Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.936
Filtrar
1.
Artigo em Inglês | MEDLINE | ID: mdl-36078502

RESUMO

It is only by knowing the most common causes of falls in the hospital that appropriate and targeted fall prevention measures can be implemented. This study aimed to assess the frequency of falls in a hospital geriatrics ward and the circumstances in which they occurred and evaluate the parameters of the comprehensive geriatric assessment (CGA) correlating with falls. We considered medical, functional, and nutritional factors associated with falls and built multivariable logistic regression analysis models. A total of 416 (median age 82 (IQR 77-86) years, 77.4% women) hospitalizations in the geriatrics ward were analyzed within 8 months. We compared the results of a CGA (including health, psycho-physical abilities, nutritional status, risk of falls, frailty syndrome, etc.) in patients who fell and did not fall. Fourteen falls (3.3% of patients) were registered; the rate was 4.4 falls per 1000 patient days. They most often occurred in the patient's room while changing position. Falls happened more frequently among people who were more disabled, had multimorbidity, were taking more medications (certain classes of drugs in particular), had Parkinson's disease and diabetes, reported falls in the last year, and were diagnosed with orthostatic hypotension. Logistic regression determined the significant independent association between in-hospital falls and a history of falls in the previous 12 months, orthostatic hypotension, Parkinson's disease, and taking statins, benzodiazepines, and insulin. Analysis of the registered falls that occurred in the hospital ward allowed for an analysis of the circumstances in which they occurred and helped to identify people at high risk of falling in a hospital, which can guide appropriate intervention and act as an indicator of good hospital care.


Assuntos
Hipotensão Ortostática , Doença de Parkinson , Idoso , Idoso de 80 Anos ou mais , Feminino , Idoso Fragilizado , Avaliação Geriátrica/métodos , Hospitais , Humanos , Masculino , Fatores de Risco
2.
Age Ageing ; 51(8)2022 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-35930723

RESUMO

Blood pressure regulation is an automatic, moment-by-moment buffering of the blood pressure in response to physiological changes such as orthostasis, exercise and haemorrhage. This finely orchestrated reflex is called the baroreflex. It is a regulated arc of afferent, central and efferent arms. Multiple physiological changes occur with ageing that can disrupt this reflex, making blood pressure regulation less effective. In addition, multiple changes can occur with ageing-related diseases such as neurodegeneration, atherosclerosis, deconditioning and polypharmacy. These changes commonly result in orthostatic hypotension, hypertension or both, and are consistently associated with multiple adverse outcomes. In this article, we discuss the healthy baroreflex, and physiological and pathophysiological reasons for impaired baroreflex function in older people. We discuss why the common clinical manifestations of orthostatic hypotension and concomitant supine hypertension occur, and strategies for balancing these conflicting priorities. Finally, we discuss strategies for treating them, outlining our practice alongside consensus and expert guidance.


Assuntos
Hipertensão , Hipotensão Ortostática , Idoso , Envelhecimento , Sistema Nervoso Autônomo , Barorreflexo/fisiologia , Pressão Sanguínea , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipotensão Ortostática/complicações , Hipotensão Ortostática/diagnóstico , Hipotensão Ortostática/terapia
3.
Age Ageing ; 51(8)2022 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-35934320

RESUMO

As people age they are at increased risk of cardiovascular disease, the leading cause of mortality and morbidity worldwide. Understanding cardiovascular ageing is essential to preserving healthy ageing and preventing serious health outcomes. This collection of papers published in Age and Ageing since 2011 cover key themes in cardiovascular ageing, with a separate collection on stroke and atrial fibrillation planned. Treating high blood pressure remains important as people age and reduces strokes and heart attacks. That said, a more personalised approach to blood pressure may be even more important as people age to lower blood pressure to tight targets where appropriate but avoid overtreatment in vulnerable groups. As people age, more people experience blood pressure drops on standing (orthostatic hypotension), particularly as they become frail. This can predispose them to falls. The papers in this collection provide an insight into blood pressure and orthostatic hypotension. They highlight areas for further research to understand blood pressure changes and management in the ageing population. Inpatient clinical care of older people with heart attacks differs from younger people in UK national audit data. People aged over 80 had improved outcomes in survival after heart attack over time, but had lower rates of specialist input from cardiology compared with younger people. This may partly reflect different clinical presentations, with heart attacks occurring in the context of other health conditions, frailty and multimorbidity. The care and outcomes of acute and chronic cardiovascular disease are impacted by the frailty and health status of an individual at baseline. The research included in this collection reinforces the wide variations in the ageing population and the necessity to focus on the individual needs and priorities, and provide a person-centred multidisciplinary approach to care.


Assuntos
Doença das Coronárias , Fragilidade , Insuficiência Cardíaca , Hipotensão Ortostática , Infarto do Miocárdio , Acidente Vascular Cerebral , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/fisiologia , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Fragilidade/terapia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Hipotensão Ortostática/diagnóstico , Hipotensão Ortostática/epidemiologia , Hipotensão Ortostática/terapia , Acidente Vascular Cerebral/prevenção & controle
4.
Diabetes Care ; 45(10): 2376-2382, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-35916730

RESUMO

OBJECTIVE: The autonomic nervous system (ANS) innervates pancreatic endocrine cells, muscle, and liver, all of which participate in glucose metabolism. We tested whether measures of cardiovascular ANS function are independently associated with incident diabetes and annual change in fasting glucose (FG) levels as well as with insulin secretion and insulin sensitivity in older adults without diabetes. RESEARCH DESIGN AND METHODS: Heart rate (HR) and measures of HR variability (HRV) were derived from 24-h electrocardiographic monitoring. Blood pressure, seated and standing, was measured. Cox proportional hazards models and linear mixed models were used to analyze the associations between HRV, HR, and orthostatic hypotension (SBP >20 mmHg decline) and incident diabetes or longitudinal FG change. RESULTS: The mean annual unadjusted FG change was 1 mg/dL. Higher detrended fluctuation analyses (DFA) values, averaged over 4-11 (DFA1) or 12-20 beats (DFA2)-reflecting greater versus less organization of beat-to-beat intervals-were associated with less FG increase over time (per 1-SD increment: DFA1: -0.49 mg/dL/year [-0.96, -0.03]; DFA2: -0.55 mg/dL/year [-1.02, -0.09]). In mutually adjusted analyses, higher SD of the N-N interval (SDNN) was associated with less FG increase over time (per 1-SD increment: SDNN: -0.62 mg/dL/year [-1.22, -0.03]). Higher values of DFA1, DFA2, and SDNN were each associated with greater insulin secretion and insulin sensitivity but not with incident diabetes. We observed no association of HR or orthostatic hypotension with diabetes or FG change. CONCLUSIONS: Specific measures of cardiac autonomic function are prospectively related to FG level changes and insulin secretion and action.


Assuntos
Diabetes Mellitus , Hipotensão Ortostática , Resistência à Insulina , Idoso , Sistema Nervoso Autônomo , Glicemia/metabolismo , Glucose , Frequência Cardíaca , Humanos , Hipotensão Ortostática/epidemiologia
5.
Rinsho Shinkeigaku ; 62(8): 615-620, 2022 Aug 27.
Artigo em Japonês | MEDLINE | ID: mdl-35871563

RESUMO

A 51-year-old Japanese man presenting with a several-month history of parasomnia, orthostatic hypotension and generalized myokymia was admitted to our hospital. He had a past medical history of unresectable recurrent thymoma, but chemotherapy for thymoma was discontinued according to the patient's decision four years before this hospitalization, and the thymoma had enlarged. He exhibited symptoms of the peripheral nervous system (myokymia), central nervous system (parasomnia, short-term memory impairment), and autonomic nervous system (orthostatic hypotension), and his serum was positive for voltage-gated potassium channel (VGKC)-complex antibodies. Based on the above findings, Morvan syndrome was diagnosed. Resumption of chemotherapy for thymoma resulted in shrinkage of the thymoma accompanied by remission of Morvan syndrome. Subsequently, discontinuation of chemotherapy led to aggravation of thymoma with recurrence of Morvan syndrome. This clinical course suggests a strong correlation between the disease activity of thymoma and Morvan syndrome. In the present case of Morvan syndrome associated with unresectable thymoma, chemotherapy contributed to the remission of Morvan syndrome. Our patient suggests a possibility that chemotherapy for thymoma is a useful treatment for Morvan syndrome.


Assuntos
Hipotensão Ortostática , Parassonias , Siringomielia , Timoma , Neoplasias do Timo , Autoanticorpos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia
6.
Age Ageing ; 51(7)2022 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-35776671

RESUMO

BACKGROUND: A postural blood pressure assessment is required to diagnose Orthostatic Hypotension. With increasing remote consultations, alternative methods of performing postural blood pressure assessment are required. OBJECTIVE: Determine whether postural blood pressure measurement at home, without a clinician, is reliable, feasible and safe. DESIGN: Service improvement project within a falls and syncope service in Northeast England. SUBJECTS: Eligibility criteria: aged ≥60 years; postural blood pressure measurement is indicated and is physically and cognitively able to perform. Exclusion criteria: nursing home residents, attending clinic in person. METHODS: Postural blood pressure measurements were performed in patients' homes under clinical observation. Patient-led assessments were performed independent of the clinician, following written guidance. This was followed by a clinical-led assessment after 10-minute supine rest. OUTCOMES: Agreement between patient and clinician derived postural blood pressure values and diagnosis of Orthostatic Hypotension; intervention safety, feasibility and acceptability. RESULTS: Twenty-eight patients were eligible and 25 participated (mean age 75, median Clinical Frailty Score five).There was 95% agreement (Cohen's kappa 0.90 (0.70, 1.00)) between patient and clinician derived readings to diagnose orthostatic hypotension.Postural systolic blood pressure drop correlated strongly (r = 0.80), with patient derived readings overestimating by 1 (-6, 3) mmHg. Limits of agreement, determined via Bland Altman analysis, were +17 and -20 mmHg, greater than pre-determined maximum clinically important difference (±5 mmHg).Twenty participants performed valid postural blood pressure assessments without clinical assistance. CONCLUSIONS: Patient-led postural blood pressure assessment at home is a reliable, safe and acceptable method for diagnosing Orthostatic Hypotension.


Assuntos
Hipotensão Ortostática , Idoso , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial , Estudos de Viabilidade , Humanos , Hipotensão Ortostática/diagnóstico , Reprodutibilidade dos Testes
7.
Exp Gerontol ; 167: 111903, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-35902001

RESUMO

AIMS: Cerebral hypoperfusion is implicated in the pathogenesis of associations between orthostatic hypotension and adverse outcome such as falls, cognitive impairment, depression, and mortality. Although the blood pressure response to orthostasis has been well studied there is a lack of information on orthostatic cerebrovascular responses in older populations. METHODS AND RESULTS: We measured cerebral hemodynamics, utilizing near infrared spectroscopy, coupled with peripheral blood pressure during an active stand in a large population of well-phenotyped older adults (N = 2764). Multi-level mixed effect models were utilized to investigate associations with age and sex, as well as confounders including anti-hypertensive medications. Normative cerebral oxygenation responses were also modelled utilizing generalized additive models for location, scale, and shape (GAMLSS). Older age groups experienced larger initial drops in oxygenation and a slower recovery, and responses also differed by sex. The drop after standing ranged from -1.85 % (95 % confidence interval (CI): -2.02 to -1.68) in the males aged 54-59 years vs -1.15 % (95 % CI: -1.31 to -1.00) in females aged 54-59 years, to -2.67 % (95 % CI: -3.01 to -2.33) in males aged ≥ 80 years vs -1.97 % (95 % CI: -2.32 to -1.62) females aged ≥ 80 years. Reduced oxygenation levels were also evident in those taking anti-hypertensive medications. CONCLUSION: Cerebral autoregulation is impaired with age, particularly in older women and those taking anti-hypertensives. SBP during the stand explained some of the age gradient in the late recovery stage of the stand for the oldest age group. Reported orthostatic symptoms did not correlate with hypoperfusion. Therefore, measures of orthostatic cerebral flow should be assessed in addition to peripheral BP in older patients irrespective of symptoms. Further studies are required to investigate the relationship between NIRS measurements and clinical outcomes such as falls, cognitive impairment and depression.


Assuntos
Anti-Hipertensivos , Hipotensão Ortostática , Idoso , Envelhecimento/fisiologia , Pressão Sanguínea/fisiologia , Feminino , Humanos , Hipotensão Ortostática/epidemiologia , Estudos Longitudinais , Masculino
9.
Andes Pediatr ; 93(1): 53-58, 2022 Feb.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-35856948

RESUMO

INTRODUCTION: Children with joint hypermobility, postural orthostatic tachycardia syndrome, and orthostatic hypotension report autonomic symptoms such as dizziness, nausea, headaches, and palpitations. It is unclear if there is a pathophysiological link between connective tissue disorders and autonomic symptoms. There is no published data on the prevalence of disorder at the community level. PRIMARY OBJECTIVE: To assess the prevalence of joint hypermobility, orthostatic hypotension, and postural or thostatic tachycardia syndrome in children. SECONDARY OBJECTIVE: To determine the relationship bet ween joint hypermobility, orthostatic hypotension, and postural orthostatic tachycardia syndrome. PATIENTS AND METHOD: Participants aged 10 to 18 years were selected from public schools in three Colombian cities. The surveys included historical questions on the incidence of dizziness, nausea, headache, tremor, blurred vision, vertigo, anxiety, near syncope and syncope, sweating, palpitations triggered by standing in the two months prior to the investigation. Each of these signs and symptoms was also assessed during the recumbency (10 minutes) and standing (2, 5 and 10 minutes) phases of the investigation. HR and BP measurements were obtained at the same intervals. Joint mobility was measured with a mechanical goniometer and assessed with the Beighton score. RESULTS: Prevalence of joint hyperlaxity: 87 of 306 (28.4%). Prevalence of orthostatic hypotension: 5 of 306 (1.6%). Prevalen ce of postural orthostatic tachycardia syndrome: 6 of 306 (2.0%). Of 87 children with joint hyperlaxi ty, only 1 child had joint hyperlaxity at the same time as postural hypotension (1.2%) (p = 0.6735), and 1 child had joint hyperlaxity and postural orthostatic tachycardia syndrome simultaneously (1.2%) (p = 0.5188). CONCLUSION: Children with joint hyperlaxity did not have a higher prevalence of postural orthostatic tachycardia syndrome and orthostatic hypotension. It seems unlikely that con nective tissue disorders are responsible for most cases of postural orthostatic tachycardia syndrome and orthostatic hypotension in the community. Of note, the pathophysiology of postural orthostatic tachycardia syndrome and orthostatic hypotension requires further investigation.


Assuntos
Hipotensão Ortostática , Instabilidade Articular , Síndrome da Taquicardia Postural Ortostática , Criança , Tontura/complicações , Tontura/diagnóstico , Cefaleia/complicações , Humanos , Hipotensão Ortostática/complicações , Hipotensão Ortostática/diagnóstico , Hipotensão Ortostática/epidemiologia , Instabilidade Articular/complicações , Instabilidade Articular/epidemiologia , Náusea/complicações , Síndrome da Taquicardia Postural Ortostática/complicações , Síndrome da Taquicardia Postural Ortostática/diagnóstico , Síndrome da Taquicardia Postural Ortostática/epidemiologia , Prevalência , Instituições Acadêmicas , Síncope/complicações , Síncope/diagnóstico , Vertigem/complicações
10.
Lancet Neurol ; 21(8): 735-746, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35841911

RESUMO

Orthostatic hypotension is an unusually large decrease in blood pressure on standing that increases the risk of adverse outcomes even when asymptomatic. Improvements in haemodynamic profiling with continuous blood pressure measurements have uncovered four major subtypes: initial orthostatic hypotension, delayed blood pressure recovery, classic orthostatic hypotension, and delayed orthostatic hypotension. Clinical presentations are varied and range from cognitive slowing with hypotensive unawareness or unexplained falls to classic presyncope and syncope. Establishing whether symptoms are due to orthostatic hypotension requires careful history taking, a thorough physical examination, and supine and upright blood pressure measurements. Management and prognosis vary according to the underlying cause, with the main distinction being whether orthostatic hypotension is neurogenic or non-neurogenic. Neurogenic orthostatic hypotension might be the earliest clinical manifestation of Parkinson's disease or related synucleinopathies, and often coincides with supine hypertension. The emerging variety of clinical presentations advocates a stepwise, individualised, and primarily non-pharmacological approach to the management of orthostatic hypotension. Such an approach could include the cessation of blood pressure lowering drugs, adoption of lifestyle measures (eg, counterpressure manoeuvres), and treatment with pharmacological agents in selected cases.


Assuntos
Hipertensão , Hipotensão Ortostática , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Humanos , Hipertensão/complicações , Hipotensão Ortostática/diagnóstico , Hipotensão Ortostática/etiologia , Hipotensão Ortostática/terapia , Síncope/complicações , Síncope/terapia
11.
Nursing ; 52(8): 55-61, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35866863

RESUMO

PURPOSE: To determine the nursing staff's knowledge of the proper procedure for measuring orthostatic vital signs. METHODS: The Knowledge of Orthostatic Vital Signs Survey was sent via email to direct staff on 31 patient-care units in a large hospital system. RESULTS: Eighty percent of the participants were RNs and 12% were unlicensed assistants. Survey results showed that many respondents did not know how to properly size the cuff and were uncertain about the timing of measurements with position changes. Fifty-seven percent of respondents did not correctly identify abnormal findings with regard to the systolic BP, but 80% were aware of the diastolic BP drop in orthostatic hypotension. CONCLUSION: This survey identified gaps in the staff's knowledge about the proper procedure for measuring orthostatic vital signs.


Assuntos
Hipotensão Ortostática , Pressão Sanguínea , Determinação da Pressão Arterial , Humanos , Hipotensão Ortostática/diagnóstico , Sinais Vitais
13.
Sci Rep ; 12(1): 10685, 2022 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-35739188

RESUMO

Blood pressure is maintained by a combined mechanism of the baroreceptor reflex and the vestibulosympathetic reflex. This study is intended to verify the hypothesis that the orthostatic hypotension (OH) seen when benign paroxysmal positional vertigo (BPPV) occurred may act as a factor that affects the recurrence of BPPV. The subjects of present study were selected from among 239 patients diagnosed with idiopathic BPPV. The average age of the group with OH was 59.3 years, and the age of the group without OH was 50.3 years, with a statistically significant difference (P = 0.013). It was shown that drug-taking increased the risk of OH occurrence by 4.08 times (C.I for exp(B): 1.20-13.77) compared to the group that did not take drugs. It was shown that the risk of recurrence of BPPV was significantly reduced in the no recurrence group compared to the multiple recurrence group when there was no OH (p = 0.000; aOR 0.0000002). Also, the risk of recurrence was significantly reduced in the no recurrence group compared to the multiple recurrence group when there was no drug-taking (p = 0.000 aOR 0.0000001). This study is the first study that studied the effect of OH on the recurrence of BPPV and showed the possibility that OH could partially influence the recurrence of BPPV.


Assuntos
Vertigem Posicional Paroxística Benigna , Hipotensão Ortostática , Pressão Sanguínea , Humanos , Pessoa de Meia-Idade , Recidiva , Reflexo , Estudos Retrospectivos
14.
Clin Auton Res ; 32(3): 185-203, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35689118

RESUMO

BACKGROUND: Orthostatic syncope (transient loss of conscious when standing-fainting) is common and negatively impacts quality of life. Many patients with syncope report experiencing fatigue, sometimes with "brain fog", which may further impact their quality of life, but the incidence and severity of fatigue in patients with syncope remain unclear. In this systematic review, we report evidence on the associations between fatigue and conditions of orthostatic syncope. METHODS: We performed a comprehensive literature search of four academic databases to identify articles that evaluated the association between orthostatic syncope [postural orthostatic tachycardia syndrome (POTS), vasovagal syncope (VVS), orthostatic hypotension (OH)] and fatigue. Studies were independently screened using a multi-stage approach by two researchers to maintain consistency and limit bias. RESULTS: Our initial search identified 2797 articles, of which 13 met our inclusion criteria (POTS n = 10; VVS n = 1; OH n = 1; VVS and POTS n = 1). Fatigue scores were significantly higher in patients with orthostatic syncope than healthy controls, and were particularly severe in those with POTS. Fatigue associated with orthostatic syncope disorders spanned multiple domains, with each dimension contributing equally to increased fatigue. "Brain fog" was an important symptom of POTS, negatively affecting productivity and cognition. Finally, fatigue was negatively associated with mental health in patients with POTS. CONCLUSION: In conditions of orthostatic syncope, fatigue is prevalent and debilitating, especially in patients with POTS. The consideration of fatigue in patients with orthostatic disorders is essential to improve diagnosis and management of symptoms, thus improving quality of life for affected individuals.


Assuntos
Hipotensão Ortostática , Síndrome da Taquicardia Postural Ortostática , Síncope Vasovagal , Fadiga/epidemiologia , Fadiga/etiologia , Humanos , Hipotensão Ortostática/complicações , Hipotensão Ortostática/diagnóstico , Hipotensão Ortostática/epidemiologia , Síndrome da Taquicardia Postural Ortostática/complicações , Síndrome da Taquicardia Postural Ortostática/diagnóstico , Síndrome da Taquicardia Postural Ortostática/epidemiologia , Qualidade de Vida , Síncope/diagnóstico , Síncope/epidemiologia , Síncope/etiologia , Síncope Vasovagal/diagnóstico , Teste da Mesa Inclinada
17.
Blood Press Monit ; 27(5): 314-319, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-35687032

RESUMO

OBJECTIVE: The relationship between the white-coat effect (WCE), defined as white-coat hypertension under treatment, and the frequency of orthostatic hypotension (OH) is not known. We conducted an orthostatic test in patients with WCE to determine the frequency of OH. METHODS: This was a cross-sectional study of 5631 patients with hypertension visiting general practitioners nationwide, in which 4305 patients with hypertension recorded their home blood pressure (BP) and consented to the orthostatic test. Patients with hypertension were divided into four groups: controlled hypertension (CHT), masked hypertension (MHT), sustained hypertension (SHT), and WCE. The orthostatic test was performed, and BP and pulse rate were measured immediately and 1 min after orthostasis. RESULTS: The OH frequencies immediately after standing in CHT, WCE, SHT, and MHT patients were 7, 11.7, 12.1, and 6.6%, respectively, and those at 1 min after standing were 7.1, 13.1, 11.6 and 6.9%, respectively (Chi-square test, P < 0.01, respectively). Logistic regression analysis was performed to examine the relationship between WCE and the frequency of OH. The frequency of OH immediately after standing was significantly increased [adjusted odds ratio (AOR), 1.702; 95% confidence interval (CI), 1.246-2.326; P < 0.01]. The frequency of OH at 1 min after standing was also significantly higher (AOR, 1.897; 95% CI, 1.396-2.578; P < 0.01). CONCLUSION: When the standing test was performed for patients with WCE, the frequency of OH increased. Thus, it is important to recognize the possibility of OH in patients with WCE to avoid adverse events associated with excessive hypotension.


Assuntos
Clínicos Gerais , Hipertensão , Hipotensão Ortostática , Hipertensão Mascarada , Pressão Sanguínea/fisiologia , Estudos Transversais , Humanos , Hipotensão Ortostática/epidemiologia , Japão/epidemiologia
18.
Ir Med J ; 115(5): 596, 2022 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-35696231

RESUMO

Aim Orthostatic Hypotension (OH) is an indicator of deteriorating autonomic dysfunction. Adherence to BP and OH measurement guidelines in an inpatient specialist palliative care unit (SPCU) was unknown. Compliance of BP and OH measurement in an advanced cancer cohort was audited. Methods A retrospective analysis of four consecutive months of patients admitted with an advanced cancer diagnosis to the inpatient SPCU was conducted. Data was obtained from 168 clinical records, and audited against current institutional clinical standards. Results Falls risk screening including BP and OH measurements were not measured on admission in 19% (n=32) cases as recommended by institutional guidelines. Where falls risks were identified in 94 (69%) patients only 71 (76%) of these had completed risk assessments. OH testing was incomplete or not conducted in 59% (n=42) of risk assessments. This had patient care and safety implications e.g. under-reporting falls risk. In addition, institutional guidelines were inflexible in clinical practice specific to a palliative care cohort of patient. Conclusions Institutional guidelines need regular reviewing. In cases where a healthcare professional determines it is inappropriate to perform an assessment, we recommend a modification to the tools allowing for recording of this decision. OH is an underestimated reality in hospice populations and the impact on hospice services is worthy of further study.


Assuntos
Hipotensão Ortostática , Neoplasias , Acidentes por Quedas/prevenção & controle , Pressão Sanguínea/fisiologia , Humanos , Hipotensão Ortostática/diagnóstico , Hipotensão Ortostática/epidemiologia , Hipotensão Ortostática/etiologia , Neoplasias/complicações , Estudos Retrospectivos
19.
Hypertens Res ; 45(9): 1468-1475, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35681041

RESUMO

Orthostatic hypotension (OH) and blood pressure circadian dysfunctions are common in older adults and may be related to aging-related autonomic nervous system deficits. This study aimed to evaluate the relationship between orthostatic and nocturnal blood pressure changes in geriatric outpatients. This cross-sectional study was carried out with 425 Italian individuals aged ≥65 years (mean age 75.8 ± 7.1 years) who attended a hypertension outpatient clinic from January 2013 to January 2020. Each patient underwent orthostatic testing and noninvasive 24-h blood pressure monitoring (ABPM). OH was detected in 38.1% of patients, and these individuals were more likely to have abnormal circadian blood pressure patterns (reverse and nondipper) than those without OH (61.7% vs. 51.7%; p = 0.045). In linear regression, after adjusting for potential confounders, orthostatic and nocturnal changes in systolic blood pressure were inversely associated (ß = -0.63, 95% CI [-0.95; -0.32]; p < 0.001). This association was stronger in patients ≥80 years. OH is highly prevalent in older patients and is associated with altered nocturnal blood pressure profiles, especially in the oldest old. Because both OH and altered blood pressure patterns are associated with elevated cardiovascular risk and mortality, our study suggests that elderly patients with OH should undergo noninvasive 24-h blood pressure monitoring.


Assuntos
Hipotensão Ortostática , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/fisiologia , Monitorização Ambulatorial da Pressão Arterial , Estudos Transversais , Humanos , Pacientes Ambulatoriais
20.
Auton Neurosci ; 241: 102997, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35679657

RESUMO

The association between dysautonomia and long-COVID syndrome has gained considerable interest. This study retrospectively characterized the findings of autonomic reflex screen (ARS) in long-COVID patients presenting with orthostatic intolerance (OI). Fourteen patients were identified. All patients had normal cardiovagal function and 2 patients had abnormal sudomotor function. The head-up tilt table (HUTT) was significantly abnormal in 3 patients showing postural orthostatic tachycardia syndrome (POTS). CASS ranged from 0 to 2. The most common clinical scenario was symptoms of orthostatic intolerance without demonstrable HUTT orthostatic tachycardia or orthostatic hypotension (OH) (n = 8, 57 %). In our case series, most long-COVID patients presenting to our laboratory with OI had no significant HUTT abnormalities; only 3 patients met the criteria for POTS.


Assuntos
COVID-19 , Hipotensão Ortostática , Intolerância Ortostática , Síndrome da Taquicardia Postural Ortostática , Pressão Sanguínea , COVID-19/complicações , Frequência Cardíaca , Humanos , Hipotensão Ortostática/diagnóstico , Hipotensão Ortostática/etiologia , Intolerância Ortostática/diagnóstico , Síndrome da Taquicardia Postural Ortostática/complicações , Síndrome da Taquicardia Postural Ortostática/diagnóstico , Estudos Retrospectivos , Teste da Mesa Inclinada
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...