children.

The purpose of this study was to investigate the functional relationship between subsyndromal orthostatic blood pressure regulation and motor skills in 3-5 year old children. It is known that the efficiency of orthostatic blood pressure regulation is affected by a variety of processes, most especially neurohumoral as well as sympathetic nervous system function. Using the DIAL-3 to evaluate gross motor (jump, hop, skip), fine motor (building) and copying abilities, we found a significant curvilinear association between the difference in systolic blood pressure following an orthostatic challenge and the DIAL-3 composite motor skills score. This relationship indicated that up to a point an increase in systolic blood pressure upon standing was associated with the highest composite motor score; further, the association was stronger in females (R(2)=0.12). This study illustrates that in response to an orthostatic challenge, a moderate increase in orthostatic systolic blood pressure serves as a marker for those processes such as dopamine and sympathetic nervous system function that provide the resources for orthostatic blood pressure regulation and cognition in young children. Thus, by identifying individuals with orthostatic systolic dysregulation early, one may attenuate problematic physiological and psychological effects associated with subsyndromal orthostatic blood pressure regulation.