Blood pressure and orthostatic hypotension as measures of autonomic dysfunction in patients from the transthyretin amyloidosis outcomes survey (THAOS)

Neurogenic orthostatic hypotension (nOH) is a subtype of orthostatic hypotension in which patients have impaired regulation of standing blood pressure due to autonomic dysfunction. Several primary and secondary causes of this disease exist. Patients may present with an array of symptoms making diagnosis difficult. This review article addresses the epidemiology, pathophysiology, causes, clinical features, and management of nOH. We highlight various pharmacological and non-pharmacological approaches to treatment, and review the recent guidelines and our approach to nOH.

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Schwindel und Blutdruck

DMW - Deutsche Medizinische Wochenschrift ◽

10.1055/a-0873-2423 ◽

2019 ◽

Vol 144 (12) ◽

pp. 795-798

Author(s):

Martin Middeke

Keyword(s):

Blood Pressure ◽

Multiple System Atrophy ◽

Neurodegenerative Diseases ◽

Orthostatic Hypotension ◽

Autonomic Dysfunction ◽

Broad Spectrum

AbstractDizziness 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.

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Paroxysmal Orthostatic Ventricular Tachycardia in a Patient With Supine Hypertension and Orthostatic Hypotension

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709620958303 ◽

2020 ◽

Vol 8 ◽

pp. 232470962095830

Author(s):

Khalil Kanjwal ◽

Shakeel M. Jamal ◽

David W. McComb ◽

Majid Mughal ◽

Asim Kichloo

Keyword(s):

Blood Pressure ◽

Ventricular Tachycardia ◽

Orthostatic Hypotension ◽

Autonomic Dysfunction ◽

Treatment Strategies ◽

Upright Posture ◽

Supine Hypertension ◽

Nonsustained Ventricular Tachycardia ◽

Premature Ventricular Beats ◽

Orthostatic Hypertension

Supine orthostatic hypertension with orthostatic hypotension is an autonomic dysfunction where the patients present with hypertension when supine and with decrease in blood pressure while bearing an upright posture. We report on a 74-year-old male who was admitted with dizziness and was found to have profound orthostatic hypotension with supine hypertension. The patient also developed orthostatic paroxysmal premature ventricular beats as well as nonsustained ventricular tachycardia. In this report, we attempt to present the possible mechanism of orthostatic ventricular tachycardia in our patient and the overview of the treatment strategies used in management of patients with supine hypertension and orthostatic hypotension.

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Nondipping in Parkinson's Disease

Parkinson s Disease ◽

10.4061/2011/897586 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 7

Author(s):

Sita Sommer ◽

Billur Aral-Becher ◽

Wolfgang Jost

Keyword(s):

Blood Pressure ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Arterial Hypertension ◽

Orthostatic Hypotension ◽

Autonomic Dysfunction ◽

Blood Pressure Monitoring ◽

Pressure Monitoring ◽

Blood Pressure Fall ◽

High Prevalence

Objective. The aim of this study was to identify patients with Parkinson's disease who showed loss or decrease of nocturnal blood pressure fall (nondipper patients) as a marker of autonomic dysfunction. Presence or absence of orthostatic hypotension was considered to investigate whether alterations in circadian blood pressure pattern are associated with posture-related dysregulation of blood pressure.Methods. 40 patients with Parkinson's disease underwent 24-hour blood pressure monitoring. 21 patients were diagnosed with arterial hypertension and received anti-hypertensive drugs. Nondipper patients were defined as having nocturnal decrease of mean systolic and diastolic blood pressure less than 10%. Presence or absence of orthostatic hypotension was determined by Schellong's test.Results. We identified 35 nondipper patients (88%). Nondipping was detected in 20 patients with orthostatic hypotension (95%) and in 15 patients without orthostatic hypotension (79%). 18 patients with hypertensive and 22 patients with normal blood pressure values were detected.Conclusions. In conclusion 24-hour blood pressure monitoring showed a high prevalence of nondipping in 40 patients with Parkinson's disease with and without orthostatic hypotension independent of coexisting arterial hypertension and antihypertensive treatment. 24-hour blood pressure monitoring may be useful to identify non-dipping as a marker of autonomic dysfunction in patients with Parkinson's disease.

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Clinical Epidemiology of Systolic and Diastolic Orthostatic Hypotension in Patients on Peritoneal Dialysis

Journal of Clinical Medicine ◽

10.3390/jcm10143075 ◽

2021 ◽

Vol 10 (14) ◽

pp. 3075

Author(s):

Claudia Torino ◽

Rocco Tripepi ◽

Maria Carmela Versace ◽

Antonio Vilasi ◽

Giovanni Tripepi ◽

...

Keyword(s):

Blood Pressure ◽

Peritoneal Dialysis ◽

Orthostatic Hypotension ◽

Clinical Epidemiology ◽

Hemodialysis Patients ◽

Excess Death ◽

Death Risk ◽

Standardized Protocol ◽

Pressure Changes ◽

The Impact

Blood pressure changes upon standing reflect a hemodynamic response, which depends on the baroreflex system and euvolemia. Dysautonomia and fluctuations in blood volume are hallmarks in kidney failure requiring replacement therapy. Orthostatic hypotension has been associated with mortality in hemodialysis patients, but neither this relationship nor the impact of changes in blood pressure has been tested in patients on peritoneal dialysis. We investigated both these relationships in a cohort of 137 PD patients. The response to orthostasis was assessed according to a standardized protocol. Twenty-five patients (18%) had systolic orthostatic hypotension, and 17 patients (12%) had diastolic hypotension. The magnitude of systolic and diastolic BP changes was inversely related to the value of the corresponding supine BP component (r = −0.16, p = 0.056 (systolic) and r = −0.25, p = 0.003 (diastolic), respectively). Orthostatic changes in diastolic, but not in systolic, BP were linearly related to the death risk (HR (1 mmHg reduction): 1.04, 95% CI 1.01–1.07, p = 0.006), and this was also true for CV death (HR: 1.08, 95% CI 1.03–1.12, p = 0.001). The strength of this association was not affected by further data adjustment (p ≤ 0.05). These findings suggest that independent of the formal diagnosis of orthostatic hypotension, even minor orthostatic reductions in diastolic BP bear an excess death risk in this population.

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Usefulness of Leg-Crossing for Maintaining Blood Pressure in a Sitting Position in Patients with Orthostatic Hypotension—Case Reports

Angiology ◽

10.1177/000331979104200512 ◽

1991 ◽

Vol 42 (5) ◽

pp. 421-425 ◽

Cited By ~ 13

Author(s):

Shuichi Takishita ◽

Takashi Touma ◽

Nobuyuki Kawazoe ◽

Hiromi Muratani ◽

Koshiro Fukiyama

Keyword(s):

Blood Pressure ◽

Orthostatic Hypotension ◽

Case Reports ◽

Sitting Position

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Effects of once-daily ampreloxetine (TD-9855), a norepinephrine reuptake inhibitor, on blood pressure in subjects with symptomatic neurogenic orthostatic hypotension

Parkinsonism & Related Disorders ◽

10.1016/j.parkreldis.2020.06.288 ◽

2020 ◽

Vol 79 ◽

pp. e79

Author(s):

H. Kaufmann ◽

I. Biaggioni ◽

W. Wang ◽

B. Haumann ◽

R. Vickery

Keyword(s):

Blood Pressure ◽

Orthostatic Hypotension ◽

Reuptake Inhibitor ◽

Neurogenic Orthostatic Hypotension ◽

Once Daily ◽

Norepinephrine Reuptake Inhibitor ◽

Norepinephrine Reuptake

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Abstract P080: Glucose Homeostasis, Diabetes, and Orthostatic Hypotension in a Community-based Population: The ARIC Study

Circulation ◽

10.1161/circ.137.suppl_1.p080 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Stephen P Juraschek ◽

Natalie Daya ◽

A. Richey Sharrett ◽

Elizabeth Selvin

Keyword(s):

Blood Pressure ◽

Orthostatic Hypotension ◽

Standing Position ◽

Continuous Variable ◽

Undiagnosed Diabetes ◽

Diabetes Group ◽

Cross Sectional ◽

Diabetes Status ◽

Group 5 ◽

Group 2

Background: Although orthostatic hypotension (OH) screening is recommended for adults with diabetes, the extent to which blood glucose (BG) levels are associated with OH has not been characterized. Hypothesis: Higher BG levels are associated with having OH, while low levels of BG are not associated with OH. Methods: We examined the cross-sectional association of OH with BG and diabetes status in middle-aged (range 44 to 66 yrs) ARIC participants (1987-1989). OH was defined as a drop in blood pressure (systolic ≥20 mm Hg or diastolic ≥10 mm Hg) within 2 min of standing, when transitioning from the supine to standing position. Using logistic regression, we examined the association of the following 5 categories of BG without diabetes or diabetes and OH: (1) low-normal BG (fasting BG <80 or non-fasting BG <100 mg/dL), (2) high-normal BG (fasting BG of 80-99 or non-fasting BG of 100-139 mg/dL), (3) pre-diabetes (fasting BG of 100-125 or non-fasting BG of 140-199 mg/dL), (4) undiagnosed diabetes (fasting BG ≥126 or non-fasting BG ≥200 mg/dL), or (5) diabetes (self-reported diagnosis or current medication use). We also modeled BG as a continuous variable by diabetes status, using restricted cubic splines to characterize the association between BG level and OH. Results: In 12,636 participants (mean age 54.6 ± 5.7 yrs, 55% women, 26% black), 4.3% had OH at baseline. The mean BG was 108 ± 38 mg/dL; 7% had diabetes (self-reported diagnosis or diabetes medications). After adjustment, adults with low BG (group 1) or diabetes (group 5) were both more likely to have OH compared to the normal BG group (group 2) with ORs of 2.15 (95% CI: 1.26, 3.65) and 2.20 (95% CI: 1.65, 2.92), respectively. Continuous characterization of the relationship between BG and OH was U-shaped for participants with or without diabetes ( Figure, panels A&B ). Conclusions: Low BG in adults without diabetes, diabetes, and high BG in adults with diabetes were associated with OH. This suggests a more prominent role for BG homeostasis in blood pressure stabilization with standing.

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Screening for orthostatic hypotension using home blood pressure measurements

Journal of Hypertension ◽

10.1097/hjh.0000000000001986 ◽

2019 ◽

Vol 37 (5) ◽

pp. 923-927 ◽

Cited By ~ 7

Author(s):

Antoine Cremer ◽

Anne-laure Rousseau ◽

Romain Boulestreau ◽

Sophie Kuntz ◽

Christophe Tzourio ◽

...

Keyword(s):

Blood Pressure ◽

Orthostatic Hypotension ◽

Home Blood Pressure ◽

Pressure Measurements

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Orthostatic Hemodynamic Changes in Brain Damage

General Reanimatology ◽

10.15360/1813-9779-2020-2-22-29 ◽

2020 ◽

Vol 16 (2) ◽

pp. 22-29

Author(s):

V. N. Dorogovtsev ◽

I. V. Molchanov ◽

D. S. Yankevich

Keyword(s):

Blood Pressure ◽

Brain Death ◽

Orthostatic Hypotension ◽

Brain Damage ◽

Disorders Of Consciousness ◽

Horizontal Position ◽

Hemodynamic Changes ◽

Short Period ◽

Chronic Disorders ◽

Chronic Disorders Of Consciousness

Aim: to study orthostatic hemodynamic changes in patients with chronic disorders of consciousness after critical brain damage.Materials and methods. We studied 30 patients (10 women and 20 men) with chronic disorders of consciousness after severe brain damage aged 45±7 years, 10 of which were in the vegetative state (VS) and 20 had the minimally conscious state (MCS). The main causes of brain damage were traumatic brain injury (53% of patients) and cerebrovascular accidents (CVA) (23.3%). The rest of the patients had posthypoxic encephalopathy or were after brain tumor removal surgery. Passive orthostatic test (POT) 0° to 60° to 0° was performed using an electrically driven tilt table (Vario Line). Hemodynamic monitoring during the verticalization was done using a non-invasive oscillometric recording of blood pressure on the brachial artery, stroke volume (SV) and cardiac minute output (CMO) were measured by impedance cardiography with the multifunctional «Task Force Monitor 3010i» (CNSystem, Austria). Data were statistically analyzed using the Statistica 10 software package.Results. Orthostatic hemodynamic stability was found in 26 out of 30 patients with chronic disorders of consciousness after critical brain damage. It was manifested by stable systolic blood pressure (SBP) in tilted orthostatic and horizontal position (120.7±2.2 and 121.1±3.6 mmHg, respectively, P>0.05). Orthostatic hypotension was observed in 3 patients and postural tachycardia syndrome (PTS) in one patient. We compared orthostatic hemodynamic changes in the studied cohort versus published data on orthostatic hemodynamic changes uncluding POT revealed in patients with severe brain damage examined before and after brain death.Conclusion. Orthostatic stability of blood circulation can be maintained for a short period of time in patients surviving after critical diffuse brain damage associated with chronic disorders of consciousness. Critical brain damage resulting in brain death associates with a significant reduction of all hemodynamic parameters and severe orthostatic hypotension with restoration of initial blood pressure values when the patient is returned to the horizontal position.

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