Case 35: Initial Orthostatic Hypotension

2019 ◽  
pp. 211-214
Author(s):  
Peter Novak
Keyword(s):  
Blood Pressure ◽  
Orthostatic Hypotension ◽  
Autonomic Failure ◽  
Rapid Decrease ◽  
Standing Up ◽  
Initial Orthostatic Hypotension

Initial orthostatic hypotension (IOH)is characterized by a rapid decrease in blood pressure in response to standing up quickly, with restoration of blood pressure in less than a minute. IOH is not associated with autonomic failure.

scholarly journals Management of initial orthostatic hypotension: lower body muscle tensing attenuates the transient arterial blood pressure decrease upon standing from squatting

2007 ◽  
Vol 113 (10) ◽  
pp. 401-407 ◽  
Author(s):  
C. T. Paul Krediet ◽  
Ingeborg K. Go-Schön ◽  
Yu-Sok Kim ◽  
Mark Linzer ◽  
Johannes J. Van Lieshout ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Orthostatic Hypotension ◽  
Healthy Subjects ◽  
Lower Body ◽  
Blood Pressure Decrease ◽  
Body Muscle ◽  
Arterial Blood ◽  
Pressure Decrease ◽  
Standing Up ◽  
Initial Orthostatic Hypotension

IOH (initial orthostatic hypotension) comprises symptoms of cerebral hypoperfusion caused by an abnormally large transient MAP (mean arterial pressure) decrease 5–15 s after arising from a supine, sitting or squatting position. Few treatment options are available. In the present study, we set out to test the hypothesis that LBMT (lower body muscle tensing) attenuates IOH after rising from squatting and its symptoms in daily life. A total of 13 IOH patients (nine men; median age, 27 years) rose from squatting twice, once with LBMT and once without. In addition, seven healthy volunteers (five men; median age, 27 years) were studied in a cross-over study design. They stood up from the squatting position three times, once combined with LBMT. Blood pressure (Finometer) was measured continuously, and CO (cardiac output) by Modelflow and TPR (total peripheral resistance) were computed. MAP, CO and TPR were compared without and with LBMT. Using a questionnaire, the perceived effectiveness of LBMT in the patients' daily lives was evaluated. With LBMT, the minimal MAP after standing up was higher in both groups (19 mmHg in patients and 13 mmHg in healthy subjects). In healthy subjects, the underlying mechanism was a blunted TPR decrease (to 47% compared with 60%; P<0.05), whereas in the patients no clear CO or TPR pattern was discernible. During follow-up, eight out of ten patients using LBMT reported fewer IOH symptoms. In conclusion, LBMT is a new intervention to attenuate the transient blood pressure decrease after standing up from squatting, and IOH patients should be advised about the use of this manoeuvre.

scholarly journals The preponderance of initial orthostatic hypotension in postural tachycardia syndrome

2020 ◽  
Vol 129 (3) ◽  
pp. 459-466
Author(s):  
Julian M. Stewart ◽  
Archana Kota ◽  
Mary Breige O’Donnell-Smith ◽  
Paul Visintainer ◽  
Courtney Terilli ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Blood Flow ◽  
Heart Rate Variability ◽  
Cerebral Blood Flow ◽  
Orthostatic Hypotension ◽  
Pressure Recovery ◽  
Postural Tachycardia Syndrome ◽  
Postural Tachycardia ◽  
Initial Orthostatic Hypotension

Significant initial orthostatic hypotension (IOH) occurs in ~50% of postural tachycardia syndrome (POTS) patients and 13% of controls. Heart rate and blood pressure recovery are prolonged in IOH sustaining lightheadedness; IOH is more prevalent and severe in POTS. Altered cerebral blood flow and cardiorespiratory regulation are more prevalent in POTS. Altered heart rate variability and baroreflex gain may cause nearly instantaneous lightheadedness in POTS. IOH alone fails to confer a strong probability of POTS.

scholarly journals Neck and other muscle pains in autonomic failure: their association with orthostatic hypotension

1998 ◽  
Vol 91 (7) ◽  
pp. 355-359 ◽  
Author(s):  
K M Bleasdale-Barr ◽  
C J Mathias
Keyword(s):  
Blood Pressure ◽  
Neck Pain ◽  
Orthostatic Hypotension ◽  
Autonomic Failure ◽  
Lower Blood Pressure ◽  
Buttock Pain ◽  
Blood Pressure Fall ◽  
Lower Blood ◽  
Calf Pain ◽  
Pressure Fall

Neck pain in the suboccipital and paracervical region (‘coathanger' configuration) is often reported by patients with autonomic failure and orthostatic hypotension. The frequency of this pain, along with pains in the buttock and calf regions, was determined by questionnaire in two major groups with primary chronic autonomic failure—pure autonomic failure (PAF) and multiple system atrophy (MSA). Comparisons were made with Parkinson's disease, cerebellar degeneration and other disorders in which neurological symptoms overlap but in which there was neither autonomic failure nor orthostatic hypotension. Neck pain was present in 93% of patients with PAF, 51% of patients with MSA and 38–47% of the non-autonomic groups. Buttock pain was present in smaller but similar proportions (8–19%) of each group, like calf pain (23–37%). Neck pain in PAF and MSA differed from that in the other groups in being relieved by sitting or lying flat and in being associated with factors that lower blood pressure in these patients. Buttock pain was posturally related in PAF and MSA; for calf pain there was no difference between groups. Neck pain was related to the degree of orthostatic hypotension; in PAF patients, whose postural blood-pressure fall was greater than that in MSA, there was a greater frequency of neck pain.

scholarly journals Orthostatic arterial hypotension

2017 ◽  
Vol 12 (2) ◽  
pp. 12-15
Author(s):  
Camelia C. DIACONU ◽  
◽  
Denisa BUCUR ◽  
Daniel BERCEANU ◽  
Ovidiu Gabriel BRATU ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Elderly Patients ◽  
Orthostatic Hypotension ◽  
Pharmacological Treatment ◽  
Elderly Population ◽  
Autonomic Failure ◽  
Clinical Manifestations ◽  
The Elderly ◽  
Cerebral Hypoperfusion ◽  
Blurred Vision

Orthostatic hypotension is a persistent decrease of systolic blood pressure by at least 20 mm Hg and/or diastolic blood pressure by at least 10 mm Hg in the first 3 minutes upon standing. Orthostatic hypotension is more common in the elderly patients, being one of relatively frequent causes of hospitalization in the elderly population. Orthostatic hypotension may be primary or secondary, acute or chronic. Its etiology is represented in most cases by the primary or secondary autonomic failure. Clinical manifestations of orthostatic hypotension occur after the transition from supine to standing, and are due to cerebral hypoperfusion. These consist of nausea, dizziness, generalized weakness, postural instability, fatigue, blurred vision. Cardiological and neurological consult are necessary for diagnosis. Pharmacological treatment of orthostatic hypotension is often unsatisfactory, imposing combination with non-pharmacological measures.

Initial orthostatic hypotension and cerebral blood flow regulation: effect of α1-adrenoreceptor activity

2013 ◽  
Vol 304 (2) ◽  
pp. R147-R154 ◽  
Author(s):  
Nia C. S. Lewis ◽  
Philip N. Ainslie ◽  
Greg Atkinson ◽  
Helen Jones ◽  
Emily J. M. Grant ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Orthostatic Hypotension ◽  
Relative Difference ◽  
Cerebral Hypoperfusion ◽  
Adrenergic Blockade ◽  
Absolute Level ◽  
Arterial Blood ◽  
Placebo Trial ◽  
Initial Orthostatic Hypotension ◽  
End Tidal

We examined the hypothesis that α1-adrenergic blockade would lead to an inability to correct initial orthostatic hypotension (IOH) and cerebral hypoperfusion, leading to symptoms of presyncope. Twelve normotensive humans (aged 25 ± 1 yr; means ± SE) attempted to complete a 3-min upright stand, 90 min after the administration of either α1-blockade (prazosin, 1 mg/20 kg body wt) or placebo. Continuous beat-to-beat measurements of middle cerebral artery velocity (MCAv; Doppler), blood pressure (finometer), heart rate, and end-tidal Pco2were obtained. Compared with placebo, the α1-blockade reduced resting mean arterial blood pressure (MAP) (−15%; P < 0.01); MCAv remained unaltered ( P ≥ 0.28). Upon standing, although the absolute level of MAP was lower following α1-blockade (39 ± 10 mmHg vs. 51 ± 14 mmHg), the relative difference in IOH was negligible in both trials (mean difference in MAP: 2 ± 2 mmHg; P = 0.50). Compared with the placebo trial, the declines in MCAv and PetCO2during IOH were greater in the α1-blockade trial by 12 ± 4 cm/s and 4.4 ± 1.3 mmHg, respectively ( P ≤ 0.01). Standing tolerance was markedly reduced in the α1-blockade trial (75 ± 17 s vs. 180 ± 0 s; P < 0.001). In summary, while IOH was little affected by α1-blockade, the associated decline in MCAv was greater in the blockade condition. Unlike in the placebo trial, the extent of IOH and cerebral hypoperfusion failed to recover toward baseline in the α1-blockade trial leading to presyncope. Although the development of IOH is not influenced by the α1-adrenergic receptor pathway, this pathway is critical in the recovery from IOH to prevent cerebral hypoperfusion and ultimately syncope.

scholarly journals Orthostatic Hypotension and Therapy with an Ace Inhibitor in Hypertensive Patients

2017 ◽  
Vol 18 (s1) ◽  
pp. 61-66 ◽  
Author(s):  
Danijela Tasic ◽  
Nebojsa Tasic ◽  
Dalibor Dragisic ◽  
Miroslav Mitrovic
Keyword(s):  
Blood Pressure ◽  
Orthostatic Hypotension ◽  
Ace Inhibitor ◽  
Incidence Rates ◽  
Positive Role ◽  
The Third ◽  
Number Of Patients ◽  
Significant Difference ◽  
Standing Up

Abstract Orthostatic hypotension (OH) is defined as a drop in the systolic blood pressure greater than 20 mmHg and that of the diastolic blood pressure greater than 10 mmHg within 3 minutes from the change of the body’s position from lying or sitting down to standing up. The objective of this study is to analyse the incidence and severity of orthostatic hypertension when taking one of the generic representatives of the ACE inhibitor group (trandolapril) as a monotherapy in patients with essential hypertension. Th e study involved 314 patients (medium age of 54±4 years; 52.5% men) with poorly regulated hypertension for whom trandolapril was introduced as monotherapy. Th e incidence rates of patients with and without orthostatic hypotension between the first and second examination were not statistically significantly different. At the second control examination, 7 patients (2,3%) still had orthostatic hypotension, as was the case at the first examination. Between the third and fourth controls, a statistically significant decrease in the number of patients with orthostatic hypotension was recorded. No statistically significant difference in the incidence of orthostatic hypotension between patients with normal body mass and those who were overweight was observed. Our study has shown that certain ACE inhibitors, such as Trandolapril, do not have a pronounced adverse effect with regard to orthostatic hypotension and that in long-term application, they can have a positive role in the prevention of hypotensive episodes and improving patient compliance.

scholarly journals Dysautonomia

2012 ◽  
Vol 116 (1) ◽  
pp. 205-215 ◽  
Author(s):  
Hossam I. Mustafa ◽  
Joshua P. Fessel ◽  
John Barwise ◽  
John R. Shannon ◽  
Satish R. Raj ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Sleep Apnea ◽  
Orthostatic Hypotension ◽  
Postoperative Care ◽  
Drug Sensitivity ◽  
Autonomic Failure ◽  
Diagnosis And Treatment ◽  
Supine Hypertension ◽  
Crucial Element ◽  
Management Of Care

Severe autonomic failure occurs in approximately 1 in 1,000 people. Such patients are remarkable for the striking and sometimes paradoxic responses they manifest to a variety of physiologic and pharmacologic stimuli. Orthostatic hypotension is often the finding most commonly noted by physicians, but a myriad of additional and less understood findings also occur. These findings include supine hypertension, altered drug sensitivity, hyperresponsiveness of blood pressure to hypo/hyperventilation, sleep apnea, and other neurologic disturbances. In this article the authors will review the clinical pathophysiology that underlies autonomic failure, with a particular emphasis on those aspects most relevant to the care of such patients in the perioperative setting. Strategies used by clinicians in diagnosis and treatment of these patients, and the effect of these interventions on the preoperative, intraoperative, and postoperative care that these patients undergo is a crucial element in the optimized management of care in these patients.

scholarly journals Standing Up Slowly Antagonises Initial Blood Pressure Decrease in Older Adults with Orthostatic Hypotension

Gerontology ◽  
2016 ◽  
Vol 63 (2) ◽  
pp. 137-143 ◽  
Author(s):  
Eline S. de Bruïne ◽  
Esmee M. Reijnierse ◽  
Marijke C. Trappenburg ◽  
Jantsje H. Pasma ◽  
Oscar J. de Vries ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Orthostatic Hypotension ◽  
Standing Position ◽  
Cross Sectional Study ◽  
Community Dwelling ◽  
Pharmacological Intervention ◽  
Cross Sectional ◽  
Normal Transition ◽  
Standing Up

Background: Orthostatic hypotension (OH) is common in older adults and associated with increased morbidity and mortality, loss of independence and high health-care costs. Standing up slowly is a recommended non-pharmacological intervention. However, the effectiveness of this advice has not been well studied. Objectives: The aim of this study was to investigate whether standing up slowly antagonises posture-related blood pressure (BP) decrease in a clinically relevant population of geriatric outpatients. Methods: In this cross-sectional study, 24 community-dwelling older adults referred to a geriatric outpatient clinic and diagnosed with OH were included. BP was measured continuously during 3 consecutive transitions from supine to standing position during normal, slow and fast transition. Results: The relative BP decrease at 0-15 s after slow transition was significantly lower than after normal transition (p = 0.003 for both systolic BP and diastolic BP) and fast transition (p = 0.045 for systolic BP; diastolic BP: non-significant). The relative diastolic BP decrease at 60-180 s after normal transition was significantly lower than after fast transition (p = 0.029). Conclusion: Standing up slowly antagonises BP decrease predominantly during the first 15 s of standing up in a clinically relevant population of geriatric outpatients diagnosed with OH. Results support the non-pharmacological intervention in clinical practice to counteract OH.

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