Non-pharmacological management of orthostatic hypotension in the elderly patient

2005 ◽  
Vol 15 (3-4) ◽  
pp. 165-173 ◽  
Author(s):  
Chie Wei Fan ◽  
Conal J Cunningham
Keyword(s):  
Blood Pressure ◽  
Elderly Patient ◽  
Pressure Drop ◽  
Older People ◽  
Systolic Blood Pressure ◽  
Orthostatic Hypotension ◽  
Supine Position ◽  
The Elderly ◽  
Common Condition ◽  
Pharmacological Management

Orthostatic hypotension (OH) is defined as a systolic blood pressure (SBP) drop of at least 20 mmHg, or a diastolic blood pressure drop of at least 10 mm Hg within three minutes of standing from a supine position. It can be symptomatic or asymptomatic and is a common condition that can affect up to one in three older people living in the community. The prevalence is higher amongst those with Parkinson's disease and, unsurprisingly, amongst those attending a syncope clinic. The aetiology and pathophysiology of OH have been comprehensively discussed in a previous article in this journal.

scholarly journals UPAYA PENGENDALIAN TEKANAN DARAH PADA PENDERITA HIPERTENSI MELALUI GUIDED IMAGERY DI KELURAHAN BINTARO KOTA MATARAM

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Dewi Nur Sukma Purqoti ◽  
Baik Heni Rispawati ◽  
Harlina Putri Rusiana ◽  
Ernawati Ernawati ◽  
Baiq Rulli Fatmawati ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Guided Imagery ◽  
The Elderly ◽  
Public Knowledge ◽  
Control Blood Pressure ◽  
Pharmacological Management ◽  
Service Activity ◽  
Elementary School Education ◽  
Basic Concepts

Hypertension or high blood pressure is a disease of the heart and blood vessels characterized by an increase in systolic blood pressure of more than 140 mmHg and diastolic more than 90 mmHg which can result in increased morbidity and mortality. Hypertension is commonly found in the elderly, hypertension can be treated using pharmacology and non-pharmacology, one of which is the Guided Imagery technique. The purpose of this service activity is to increase public knowledge about the basic concepts of hypertension and how to control it. The method used in this activity is to provide counseling on the basic concepts of hypertension and how to control it in non-pharmacological form in the form of Guided Imagery technique. The results of this activity obtained that the majority of participants were over 50 years of age, mostly elementary school education, the sex of the majority of women there was an increase in knowledge after health education. After the implementation of this service, it is hoped that the community will carry out the Guided Imagery technique routinely to control blood pressure and the introduction of non-pharmacological management should be carried out as a preventive for hypertension in the community.

Abstract 10245: Arterial Stiffness, Central Pulsatile Hemodynamic Load and Orthostatic Hypotension: A Cross-sectional Survey of Community Residents in Chengdu

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kai Liu ◽  
Xiaoping Chen ◽  
Si Wang ◽  
Shixi Wan ◽  
Yufei Zhou ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Systolic Blood Pressure ◽  
Orthostatic Hypotension ◽  
Multiple Logistic Regression Analysis ◽  
The Elderly ◽  
Discriminatory Power ◽  
Receiver Operating Curve ◽  
Cross Sectional Survey ◽  
Central Systolic Blood Pressure

Introduction: Orthostatic hypotension (OH) is an independent risk factor for cardiovascular morbidity and often unrecognized in the elderly. The association between measures of central pulsatile hemodynamic load or arterial stiffness with OH is unclear. This study evaluated the usefulness of these indexes to identify OH. Hypothesis: We hypothesize that direct measures of central pulsatile hemodynamic load (e.g. central systolic blood pressure) and arterial stiffness (pulse wave velocity) both associated with OH. And Measures of central pulsatile hemodynamic load may represent a better indicator of OH. Methods: A sample of 1099 participants was recruited from the general population who attended health check-ups. Questionnaire, physical examination and laboratory tests were performance by a standard protocol. To assess the correlation between central hemodynamic indexes and the probability of OH, multiple logistic regression analysis was used to estimate the odds ratio in different models, and the discriminatory power of hemodynamic indexes for OH was assessed by the area under the receiver operating curve (ROC). Results: The prevalence of OH in this population was 5.6 %. Compared with those without OH, OH subjects had a higher age, SBP in sitting position, BP in supine position, brachial-ankle PWV (BaPWV) and central systolic blood pressure (CSBP) (all P<0.05). After adjusting for potential confounders, both CSBP (OR=1.039, 95%CI: 1.016-1.062, P=0.001) and BaPWV (OR=1.259, 95%CI: 1.130-1.402, P< 0.001) were significantly positive correlated with OH. However, in subgroup analysis, CSBP (OR=1.017, 95%CI: 0.985-1.050, P=0.310) was insignificantly associated with OH in non hypertension subgroup. In addition, BaPWV seemed to be a better discriminatory power than CSBP in both two subgroups (BaPWVAUC-CSBPAUC =0.127, 95%CI: 0.020-0.233, P=0.02 in non hypertension group; BaPWVAUC-CSBPAUC =0.118, 95%CI: -0.030-0.267, P=0.117 in hypertension group). Conclusion: BaPWV appears to be a better indicator of OH in the elderly. If a patient’s BaPWV is greater than 18m/s, Clinicians should better to carry out supine to standing blood pressures measurement in routine clinical practice.

Intra-individual variability in postural blood pressure in the elderly

1985 ◽  
Vol 69 (3) ◽  
pp. 337-341 ◽  
Author(s):  
Lewis A. Lipsitz ◽  
Helene A. Storch ◽  
Kenneth L. Minaker ◽  
John W. Rowe
Keyword(s):  
Blood Pressure ◽  
Body Weight ◽  
Systolic Blood Pressure ◽  
Orthostatic Hypotension ◽  
Coefficient Of Variation ◽  
Pressure Change ◽  
The Elderly ◽  
Blood Pressure Change ◽  
Blood Pressure Elevation ◽  
Basal Blood Pressure

1. Orthostatic hypotension, an age-related phenomenon, has been associated with hypertension and body weight variability. To evaluate the relative contributions of blood pressure elevation and abnormalities in extracellular volume regulation to orthostatic hypotension, elderly institutionalized subjects (mean age = 87 ± 7 years), taking no cardiovascular medications, underwent measurement of body weight (n = 15) and first morning supine and standing blood pressures (n = 19), 12–13 times per subject over a 2–4 week period. 2. There was a wide day-to-day variability in postural systolic blood pressure change (coefficient of variation = 533%) and a strong negative correlation between each day's postural change in systolic blood pressure and basal supine blood pressure (r = −0.55, P < 0.0001). 3. There was no association between postural blood pressure change and heart rate response or body weight changes, which were very small over the duration of the study (coefficient of variation = 0.6%). 4. Elderly individuals have intact homoeostatic mechanisms for the control of standing pressure when basal blood pressure is normal. Postural hypotension in the elderly is a variable phenomenon related to elevations in basal blood pressure.

Do Elderly Patients with An Excessive Fall in Blood Pressure on Standing Have Evidence of Autonomic Failure?

1983 ◽  
Vol 64 (6) ◽  
pp. 587-591 ◽  
Author(s):  
Brian J. Robinson ◽  
Ralph H. Johnson ◽  
David G. Lambie ◽  
Karen T. Palmer
Keyword(s):  
Blood Pressure ◽  
Orthostatic Hypotension ◽  
Diastolic Blood Pressure ◽  
Supine Position ◽  
The Elderly ◽  
Elderly Subjects ◽  
Control Group ◽  
Percentage Increase ◽  
Significant Difference ◽  
Noradrenaline Levels

1. Blood pressure, heart rate and plasma catecholamine responses were examined in two groups of elderly subjects distinguished by blood pressure responses to standing. Subjects in the control group showed a fall of less than 15 mmHg in systolic blood pressure on standing; subjects in the orthostatic hypotension group had falls of more than 20 mmHg systolic and 10 mmHg diastolic blood pressure on standing. 2. The heart pressure response on standing showed no significant difference between the two groups. 3. The orthostatic hypotension patients had lower plasma noradrenaline concentrations than the control patients (P < 0.01) in the supine position, but during 10 min standing there was no significant difference in noradrenaline levels between the groups, and the percentage increase of noradrenaline levels in the orthostatic hypotension group was greater (P < 0.05) than in the control group. 4. in the supine position, diastolic blood pressure was higher (P < 0.05) in the orthostatic hypotension group than in the control group. 5. We conclude that impairment of baroreceptor function is not involved in most cases of orthostatic hypotension in the elderly, nor is there reduction of sympathetic nervous activity. We suggest that mechanical changes or adrenoreceptor dysfunction are more likely to be important factors in orthostatic hypotension in the elderly.

Circadian blood pressure rhythmicity in the elderly patient

1993 ◽  
pp. 560-566
Author(s):  
C. Spieker ◽  
M. Barenbrock ◽  
E. Zierden ◽  
K. H. Rahn ◽  
W. Zidek
Keyword(s):  
Blood Pressure ◽  
Elderly Patient ◽  
The Elderly ◽  
Circadian Blood Pressure

P5728Association of systolic blood pressure and cardiovascular outcomes at different age groups in the healthy general population: a nationwide prospective cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M H Jung ◽  
S H Ihm ◽  
S J An ◽  
S W Yi
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Age Groups ◽  
The Elderly ◽  
Cardiovascular Outcomes ◽  
Stroke Mortality ◽  
Linear Association ◽  
Hazard Ratios ◽  
Individualized Approach ◽  
Cvd Mortality

Abstract Background Uncertainties remain regarding the effect of blood pressure on various cardiovascular outcomes in different age groups. Purpose We aimed to identify 1) whether a systolic blood pressure (SBP) of 130–139 mm Hg elevates cardiovascular disease (CVD) mortality and 2) whether SBP shows a linear association with cause-specific CVD mortality in all age groups among individuals without known hypertension and CVD. Methods We used the Korean National Health Insurance sample data (n=429,220). Participants were categorized into three groups by age (40–59, 60–69, and 70–80 years). Results A positive and graded association was generally observed between SBP and overall and cause-specific CVD mortality regardless of age, except for ischemic heart disease (IHD) mortality in those aged 70–80 years. Among those aged 70–80, the hazard ratios (HRs) (95% CIs) for overall CVD mortality were 1.08 (0.92–1.28), 1.14 (0.97–1.34), and 1.34 (1.14–1.58) for SBP values of 120–129, 130–139, and 140–149 mm Hg, respectively, compared to SBP <120 mm Hg. For total stroke mortality, the corresponding HRs were 1.29 (1.02–1.64), 1.37 (1.09–1.72), and 1.52 (1.20–1.93), while for IHD mortality, the corresponding HRs were 0.90 (0.64–1.26), 0.86 (0.62–1.19), and 1.29 (0.93–1.78). Nonlinear associations were significant for IHD (Fig 1). Figure 1 Conclusion In the elderly Korean population, SBPs of 130–139 mm Hg elevated total stroke mortality, but not IHD mortality, compared to normal BP, and a linear association was not observed for IHD mortality in the range <140 mm Hg. Regarding an appropriate diagnostic cutoff for hypertension, an individualized approach considering each person's organ susceptibility is needed for the elderly population. Acknowledgement/Funding None

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