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The American Journal of Managed Care Oct 2015Although orthostatic hypotension in elderly patients is common, neurogenic orthostatic hypotension (NOH) is a condition with substantial morbidity and a variable... (Review)
Review
Although orthostatic hypotension in elderly patients is common, neurogenic orthostatic hypotension (NOH) is a condition with substantial morbidity and a variable prognosis. Patients with severe NOH have difficulty standing for any period of time and must scrupulously avoid orthostatic stressors that exacerbate their condition. In about half of patients, supine hypertension complicates management. The diagnosis is based on measurements of supine and standing blood pressures or head-up tilt testing and is confirmed by autonomic testing. Two self-report questionnaires, the Orthostatic Hypotension Questionnaire and the Orthostatic Grading Scale, can help evaluate a patient's level of impairment, document progression, and assess the response to pharmacotherapy in clinical practice. There are many gaps in our knowledge of this rare disorder; this review summarizes what is currently known about the pathophysiology, epidemiology, prognosis, signs and symptoms, and the diagnosis of NOH.
Topics: Comorbidity; Humans; Hypertension; Hypotension, Orthostatic; Neurodegenerative Diseases; Prognosis; Quality of Life; Supine Position; Surveys and Questionnaires
PubMed: 26790109
DOI: No ID Found -
Age and Ageing Oct 2020The relationship between sarcopenia and orthostatic hypotension (OH) is unclear.
BACKGROUND
The relationship between sarcopenia and orthostatic hypotension (OH) is unclear.
OBJECTIVES
The aim of the present study was to investigate associations between sarcopenia/sarcopenia severity and OH.
DESIGN
A total of 511 patients attending a geriatric outpatient clinic were included. OH was defined as a decrease in systolic and/or diastolic blood pressure of ≥ 20 mmHg and/or ≥ 10 mmHg, respectively, when one transitions from the supine to an upright position. OH was measured by the Head-up Tilt Table test at 1, 3 and 5 min (OH1, OH3 and OH5, respectively). Sarcopenia and its severity were defined according to the revised European consensus on definition and diagnosis.
RESULTS
The mean age of the sample was 75.40 ± 7.35 years, and 69.9% were female. The prevalence of probable sarcopenia, sarcopenia and severe sarcopenia was 42.2%, 6.06% and 11.1%, respectively. After adjustment for all covariates, systolic OH1, OH1 and systolic OH5 were statistically significantly different between severe sarcopenia and the robust group (odds ratio [OR]: 3.26, confidence interval [CI] 0.98-10.84; P = 0.05 for systolic OH1; OR 4.31, CI 1.31-14.15; P = 0.016 for OH1; OR 4.09, CI 1.01-16.55; P = 0.048 for systolic OH5). Only systolic OH1 was statistically different between the sarcopenia and severe sarcopenia groups (OR 2.64, CI 1.87-8.73; P = 0.012). OH1 and OH5 were statistically significant different between severe sarcopenia and probable sarcopenia groups (P < 0.05); there was no relationship between the robust group and probable sarcopenia (P > 0.05).
CONCLUSIONS
There is a close relationship between sarcopenia and severe sarcopenia and OH in older adults. Therefore, when a healthcare practitioner is evaluating an older patient with sarcopenia, OH should also be evaluated, and vice versa.
Topics: Aged; Blood Pressure; Female; Humans; Hypotension, Orthostatic; Sarcopenia; Systole; Tilt-Table Test
PubMed: 32614946
DOI: 10.1093/ageing/afaa077 -
Journal of the American Society of... Dec 2015Most studies of postural hypotension (PH) have focused on standing PH. Less is known about PH after transition from a supine to sitting position. Moreover, seated PH has... (Review)
Review
Most studies of postural hypotension (PH) have focused on standing PH. Less is known about PH after transition from a supine to sitting position. Moreover, seated PH has not been previously reviewed in the English literature. The aim of this review was to provide current information regarding seating-induced PH. Seventeen studies were reviewed regarding prevalence, methods of evaluation, manifestations, predisposing factors, prognosis, and management of seated PH. Prevalence ranged from 8% among community-dwelling persons to 56% in elderly hospitalized patients. Dizziness and palpitations were the most frequent symptoms. Of a variety of factors that have been identified as predisposing and contributing to seated PH, aging, bed rest, and hypertension were most important. Because seated PH is a common, easily diagnosable and frequently symptomatic condition, especially in elderly inpatients, this disorder warrants attention. Moreover, seating-induced falls in blood pressure and the associated symptoms, may be largely prevented by nonpharmacologic interventions.
Topics: Adult; Age Factors; Aged; Aged, 80 and over; Blood Pressure Determination; Female; Humans; Hypotension, Orthostatic; Incidence; Male; Middle Aged; Posture; Prognosis; Risk Assessment; Severity of Illness Index; Sex Factors; Young Adult
PubMed: 26515671
DOI: 10.1016/j.jash.2015.10.001 -
Autonomic Neuroscience : Basic &... Dec 2020Orthostatic hypotension (OH), a debilitating disorder characterized by a drop in blood pressure when in the upright position, may be treated through several... (Review)
Review
Orthostatic hypotension (OH), a debilitating disorder characterized by a drop in blood pressure when in the upright position, may be treated through several pharmacologic and lifestyle modifications. The treatment is aimed at decreasing the symptoms, mainly the falls, increase the standing time, and improve the activities of daily life. A recent expert consensus outlined the management of orthostatic hypotension and included 4 sequential steps: 1) review medications and modify or remove those that may aggravate or cause OH; 2) non-pharmacologic measures; 3) pharmacologic measures and 4) treatment combinations. The aim of this manuscript is to review the non-pharmacological approach. In milder cases, this approach may suffice, but with more severe symptoms, such as falls, syncope or near-syncope, a pharmacological strategy is simultaneously employed. Furthermore, most non-pharmacological measures are combined. The non-pharmacological approach is aimed at optimizing blood volume, decreasing postural venous pooling, reducing heat and post-prandial induced vasodilation, emphasizing physical conditioning, and minimizing nocturnal diuresis.
Topics: Diet Therapy; Exercise Therapy; Humans; Hypotension, Orthostatic; Patient Education as Topic; Posture; Stockings, Compression
PubMed: 33126146
DOI: 10.1016/j.autneu.2020.102732 -
Journal of Cardiovascular Medicine... Feb 2015Orthostatic hypotension commonly affects elderly patients and those suffering from diabetes mellitus and Parkinson's disease. It is a cause of significant morbidity in... (Review)
Review
Orthostatic hypotension commonly affects elderly patients and those suffering from diabetes mellitus and Parkinson's disease. It is a cause of significant morbidity in the affected patients. The goal of this review is to outline the pathophysiology, evaluation, and management of the patients suffering from orthostatic hypotension.
Topics: Autonomic Nervous System Diseases; Disease Management; Humans; Hypotension, Orthostatic; Posture
PubMed: 24933201
DOI: 10.2459/01.JCM.0000446386.01100.35 -
Blood Pressure Jun 2019Orthostatic hypotension (OH) is a common and clinically important disorder. Published papers vary regarding the definitions of OH and methodologies of evaluation....
PURPOSE
Orthostatic hypotension (OH) is a common and clinically important disorder. Published papers vary regarding the definitions of OH and methodologies of evaluation. Moreover, substantial gaps in the skills and knowledge required for assessment of OH have been reported by clinicians. We aimed to provide current information regarding the definition, classification and evaluation of OH.
METHODS
We performed a comprehensive search of medical databases, using the following keywords: "postural hypotension" or "orthostatic hypotension", combined with: "definition", "classification", "diagnosis", "evaluation" or "meaning". We selected for this review the most relevant recent publications and key papers in the field, published in the English language.
RESULTS
Current data regarding definitions, classification and the evaluation of OH are reviewed. The various aspects of OH assessment are extensively discussed. Considerable discrepancies exist between the published guidelines regarding the methodology of OH diagnosing. We propose an algorithm for OH evaluation and a standardized protocol for bedside determination of OH by healthcare providers.
CONCLUSIONS
Correct assessment of OH is essential for its accurate diagnosis. The methodology of OH evaluation has not been sufficiently standardized. We emphasize the clinical importance of the uniform investigation of OH, according to the current guidelines for OH definition and meaning.
Topics: Algorithms; Diagnostic Techniques and Procedures; Humans; Hypotension, Orthostatic; Point-of-Care Testing
PubMed: 30982364
DOI: 10.1080/08037051.2019.1604067 -
Seminars in Neurology Oct 2020This review provides recommendations for the treatment of neurogenic orthostatic hypotension (nOH), postprandial hypotension, and supine hypertension. It focuses on... (Review)
Review
This review provides recommendations for the treatment of neurogenic orthostatic hypotension (nOH), postprandial hypotension, and supine hypertension. It focuses on novel treatment strategies and new insights into the mechanism underlying these conditions. Our goal is to provide practical advice for clinicians on how to screen, diagnose, and treat these conditions with nonpharmacological and pharmacological approaches. For each disorder, we offered a stepwise recommendation on how to apply these new concepts to successfully ameliorate the symptoms associated with OH to prevent syncope and falls. The management of OH in patients who also have supine hypertension requires special considerations and pharmacotherapy. It is noteworthy that there are few therapeutic options for OH and only two Food and Drug Administration-approved drugs for the treatment of OH and nOH based on randomized clinical trials. We will use these studies to develop evidence-based guidelines for OH. The research is limited for postprandial hypotension and supine hypertension, and therefore the recommendations will be based on small studies, clinical expertise, and, above all, an understanding of the underlying pathophysiology.
Topics: Autonomic Nervous System Diseases; Humans; Hypertension; Hypotension; Hypotension, Orthostatic
PubMed: 33058087
DOI: 10.1055/s-0040-1713886 -
American Journal of Hypertension Mar 2021Maintenance of upright blood pressure critically depends on the autonomic nervous system and its failure leads to neurogenic orthostatic hypotension (NOH). The most... (Review)
Review
Maintenance of upright blood pressure critically depends on the autonomic nervous system and its failure leads to neurogenic orthostatic hypotension (NOH). The most severe cases are seen in neurodegenerative disorders caused by abnormal α-synuclein deposits: multiple system atrophy (MSA), Parkinson's disease, Lewy body dementia, and pure autonomic failure (PAF). The development of novel treatments for NOH derives from research in these disorders. We provide a brief review of their underlying pathophysiology relevant to understand the rationale behind treatment options for NOH. The goal of treatment is not to normalize blood pressure but rather to improve quality of life and prevent syncope and falls by reducing symptoms of cerebral hypoperfusion. Patients not able to recognize NOH symptoms are at a higher risk for falls. The first step in the management of NOH is to educate patients on how to avoid high-risk situations and providers to identify medications that trigger or worsen NOH. Conservative countermeasures, including diet and compression garments, should always precede pharmacologic therapies. Volume expanders (fludrocortisone and desmopressin) should be used with caution. Drugs that enhance residual sympathetic tone (pyridostigmine and atomoxetine) are more effective in patients with mild disease and in MSA patients with spared postganglionic fibers. Norepinephrine replacement therapy (midodrine and droxidopa) is more effective in patients with neurodegeneration of peripheral noradrenergic fibers like PAF. NOH is often associated with other cardiovascular diseases, most notably supine hypertension, and treatment should be adapted to their presence.
Topics: Humans; Hypotension, Orthostatic; Synucleinopathies
PubMed: 33705537
DOI: 10.1093/ajh/hpaa131 -
Neurology Oct 2015
Topics: Female; Humans; Hypotension, Orthostatic; Male
PubMed: 26400575
DOI: 10.1212/WNL.0000000000002031 -
BMJ (Clinical Research Ed.) Apr 2021
Topics: Blood Pressure; Blood Pressure Determination; Diagnosis, Differential; Dizziness; Humans; Hypotension, Orthostatic
PubMed: 33893162
DOI: 10.1136/bmj.n922