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1.
Adv Exp Med Biol ; 1232: 77-83, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31893397

RESUMEN

Instantaneous orthostatic hypotension (INOH) is one of the main types of orthostatic dysregulation in children and adolescents. In patients with INOH arterial pressure drops considerably after active standing and is slow to recover. We investigated changes in cerebral oxygenation in the bilateral prefrontal cortex during an active standing test in juvenile INOH patients to evaluate changes in cerebral oxygen metabolism. We enrolled 82 INOH patients (mean age 13.8 ± 2.2 years, 52 mild and 30 severe patients) at Nihon University Itabashi Hospital from October 2013 to April 2018. We measured cerebral oxygenated hemoglobin, deoxygenated hemoglobin, and total hemoglobin levels in the bilateral prefrontal cortex using near-infrared spectroscopy during an active standing test. In severe INOH patients, cerebral oxygenation of the right prefrontal cortex remained constant when blood pressure dropped; however, de-oxy-Hb significantly increased. These findings confirm that there is asymmetrical autoregulation between the right and left prefrontal cortex.


Asunto(s)
Circulación Cerebrovascular , Hipotensión Ortostática , Adolescente , Circulación Cerebrovascular/fisiología , Niño , Homeostasis , Humanos , Hipotensión Ortostática/fisiopatología , Oxihemoglobinas , Espectroscopía Infrarroja Corta
2.
Adv Exp Med Biol ; 1232: 85-90, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31893398

RESUMEN

Delayed orthostatic hypotension (OH) is a minor subset of orthostatic dysregulation (OD). Cerebral blood oxygenation in juvenile patients with delayed OH has not been studied. We investigated the bilateral changes in cerebral oxygenation in the prefrontal cortex during an active standing test in 23 juvenile patients with delayed OH using near-infrared spectroscopy (NIRS). We measured the oxy-Hb, deoxy-Hb, and total-Hb during the active standing test. Four observations were made during the test: t1 in a resting supine position, t2 when maintaining blood pressure, and the remaining two (t3, t4) during hypotension. The concentration of oxy-Hb significantly decreased prior to satisfying the diagnostic criteria of delayed OH after standing and did not change thereafter. The concentration of deoxy-Hb increased gradually during the measurement periods. In addition, total-Hb increased from t2 to t3. There was no significant difference in the change in each Hb parameter between the left and right cerebral hemispheres. Our results indicate that NIRS parameters are more sensitive than blood pressure for the interpretation of cerebral autoregulation in juvenile patients with delayed OH.


Asunto(s)
Sistema Cardiovascular , Circulación Cerebrovascular , Hipotensión Ortostática , Oxígeno , Posición de Pie , Adolescente , Presión Sanguínea , Circulación Cerebrovascular/fisiología , Humanos , Hipotensión Ortostática/sangre , Hipotensión Ortostática/diagnóstico , Oxígeno/sangre , Espectroscopía Infrarroja Corta
3.
Neurology ; 93(14): e1339-e1347, 2019 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-31484717

RESUMEN

OBJECTIVE: To evaluate the pattern and severity of autonomic dysfunction in autopsy-confirmed progressive supranuclear palsy (PSP) compared to α-synuclein pathology. METHODS: Autopsy-confirmed cases of 14 patients with PSP, 18 with multiple system atrophy (MSA), and 24 with Lewy body disease (LBD) with antemortem autonomic testing were reviewed retrospectively. All patients underwent comprehensive clinical evaluations by a movement disorder specialist, formal autonomic testing, and postmortem examinations at Mayo Clinic. RESULTS: The absence of orthostatic hypotension (OH) was the strongest autonomic parameter that distinguished PSP from α-synucleinopathies (0% vs 69%, p < 0.0001). Tests of adrenergic failure, which distinguish neurogenic OH, also differentiated PSP from other groups. These included the pressure recovery time (p = 0.0008), adrenergic impairment score (p = 0.001), and magnitude of change of systolic (p = 0.0002) and diastolic (p = 0.0001) blood pressures (BPs) during upright tilt. In addition, REM sleep behavior disorder was seen less frequently (p = 0.006) in PSP (33%) compared to MSA (87%) and LBD (90%). Antemortem clinical diagnostic accuracy for these phenotypically variable disorders was 57% for PSP and 83% for α-synucleinopathies. CONCLUSION: Our results suggest that the cardiovascular adrenergic system, which sustains BP during standing, is relatively unaffected, if not spared, in PSP. These findings increase our understanding of the clinical signature of PSP and have the potential to improve diagnostic accuracy in atypical parkinsonisms by distinguishing PSP from the α-synucleinopathies.


Asunto(s)
Hipotensión Ortostática/diagnóstico , Hipotensión Ortostática/fisiopatología , Parálisis Supranuclear Progresiva/diagnóstico , Parálisis Supranuclear Progresiva/fisiopatología , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
4.
Hypertension ; 74(4): 1033-1040, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31476905

RESUMEN

Hypertension treatment has been implicated in falls, syncope, and orthostatic hypotension (OH), common events among older adults. Whether the choice of antihypertensive agent influences the risk of falls, syncope, and OH in older adults is unknown. ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) was a randomized clinical trial that compared the effects of hypertension first-step therapy on fatal coronary heart disease or nonfatal myocardial infarction (1994-2002). In a subpopulation of ALLHAT participants, age 65 years and older, we determined the relative risk of falls, syncope, OH, or a composite based on Centers for Medicare and Medicaid Services and Veterans Affairs claims, using Cox regression. We also determined the adjusted association of self-reported atenolol use (ascertained at the 1-month visit for indications other than hypertension) on outcomes in Cox models adjusted for age, sex, and race. Among 23 964 participants (mean age 69.8±6.8 years, 45% women, 31% non-Hispanic black) followed for a mean of 4.9 years, we identified 267 falls, 755 syncopes, 249 OH, and 1157 composite claims. There were no significant differences in the cumulative incidences of events across randomized drug assignments. However, amlodipine increased risk of falls during the first year of follow-up compared with chlorthalidone (hazard ratio [95% CI]: 2.24 [1.06-4.74]; P=0.03) or lisinopril (hazard ratio [95% CI]: 2.61 [1.03-6.72]; P=0.04). Atenolol use (N=928) was not associated with any of the 3 individual or composite claims. In older adults, the choice of antihypertensive agent had no effect on risk of fall, syncope, or OH long-term. However, amlodipine increased risk of falls within 1 year of initiation. These short-term findings require confirmation. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000542.


Asunto(s)
Accidentes por Caídas/estadística & datos numéricos , Antihipertensivos/uso terapéutico , Hipertensión/tratamiento farmacológico , Hipotensión Ortostática/epidemiología , Síncope/epidemiología , Anciano , Anciano de 80 o más Años , Amlodipino/uso terapéutico , Atenolol/uso terapéutico , Clortalidona/uso terapéutico , Femenino , Humanos , Incidencia , Masculino , Medicare , Resultado del Tratamiento , Estados Unidos
5.
Artículo en Ruso | MEDLINE | ID: mdl-31407676

RESUMEN

AIM: To define the mechanism of formation of orthostatic hypotension in patients with traumatic tetraplegia. MATERIAL AND METHODS: The study included 64 patients with chronic (more 6 month) and subacute (less 6 month) tetraplegia; the period of observation was about 30 days after admission to the rehabilitation center. Changes in the state of the autonomic nervous systems (heart rate variability at rest and head-up tilt test, sinus arrhythmia) were studied. RESULTS: In the first 6 months, all patients, and after 6-12 months, one third of the patients experienced orthostatic hypotension, which was accompanied by lower values of the normalized sympatovagal index (LFn/HFn) 0.35 (0.260; 0.650) and expiratory-inspiratory coefficient (RRmax/RRmin) 1.09 (1.040; 1200). An increase in expiratory-inspiratory coefficient as a result of physical rehabilitation up to 1.16 (1.120; 1.24) was noted only in patients less than 6 months after injury. CONCLUSION: Both sympathetic and parasympathetic parts of the autonomic nervous system are involved in the formation of orthostatic hypotension syndrome in patients with spinal tetraplegia.


Asunto(s)
Hipotensión Ortostática , Enfermedades de la Médula Espinal , Sistema Nervioso Autónomo , Frecuencia Cardíaca , Humanos , Hipotensión Ortostática/etiología , Enfermedades de la Médula Espinal/complicaciones , Pruebas de Mesa Inclinada
6.
BMJ Case Rep ; 12(8)2019 Aug 20.
Artículo en Inglés | MEDLINE | ID: mdl-31434666

RESUMEN

A 62-year-old man presented with a 2-year history of syncope, collapse and fluctuating blood pressure (BP). His medications included midodrine (10 mg, three times per day) and fludrocortisone (0.1 mg, two times per day), but neither treatment afforded symptomatic relief. Autonomic testing was performed. Head-up tilt table testing revealed a supine BP of 112/68 mm Hg (heart rate, 74 beats per minute (bpm)) after 6 min, which dropped to 76/60 mm Hg (83 bpm) within 2 min of 80° head-up tilt. Findings from a heart rate with deep breathing test and a Valsalva test were consistent with autonomic dysfunction. The patient was diagnosed with neurogenic orthostatic hypotension and treated with droxidopa (100 mg, two times per day; titrated to 100 mg, one time per day). After initiating treatment with droxidopa, the patient no longer reported losing consciousness on standing and experienced improvement in activities of daily living. These improvements were maintained through 1 year of follow-up.


Asunto(s)
Antiparkinsonianos/uso terapéutico , Sistema Nervioso Autónomo/fisiopatología , Droxidopa/uso terapéutico , Hipotensión Ortostática/diagnóstico , Síncope/etiología , Pruebas de Mesa Inclinada , Accidentes por Caídas , Actividades Cotidianas , Humanos , Hipotensión Ortostática/tratamiento farmacológico , Hipotensión Ortostática/fisiopatología , Masculino , Persona de Mediana Edad , Resultado del Tratamiento
7.
Hypertension ; 74(3): 639-644, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31327261

RESUMEN

There has been much interest in investigating vitamin D status with orthostatic hypotension. However, studies have been small, inconsistent, and with a lack of standardization. The aim of this study was to investigate the association with vitamin D status in a large, nationally representative older adult population using a traceable standard of measurement and an accurate assessment of beat-to-beat blood pressure (BP). This study used participants aged >50 years from The Irish Longitudinal Study on Ageing. Impaired stabilization of BP on standing was defined as a sustained drop of ≥20 mm Hg systolic BP or ≥10 mm Hg diastolic BP up to 40 seconds post stand (impaired stabilization of BP on standing). We also analyzed participants who sustained a drop of ≥20 mm Hg systolic BP or ≥10 mm Hg diastolic BP throughout the 110 seconds stand (OH110). Vitamin D was categorized into sufficient (≥50 nmol/L), insufficient (30-50 nmol/L), and deficient (<30 nmol/L) status. After exclusion criteria 4209 participants were included. Those with deficiency were more likely to be smokers, take antihypertensive medications and had higher levels of cardiovascular disorders compared with those with sufficient status. In a univariate logistic regression those with deficient (odds ratio, 1.18; 95% CI, 0.86-1.61; P=0.303) or insufficient (odds ratio, 1.13; 95% CI, 0.91; P=0.272) status were no more likely to have evidence of impaired stabilization of BP on standing on active stand compared with sufficiency. Similar findings were found for OH110: deficient (odds ratio, 0.85; 95% CI, 0.52-1.40; P=0.528) or insufficient (odds ratio, 0.86; 95% CI, 0.61-1.21; P=0.384) versus sufficiency. In conclusion, vitamin D is not significantly associated with orthostatic hypotension in older adults.


Asunto(s)
Evaluación Geriátrica/métodos , Hipotensión Ortostática/diagnóstico , Deficiencia de Vitamina D/diagnóstico , Vitamina D/sangre , Anciano , Anciano de 80 o más Años , Envejecimiento/fisiología , Estudios de Cohortes , Femenino , Hospitales Universitarios , Humanos , Hipotensión Ortostática/epidemiología , Vida Independiente , Irlanda , Modelos Logísticos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Sensibilidad y Especificidad , Deficiencia de Vitamina D/epidemiología
11.
Intern Med ; 58(19): 2861-2864, 2019 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-31178512

RESUMEN

After experiencing upper respiratory-tract symptoms, a 41-year-old woman developed encephalitis with consciousness disturbance and respiratory failure. She had external ophthalmoplegia and facial diplegia. Magnetic resonance imaging revealed a brainstem lesion with spared longitudinal pontine bundles. Abnormal findings of the brainstem auditory-evoked potentials and blink reflex supported brainstem damage. The patient was positive for anti-N-methyl-D-aspartate receptor (NMDAR) antibodies. Repeated immunological treatments improved her symptoms, but severe orthostatic hypotension emerged. A head-up tilt test revealed no arginine vasopressin response to hypotension. The atypical symptoms of this case highlighted that the brainstem is one of the pivotal regions in anti-NMDAR encephalitis.


Asunto(s)
Encefalitis Antirreceptor N-Metil-D-Aspartato/diagnóstico , Tronco Encefálico/diagnóstico por imagen , Hipotensión Ortostática/etiología , Adulto , Encefalitis Antirreceptor N-Metil-D-Aspartato/complicaciones , Electroencefalografía , Femenino , Humanos , Hipotensión Ortostática/diagnóstico , Imagen por Resonancia Magnética
12.
Lakartidningen ; 1162019 Feb 19.
Artículo en Sueco | MEDLINE | ID: mdl-31192373

RESUMEN

Syncope is the chief complaint in 1-2 percent of emergency department visits. Syncope belongs to the broader category transient loss of consciousness (TLOC), defined as a short loss of consciousness with loss of awareness and responsiveness, and with subsequent amnesia for the event. Syncope is defined as TLOC due to cerebral hypoperfusion, with rapid onset and spontaneous complete recovery. The main categories of syncope are reflex syncope, orthostatic hypotension, and cardiac syncope. The 2018 guidelines by the European Society of Cardiology emphasizes the process of risk stratification in the initial management of suspected syncope. Risk stratification serves to separate the patients with likely orthostatic and reflex syncope with good prognosis from the patients with likely cardiac syncope and high short-term risk of an adverse outcome. It determines the appropriate next level of care. Further evaluation should be based on clinical suspicion and frequency of symptoms.


Asunto(s)
Síncope/diagnóstico , Cardiología , Vías Clínicas , Diagnóstico Diferencial , Manejo de la Enfermedad , Europa (Continente) , Humanos , Hipotensión Ortostática/diagnóstico , Hipotensión Ortostática/etiología , Hipotensión Ortostática/terapia , Guías de Práctica Clínica como Asunto , Medición de Riesgo , Sociedades Médicas , Síncope/etiología , Síncope/terapia , Síncope Vasovagal/diagnóstico , Síncope Vasovagal/etiología , Síncope Vasovagal/terapia
13.
J Stroke Cerebrovasc Dis ; 28(8): 2124-2131, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31147254

RESUMEN

BACKGROUND: Orthostatic hypotension (OH) has been independently associated with increased risk of stroke and other cardiovascular events. We sought to investigate the relationship between OH at follow-up and recurrent stroke risk in SPS3 (Secondary Prevention of Small Subcortical Strokes) trial patient cohort. This is a retrospective cohort analysis. METHODS: We included all SPS3 trial participants with blood pressure measurements in both sitting and standing position per protocol at baseline, with at least 1 follow-up visit to establish the relationship between OH at follow-up and recurrent stroke risk (primary outcome). Secondary outcomes included major vascular events, myocardial infarction, all-cause mortality, and, ischemic and hemorrhagic stroke subtypes. Participants were classified as having OH at baseline and at each follow-up visit based on a systolic BP decline ≥20 mm Hg or a diastolic BP decline ≥10 mm Hg on position change from sitting to standing. We used Cox proportional hazards regression modeling to compare the risk of outcomes among those with and without OH. RESULTS: A total of 2275 patients were included with a mean follow up time 3.2 years (standard deviation = 1.6 years). 39% (881/2275) had OH at some point during their follow-up. Of these, 41% (366/881) had orthostatic symptoms accompanying the BP drop. In a fully adjusted model, those with OH had a 1.8 times higher risk of recurrent stroke than those without OH (95% confidence interval: 1.1-3.0). The risk of ischemic stroke, major vascular events, and all-cause mortality was similarly elevated among the OH group. CONCLUSION: OH was associated with increased recurrent stroke risk, vascular events, and all-cause death in this large cohort of lacunar stroke patients. Whether minimizing OH in the management of poststroke hypertension in patients with lacunar stroke reduces recurrent stroke risk deserves further study.


Asunto(s)
Presión Sanguínea , Hipotensión Ortostática/complicaciones , Prevención Secundaria/métodos , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Anciano , Causas de Muerte , Femenino , Humanos , Hipotensión Ortostática/mortalidad , Hipotensión Ortostática/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Recurrencia , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/fisiopatología , Factores de Tiempo , Resultado del Tratamiento
14.
Dtsch Med Wochenschr ; 144(12): 795-798, 2019 06.
Artículo en Alemán | MEDLINE | ID: mdl-31212322

RESUMEN

Dizziness is most frequently caused by blood pressure dysregulation comprising a broad spectrum from constitutional and orthostatic hypotension to severe conditions like endocrinopathies and neurodegenerative diseases with autonomic dysfunction like in multiple system atrophy.


Asunto(s)
Presión Sanguínea/fisiología , Mareo , Hipertensión , Hipotensión Ortostática , Sistema Nervioso Autónomo/fisiopatología , Mareo/etiología , Mareo/fisiopatología , Femenino , Humanos , Persona de Mediana Edad , Atrofia de Múltiples Sistemas , Vértigo/etiología , Vértigo/fisiopatología
16.
Geriatr Nurs ; 40(6): 558-564, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31078324

RESUMEN

Postural hypotension (PH) is a very common and often symptomatic disorder among elderly hospitalized patients. Little is known about measures for preventing previously unknown PH in this population. We evaluated the effectiveness of high compression leg bandaging in preventing seated PH during the initial phase of ambulation, among elderly inpatients without a history of PH. We compared the occurrence of seated PH between patients who were bandaged (n = 100) and unbandaged (n = 100). The rate of seated PH was significantly lower in the bandaged than the unbandaged group (27% vs. 51%, p < 0.001, relative risk reduction 47%, and the number of patients needed to treat 4.2). On multivariate analysis, not wearing leg bandaging was one of the variables most significantly associated with eventual occurrence of PH (p = 0.002, odds ratio 2.65, and 95% confidence interval 1.42-4.97). We conclude that during ambulation of elderly inpatients, high compression leg bandaging is beneficial to prevent seated PH.


Asunto(s)
Vendajes de Compresión , Hipotensión Ortostática , Pierna/fisiología , Pacientes/estadística & datos numéricos , Sedestación , Anciano , Femenino , Hospitalización , Humanos , Hipotensión Ortostática/prevención & control , Hipotensión Ortostática/terapia , Masculino
17.
Int J Radiat Oncol Biol Phys ; 104(5): 1141-1152, 2019 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-31063799

RESUMEN

PURPOSE: Despite the development of high-precision radiation therapy, ionizing radiation inevitably damages healthy tissues. Radiodermatitis and radioinduced oral mucositis are frequent and significant side effects among patients with breast and head and neck cancer, respectively. These radiation-related injuries negatively affect patient quality of life and can lead to unplanned therapeutic breaks and compromise treatment outcomes. Currently, no preventive or mitigating agent has emerged to address these issues. Although amifostine, a well-known free radical scavenger, has proven efficacy against specific radio- and chemo-induced toxicities, severe adverse side effects (reversible hypotension, nausea, emesis, etc) combined with logistical hurdles are associated with its recommended intravenous route of administration, limiting its use. METHODS AND MATERIALS: We developed a thermogel containing the active thiol metabolite of amifostine (CPh-1014) that polymerizes at body temperature and serves as a matrix for topical application onto the skin or mucosa. RESULTS: Applied before irradiation, CPh-1014 greatly reduced the severity of oral mucositis and dermatitis induced by either a single dose or fractionated irradiation regimens in in vivo mouse models. The cytoprotective effect of CPh-1014 was confirmed by the decrease in DNA double-strand breaks in the irradiated epithelium. Noticeably, CPh-1014 did not affect radiation therapy efficacy against tumors grafted at submucosal and subcutaneous sites. In contrast to the intravenous administration of amifostine, CPh-1014 oral application did not induce hypotension in dogs. CONCLUSIONS: CPh-1014 confers radioprotective effects in healthy tissues with reduced systemic side effects without compromising radiation therapy efficacy. We propose CPh-1014 as an easy-to-implement therapeutic approach to alleviate radiation therapy toxicity in patients with breast and head and neck cancer.


Asunto(s)
Amifostina/administración & dosificación , Geles/administración & dosificación , Traumatismos Experimentales por Radiación/prevención & control , Protectores contra Radiación/administración & dosificación , Radiodermatitis/prevención & control , Estomatitis/prevención & control , Amifostina/efectos adversos , Animales , Presión Sanguínea/efectos de los fármacos , Neoplasias de la Mama/radioterapia , Daño del ADN , Modelos Animales de Enfermedad , Perros , Portadores de Fármacos , Femenino , Neoplasias de Cabeza y Cuello/radioterapia , Hipotensión Ortostática/inducido químicamente , Ratones , Ratones Endogámicos C57BL , Traumatismos Experimentales por Radiación/tratamiento farmacológico , Protectores contra Radiación/efectos adversos , Radiodermatitis/tratamiento farmacológico , Distribución Aleatoria , Neoplasias Cutáneas/radioterapia , Estomatitis/tratamiento farmacológico , Estomatitis/etiología
18.
Int J Mol Sci ; 20(10)2019 May 18.
Artículo en Inglés | MEDLINE | ID: mdl-31109053

RESUMEN

Cognitive impairment following spinal cord injury (SCI) has received considerable attention in recent years. Among the various systemic effects of SCI that contribute towards cognitive decline in this population, cardiovascular dysfunction is arguably one of the most significant. The majority of individuals with a cervical or upper-thoracic SCI commonly experience conditions called orthostatic hypotension and autonomic dysreflexia, which are characterized by dangerous fluctuations in systemic blood pressure (BP). Herein, we review the potential impact of extreme BP lability on vascular cognitive impairment (VCI) in individuals with SCI. Albeit preliminary in the SCI population, there is convincing evidence that chronic hypotension and hypertension in able-bodied individuals results in devastating impairments in cerebrovascular health, leading to VCI. We discuss the pertinent literature, and while drawing mechanistic comparisons between able-bodied cohorts and individuals with SCI, we emphasize the need for additional research to elucidate the mechanisms of cognitive impairment specific to the SCI population. Lastly, we highlight the current and potential future therapies to manage and treat BP instability, thereby possibly mitigating VCI in the SCI population.


Asunto(s)
Presión Sanguínea , Vasos Sanguíneos/fisiopatología , Reflejo Anormal , Traumatismos de la Médula Espinal/fisiopatología , Animales , Disreflexia Autónoma/etiología , Disreflexia Autónoma/fisiopatología , Disreflexia Autónoma/terapia , Humanos , Hipotensión Ortostática/fisiopatología , Hipotensión Ortostática/terapia , Traumatismos de la Médula Espinal/etiología , Traumatismos de la Médula Espinal/terapia
19.
Zhonghua Xin Xue Guan Bing Za Zhi ; 47(5): 381-387, 2019 May 24.
Artículo en Chino | MEDLINE | ID: mdl-31142082

RESUMEN

Objective: To explore the characteristics of postural blood pressure changes in elderly inpatients and the related factors of orthostatic hypotension (OH). Methods: This study was a clinical case control study. Two hundred and sixty-six elderly patients (≥60 years old), who were hospitalized between April 2016 and November 2017 in Geriatric Department of Peking University First Hospital, were included. They were divided into direct standing group and indirect standing group. Direct standing group involved 102 patients, they changed posture from supine directly to standing position, and the blood pressures at the moments of supine, immediately after standing and the first, second, and third minute after standing were recorded by continuous noninvasive arterial pressure (CNAP) system. Indirect standing group involved 164 patients, and they changed posture from supine to sitting for 3 minutes, and then changed to standing position. Blood pressures at the moments of supine, immediately after sitting, the third minute after sitting, immediately after standing and the third minute after standing was recorded by CNAP. Blood pressure changes after different postural changes mode and the rates of OH were compared. The related factors of OH was analyzed by binary logistic regression analysis. Results: The lowest systolic blood pressures (SBP) mostly occurred immediately after postural change: immediately after standing for direct standing group (86.3%(88/102)), and immediately after sitting for indirect standing group (59.1%(97/164)). The lowest diastolic blood pressures (DBP) mostly occurred immediately after standing in the two groups: 87.3%(89/102) for direct standing group and 43.3% (71/164) for indirect standing group. The maximum SBP drop (SBP of supine minus the lowest SBP during postural changes) of direct standing group was significantly higher than indirect standing group (median 20.5(14.0, 29.3) vs. 18.0(11.0, 26.0) mmHg (1 mmHg=0.133 kPa, P<0.05). The rates of OH occurred immediately and within 3 minutes from supine to standing position were significantly higher in direct standing group than in indirect standing group (65.7% (67/102) vs. 43.9% (72/164), and 70.6% (72/102) vs. 49.4% (81/164), both P<0.05). Binary logistic regression analysis showed that brachial-ankle pulse wave velocity was positively associated with OH after a transition from supine to standing position (immediately and within 3 minutes, OR=1.002 (95%CI 1.000-1.004), 1.003 (95%CI 1.001-1.006), P=0.014, 0.006) in direct standing group. Conclusions: OH is common in elderly hospitalized patients. The most obvious blood pressure changes are likely to occur immediately after position changes. Adding a sitting position during the transition of supine to standing position may decrease the amplitude of SBP drop. Brachial-ankle pulse wave velocity is associated with OH after the transition from the supine to standing position in the elderly inpatients.


Asunto(s)
Presión Arterial , Hipotensión Ortostática , Anciano , Índice Tobillo Braquial , Presión Sanguínea , Determinación de la Presión Sanguínea , Estudios de Casos y Controles , Humanos , Hipotensión Ortostática/diagnóstico , Persona de Mediana Edad , Postura , Análisis de la Onda del Pulso
20.
Aten. prim. (Barc., Ed. impr.) ; 51(5): 294-299, mayo 2019. tab, graf
Artículo en Español | IBECS | ID: ibc-180878

RESUMEN

Objetivo: Estimar la prevalencia de la hipotensión ortostática (HO) en pacientes de 80 o más años de edad que demandan consulta en una unidad de atención primaria. Relacionar la HO con las enfermedades más prevalentes y los fármacos más consumidos. Diseño: Transversal observacional. Localización: Unidad de atención primaria, Santiago de Compostela. Participantes: Se reclutaron 81 pacientes de 80 o más años representativos de una unidad de atención primaria. Se excluyeron 10 pacientes. Mediciones principales: Se realizó la medición de la presión arterial en decúbito y posteriormente en bipedestación en el instante siguiente a la incorporación y tras 3 min. Se revisaron en la historia clínica electrónica los diagnósticos y los tratamientos activos mediante una entrevista al paciente y cuidador. Resultados: En un 26,76% de los pacientes se produjo un descenso mayor o igual de 20 mmHg en la presión arterial sistólica y/o 10 mmHg en la presión arterial diastólica, en el instante siguiente al cambio postural. El descenso se mantuvo tras 3min de la incorporación de decúbito a bipedestación en el 16,90% de los pacientes. Ningún paciente estaba diagnosticado de HO. La mayor razón de prevalencia se dio con la diabetes mellitus (1,6; p = 0,412), no habiendo diferencias para la hipertensión arterial (p = 0,881). La HO se relacionó de forma estadísticamente significativa con la toma de bloqueadores de sistema renina-angiotensina-aldosterona (OR: 8,174; IC95%: 1,182-56,536; p = 0,033) y benzodiacepinas (OR: 5,938; IC95%: 1,242-28,397; p = 0,026). Conclusión: La HO tuvo una prevalencia del 16,90% en los pacientes de edad avanzada que acudieron a consulta. Debe tenerse en cuenta su relación con algunos fármacos (bloqueadores de sistema renina-angiotensina-aldosterona y benzodiacepinas)


Objective: To estimate the prevalence of orthostatic hypotension (OH) in patients 80 years old and over attending a primary care unit. To relate OH to the most prevalent pathologies and to the most used drugs. Design: Transversal observational study. Location: Primary care unit, Santiago de Compostela. Participants: Eighty one patients 80 years old or over representative of a primary care unit were recruited. Ten patients were excluded. Main measurements: Blood pressure was measured in decubitus and later in erect position first immediately after standing and then after 3 minutes. Diagnoses and active treatments were reviewed in the electronic clinical history and through an interview with the patient and caregiver. Results: In 26.76% of patients the systolic blood pressure fell by 20 mmHg or more and/or the diastolic blood pressure fell by 10 mmHg in the instant following the postural shift. In 16.90% of patients the drop persisted after 3 minutes of standing from decubitus position. None of the patients was diagnosed with OH. The highest prevalence ratio was observed for diabetes mellitus (1.6; P=.412), not existing differences for arterial hypertension (P=.881). OH related in a statistically meaningful way to the use of renin angiotensin aldosterone system inhibitors (OR: 8.174, CI95%: 1.182-56.536); P=.033] and benzodiazepines (OR: 5.938, CI95%: 1.242-28.397; P=.026)]. Conclusion: OH had a prevalence of 16.90% among the elderly patients who had a consultation. Its connection with some drugs (renin angiotensin aldosterone system inhibitors and benzodiazepines) must be considered


Asunto(s)
Humanos , Masculino , Femenino , Anciano de 80 o más Años , Hipotensión Ortostática/epidemiología , Atención Primaria de Salud/estadística & datos numéricos , Determinación de la Presión Sanguínea/métodos , Estudios Transversales , Registros Electrónicos de Salud/estadística & datos numéricos , Benzodiazepinas/uso terapéutico , Salud del Anciano
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