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Journal of the American Medical... Dec 2016Late life depression (LLD), defined as depressive illness in people aged 60 years or older, is more complex than depression presenting in earlier life, with different... (Review)
Review
BACKGROUND
Late life depression (LLD), defined as depressive illness in people aged 60 years or older, is more complex than depression presenting in earlier life, with different clinical features and a poorer response to therapy. Different biological factors underlie LLD and hypotension may be an important modifiable risk factor. The aim of this systematic review is to clarify the relationship between hypotension and LLD.
METHODS
A systematic search was conducted in PubMed and Embase for articles published up to December 31, 2015. Key search terms were "depression," "depressive disorder," "hypotension," and "blood pressure." Studies were included if they were published as a primary research paper in a peer-reviewed journal, involved participants with a mean age of 60 years or more, and examined the relationship between hypotension and depression.
RESULTS
The initial combined search retrieved 2268 nonduplicate articles. Of these, 116 full texts were assessed for eligibility, of which 19 were included in this systematic review. Nine cross-sectional studies examined the association between hypotension and LLD, with 8/9 indicating a positive association between the 2. Five cross-sectional studies examined the relationship between orthostatic hypotension (OH) and LLD, with each study finding a positive association between the 2. Five longitudinal studies examined the relationship between hypotension and LLD, with discordant findings between studies. There were no longitudinal studies examining the relationship between OH and LLD.
DISCUSSION
This systematic review found that cross-sectional studies demonstrated a consistent relationship between hypotension and LLD, but longitudinal data to date is less consistent, with discordant findings. There are several methodological limitations of published longitudinal data that may explain these differences, including differences in age at enrollment, depression and blood pressure assessment, and controlling for covariates. Further longitudinal studies to clarify the role of these potentially modifiable factors in the development of this complex illness are essential.
Topics: Aged; Blood Pressure; Depression; Female; Humans; Hypotension; Male; Middle Aged
PubMed: 27523406
DOI: 10.1016/j.jamda.2016.06.027 -
Alpha Psychiatry Sep 2022Falls among psychiatric inpatients are common and have significant health consequences. The purpose of this study is to systematically review the published research on... (Review)
Review
BACKGROUND
Falls among psychiatric inpatients are common and have significant health consequences. The purpose of this study is to systematically review the published research on risk factors and consequences.
METHODS
PubMed and Embase were searched for relevant studies. A total of 18 studies were included in this systematic review. The heterogeneity and low quality of the reviewed studies limit the generalizability of the results.
RESULTS
Several intrinsic and extrinsic factors are reported. Some of these factors are unique to psychiatric inpatients such as acute mental state, psychotic symptoms, and bipolar disorder leading to cognitive distortions and risk-taking; psychotropic medications inducing side effects like sedation and orthostatic hypotension; while others are similar to those found among general medical inpatients.
CONCLUSION
Given the clinical importance of a fall and its implication on residential treatment, there is a need for targeted fall prevention programs. In order to further identify and quantify these risks and consequences, prospective research and additional study designs, describing and recording risk factors in a systematic and standardized way with the underlying etiological processes in mind, are needed.
PubMed: 36426266
DOI: 10.5152/alphapsychiatry.2022.21735 -
The Journals of Gerontology. Series A,... Jan 2020Orthostatic hypotension (OH) is associated with increased risk of falls, cognitive impairment and death, as well as a reduced quality of life. Although it is presumed to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Orthostatic hypotension (OH) is associated with increased risk of falls, cognitive impairment and death, as well as a reduced quality of life. Although it is presumed to be common in older people, estimates of its prevalence vary widely. This study aims to address this by pooling the results of epidemiological studies.
METHODS
MEDLINE, EMBASE, PubMed, Web of Science, and ProQuest were searched. Studies were included if participants were more than 60 years, were set within the community or within long-term care and diagnosis was based on a postural drop in systolic blood pressure (BP) ≥20 mmHg or diastolic BP ≥10 mmHg. Data were extracted independently by two reviewers. Random and quality effects models were used for pooled analysis.
RESULTS
Of 23,090 identified records, 20 studies were included for community-dwelling older people (n = 24,967) and six were included for older people in long-term settings (n = 2,694). There was substantial variation in methods used to identify OH with differing supine rest duration, frequency and timing of standing BP, measurement device, use of standing and tilt-tables and interpretation of the diagnostic drop in BP. The pooled prevalence of OH in community-dwelling older people was 22.2% (95% CI = 17, 28) and 23.9% (95% CI = 18.2, 30.1) in long-term settings. There was significant heterogeneity in both pooled results (I2 > 90%).
CONCLUSIONS
OH is very common, affecting one in five community-dwelling older people and almost one in four older people in long-term care. There is great variability in methods used to identify OH.
Topics: Aged; Blood Pressure; Global Health; Humans; Hypotension, Orthostatic; Independent Living; Prevalence; Quality of Life; Risk Factors
PubMed: 30169579
DOI: 10.1093/gerona/gly188 -
Clinical Obesity Dec 2021There have been increased reports of orthostatic intolerance post-bariatric surgery. However, the prevalence, pathophysiology and long-term outcomes have not been well... (Meta-Analysis)
Meta-Analysis
There have been increased reports of orthostatic intolerance post-bariatric surgery. However, the prevalence, pathophysiology and long-term outcomes have not been well described. Therefore, we sought to summarize evidence of orthostatic intolerance after bariatric surgery. We conducted a systematic review using PubMed, Scopus, CINAHL, Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (CENTRAL) to identify relevant articles from the date of inception until 1st April 2020. Study selection, data extraction and quality assessment of the included studies were performed independently by two reviewers. The findings of the included studies were narratively reported. When feasible, a meta-analysis was done to summarize the relevant results. We included 20 studies (n = 19 843 participants) reporting findings of 12 prospective cohort studies, 5 retrospective cohort studies, 2 cross-sectional studies and one randomized controlled trial. The 5-year cumulative incidence of orthostatic intolerance was 4.2% (one study). Common clinical presentations of orthostatic intolerance were lightheadedness, dizziness, syncope and palpitation. The pooled data suggested improvement in overall cardiac autonomic function (sympathetic and parasympathetic) post-bariatric surgery. In addition, a significant systolic blood pressure drop may reflect a reset of the balance between the sympathetic and parasympathetic nervous systems after weight loss in the pooled analysis. Existing literature on orthostatic intolerance post-bariatric surgeries was limited or of low quality, and larger studies are needed to know the true incidence of orthostatic intolerance post-bariatric surgeries and the pathophysiology. We found one study reporting the 5-years cumulative incidence of orthostatic intolerance post-bariatric surgeries as only 4.2%. This could challenge the idea of increased orthostatic intolerance prevalence post-bariatric surgeries. Registration The review protocol was registered at the International Prospective Register of Systemic Reviews PROSPERO (CRD42020170877).
Topics: Bariatric Surgery; Cross-Sectional Studies; Humans; Orthostatic Intolerance; Prospective Studies; Retrospective Studies
PubMed: 34409762
DOI: 10.1111/cob.12483 -
Obesity Surgery May 2021Predisposing factors of new-onset orthostatic intolerance (OI) after bariatric surgery (BS) are unknown. The purpose of this study is to summarize current existing data... (Review)
Review
Predisposing factors of new-onset orthostatic intolerance (OI) after bariatric surgery (BS) are unknown. The purpose of this study is to summarize current existing data on new-onset OI after BS. Materials and methods were considered for a search of articles that were published by the 30 of July 2020. A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and in line with the protocol agreed by all authors was conducted. Of the 604 initially identified articles, four studies were found to match the established criteria and were extracted for eligibility. 83.3% were female. Hypertension, type 2 diabetes mellitus, and obstructive sleep apnea syndrome were the most frequently reported comorbidities. Surgical intervention such as revision, conversion, or reversal was not documented in these studies. Awareness of this issue must be raised due to the possibility of reduced quality of life and the risk of syncope.
Topics: Bariatric Surgery; Diabetes Mellitus, Type 2; Female; Humans; Male; Obesity, Morbid; Orthostatic Intolerance; Quality of Life
PubMed: 33655427
DOI: 10.1007/s11695-021-05266-4 -
Therapeutic Advances in... 2022Clozapine is the most effective medication for treatment-refractory schizophrenia but is associated with significant adverse drug effects, including hypotension and... (Review)
Review
BACKGROUND
Clozapine is the most effective medication for treatment-refractory schizophrenia but is associated with significant adverse drug effects, including hypotension and dizziness, which have a negative impact on quality of life and treatment compliance. Available evidence for the management of clozapine-induced hypotension is scant.
OBJECTIVES
Due to limited guidance on the safety and efficacy of pharmacological treatments for clozapine-induced hypotension, we set out to systematically review and assess the evidence for the management of clozapine-induced hypotension and provide guidance to clinicians, patients, and carers.
DESIGN
We undertook a systematic review of the safety and efficacy of interventions for clozapine-induced hypotension given the limited available evidence.
DATA SOURCES AND METHODS
PubMed, Embase, PsycINFO, CINAHL, and the Cochrane trial Registry were searched from inception to November 2021 for literature on the treatment strategies for clozapine-induced hypotension and dizziness using a PROSPERO pre-registered search strategy. For orthostatic hypotension, we developed a management framework to assist in the choice of intervention.
RESULTS
We identified nine case studies and four case series describing interventions in 15 patients. Hypotension interventions included temporary clozapine dose reduction, non-pharmacological treatments, and pharmacological treatments. Midodrine, fludrocortisone, moclobemide and Bovril combination, and etilefrine were associated with improvement in symptoms or reduction in orthostatic hypotension. Angiotensin II, arginine vasopressin, and noradrenaline successfully restored and maintained mean arterial pressure in critical care situations. A paradoxical reaction of severe hypotension was reported with adrenaline use.
CONCLUSION
Orthostatic hypotension is a common side effect during clozapine titration. Following an assessment of the titration schedule, salt and fluid intake, and review of hypertensive and nonselective α1-adrenergic agents, first-line treatment should be a temporary reduction in clozapine dose or non-pharmacological interventions. If orthostatic hypotension persists, fludrocortisone should be trialled with monitoring of potassium levels and sodium and fluid intake. Midodrine may be considered second-line or where fludrocortisone is contraindicated or poorly tolerated. For patients on clozapine with hypotension in critical care settings, the use of adrenaline to maintain mean arterial pressure should be avoided.
REGISTRATION
PROSPERO (Registration No. CRD42020191530).
PubMed: 35633931
DOI: 10.1177/20451253221092931 -
Experimental Gerontology Jun 2019Orthostatic hypotension (OH) is common in older adults with reported prevalence rates of 5-40%. A direct link between OH and cognitive performance has been proposed due... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Orthostatic hypotension (OH) is common in older adults with reported prevalence rates of 5-40%. A direct link between OH and cognitive performance has been proposed due to impaired vascular autoregulation.
AIM
To systematically assess the literature of the association between OH and cognitive performance in older adults.
METHODS
Literature search of MEDLINE, Embase, Cochrane Central Register of Controlled Trials and PsycINFO from inception to May 2017. Studies were included if OH and cognition were assessed in subjects of mean or median age ≥65 years. Risk of bias was assessed with the Newcastle Ottawa Scale.
RESULTS
Of 3266 studies screened, 32 studies (22 cross-sectional; 10 longitudinal) reporting data of 28,980 individuals were included. OH prevalence ranged from 3.3% to 58%. Of the 32 studies, 18 reported an association between OH and worse cognitive performance and 14 reported no association. Mini Mental State Examination (MMSE) was the most commonly used cognitive assessment tool. Studies using more than one cognitive assessment tool were more likely to find an association between OH and worse cognition. OH was significantly associated with a lower MMSE mean score (mean difference - 0.51 (95% CI: -0.85, -0.17, p = 0.003)) and an increased risk of cognitive impairment (OR 1.19 (95% CI, 1.00-1.42, p = 0.048)).
CONCLUSIONS
OH is common in older populations and is associated with worse cognition expressed as lower MMSE scores. Use of MMSE alone as a cognitive assessment tool may underestimate the association. It is yet unclear whether the association between OH and worse cognitive performance is causative.
Topics: Aged; Aged, 80 and over; Bias; Cognition; Cognitive Dysfunction; Humans; Hypotension, Orthostatic; Mental Status and Dementia Tests
PubMed: 30825549
DOI: 10.1016/j.exger.2019.02.017 -
Age and Ageing Sep 2021Initial orthostatic hypotension (OH) is a clinical syndrome of exaggerated transient orthostasis associated with higher risks of falls, frailty and syncope in older... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Initial orthostatic hypotension (OH) is a clinical syndrome of exaggerated transient orthostasis associated with higher risks of falls, frailty and syncope in older adults.
OBJECTIVE
To provide a prevalence estimate of initial OH in adults aged 65 years or older.
METHODS
Literature search of MEDLINE (from 1946), Embase (from 1947) and Cochrane Central Register of Controlled Trials was performed until 6 December 2019, using the terms 'initial orthostatic hypotension', 'postural hypotension' and 'older adults'. Articles were included if published in English and participants were 65 years or older. Random effects models were used for pooled analysis.
RESULTS
Of 5,136 articles screened, 13 articles (10 cross-sectional; 3 longitudinal) reporting data of 5,465 individuals (54.5% female) from the general (n = 4,157), geriatric outpatient (n = 1,136), institutionalised (n = 55) and mixed (n = 117) population were included. Blood pressure was measured continuously and intermittently in 11 and 2 studies, respectively. Pooled prevalence of continuously measured initial OH was 29.0% (95% CI: 22.1-36.9%, I2 = 94.6%); 27.8% in the general population (95% CI: 17.9-40.5%, I2 = 96.1%), 35.2% in geriatric outpatients (95% CI: 24.2-48.1%, I2 = 95.3%), 10.0% in institutionalised individuals (95% CI: 2.4-33.1%, I2 = 0%) and 21.4% in the mixed population (95% CI: 7.0-49.6, I2 = 0%). Pooled prevalence of intermittently measured initial OH was 5.6% (95% CI: 1.5-18.9%, I2 = 81.1%); 1.0% in the general population (95% CI: 0.0-23.9%, I2 = 0%) and 7.7% in geriatric outpatients (95% CI: 1.8-27.0%, I2 = 86.7%).
CONCLUSION
The prevalence of initial OH is high in older adults, especially in geriatric outpatients. Proper assessment of initial OH requires continuous blood pressure measurements.
Topics: Accidental Falls; Aged; Blood Pressure; Cross-Sectional Studies; Female; Frailty; Humans; Hypotension, Orthostatic; Male; Prevalence
PubMed: 34260686
DOI: 10.1093/ageing/afab090 -
The Journals of Gerontology. Series A,... Feb 2024Falls are a common cause of injury, hospitalization, functional decline, and residential care admission among older adults. Cardiovascular disorders are recognized risk... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Falls are a common cause of injury, hospitalization, functional decline, and residential care admission among older adults. Cardiovascular disorders are recognized risk factors for falls. This systematic review assesses the association between cardiovascular disorders and falls in older adults.
METHODS
Systematic searches were conducted on MEDLINE and Embase, encompassing all literature published prior to December 31, 2022. Included studies addressed persons aged 50 years and older, and assessed the association between cardiovascular disorders and falls or the efficacy of cardiovascular-based interventions to reduce falls. Two reviewers independently extracted data and assessed study quality utilizing a modified Newcastle-Ottawa scale for observational studies, and the Cochrane Risk of Bias 2 tool for interventional studies. A systematic narrative analysis of all cardiovascular outcomes, and meta-analyses of unadjusted odds ratios (ORs) were performed.
RESULTS
One hundred and eighty-four studies were included: 181 observational and 3 interventional. Several cardiovascular disorders, including stroke, coronary artery disease, valvular heart disease, arterial stiffness, arrhythmia, orthostatic hypotension, and carotid sinus hypersensitivity, were consistently associated with falls. In meta-analysis of unadjusted ORs, the largest positive pooled associations with falls during a 12-month reporting interval were for stroke (OR: 1.90, 95% confidence interval [CI]: 1.70-2.11), peripheral arterial disease (OR: 1.82, 95% CI: 1.12-2.95), atrial fibrillation (OR: 1.52, 95% CI: 1.27-1.82), and orthostatic hypotension (OR: 1.39, 95% CI: 1.18-1.64).
CONCLUSIONS
Several cardiovascular disorders are associated with falls. These results suggest the need to incorporate cardiovascular assessments for patients with falls. This review informed the cardiovascular recommendations in the new World Guidelines for falls in older adults.Clinical Trials Registration Number: CRD42021272245.
Topics: Humans; Middle Aged; Aged; Hypotension, Orthostatic; Accidental Falls; Cardiovascular Diseases; Risk Factors; Stroke
PubMed: 37738307
DOI: 10.1093/gerona/glad221 -
Journal of Hypertension Jun 2016Orthostatic hypotension is a common condition among older adults and is associated with a range of deleterious outcomes. Recently, interest has developed in... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Orthostatic hypotension is a common condition among older adults and is associated with a range of deleterious outcomes. Recently, interest has developed in hypovitaminosis D (defined as low 25 hydroxiyvitamin D levels) as a potential risk factor for orthostatic hypotension. We conducted a systematic review and meta-analysis examining the association of orthostatic hypotension between study participants with and without hypovitaminosis D, including the adjustment of potential confounders (age, sex, BMI, renal function, comorbidities, seasonality, use of antihypertensive medications, and supplementation with cholecalciferol).
METHODS
A systematic literature search of major electronic databases from inception until 09/2015 was made for articles providing data on orthostatic hypotension and hypovitaminosis D. A random effects meta-analysis of cross-sectional studies investigating orthostatic hypotension prevalence comparing participants with vs. those without hypovitaminosis D was undertaken, calculating the odds ratios (ORs) and 95% confidence intervals (CIs).
RESULTS
Of 317 initial hits, five cross-sectional studies were meta-analysed including 3646 participants (1270 with hypovitaminosis D and 2376 without). The participants with hypovitaminosis D had a higher prevalence of orthostatic hypotension (OR = 1.88; 95% CI: 1.25-2.84; I = 68%) that was not affected by adjusting for a median of five potential confounders (OR = 2.03; 95% CI: 1.13-3.68; I = 73%). People with orthostatic hypotension had significantly reduced serum vitamin D concentrations (standardized mean difference = -0.42; 95% CI: -0.72 to -0.12). One longitudinal study confirmed the association between hypovitaminosis D and orthostatic hypotension.
CONCLUSION
Our meta-analysis highlights that hypovitaminosis D is associated with orthostatic hypotension, independent of potential confounders. Further longitudinal studies and clinical trials are required to confirm these findings.
Topics: Case-Control Studies; Cross-Sectional Studies; Humans; Hypotension, Orthostatic; Prevalence; Risk Factors; Vitamin D; Vitamin D Deficiency
PubMed: 27027426
DOI: 10.1097/HJH.0000000000000907