Abstract 49: Supine Versus Seated Positions On The Detection Of Orthostatic Hypotension And Its Association With Fall Risk And Orthostatic Symptoms

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Stephen P Juraschek ◽  
Lawrence J Appel ◽  
Edgar R Miller
Keyword(s):  
Blood Pressure ◽  
Vitamin D ◽  
Orthostatic Hypotension ◽  
Fall Risk ◽  
Ad Hoc ◽  
The Past ◽  
Trial Testing ◽  
Risk Of Falls ◽  
Orthostatic Symptoms ◽  
The Impact

Background: Hypertension trials that monitor orthostatic hypotension (OH) compare standing to seated blood pressure (BP) rather than supine BP. We determined the impact of a supine vs seated position on OH prevalence and its relationship with fall risk and orthostatic symptoms. Methods: The Study to Understand Fall Reduction and Vitamin D in You (STURDY) was a randomized trial testing the effects of vitamin D3 dose on falls in adults age ≥70 years at higher risk of falls. OH was determined at baseline, 3, 12, and 24 months with each of 2 protocols: (1) seated to standing and (2) supine to standing. OH was defined as a drop in systolic or diastolic BP of at least 20 or 10 mm Hg. Participants were asked about orthostatic symptoms in the past month. Falls were ascertained via daily fall calendar, ad hoc reporting, and scheduled interviews. Results: Among 522 participants with 953 OH assessments (mean age 76 ± 5 years, 42% women, 18% Black), mean baseline BP was 129 ± 18/68 ± 11 mm Hg. Mean BP increased 3.4/2.6 mm Hg after sitting, but decreased -3.7/-0.7 mm Hg after being supine. OH was detected in 2.2% of seated vs 14.8% of supine assessments. Supine OH better predicted falls (HR 1.60; 95% CI: 0.98, 2.61; P =0.06) than seated OH (HR 0.70; 95% CI: 0.30, 1.60; P =0.39), although both were non-significant ( Figure ). While seated OH was not associated with orthostatic symptoms, supine OH was associated with a greater risk of fainting, blacking out, seeing spots, room spinning, and headache in the prior month ( P -values of 0.048 to 0.002). Conclusions: Supine OH was more prevalent and appeared to better predict falls and orthostatic symptoms than seated OH. These findings support a supine protocol for OH in clinical practice.

Abstract P125: The Effects Of Vitamin D Supplementation On Orthostatic Hypotension: Results From STURDY

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Stephen P Juraschek ◽  
Edgar R Miller ◽  
Lawrence J Appel
Keyword(s):  
Blood Pressure ◽  
Vitamin D ◽  
Orthostatic Hypotension ◽  
Diastolic Blood Pressure ◽  
Lower Risk ◽  
Serum Vitamin ◽  
Vitamin D Supplementation ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
Orthostatic Symptoms

Background: In some trials, vitamin D supplementation is associated with a lower risk of falls. Observational evidence has implicated orthostatic hypotension (OH) as a potential mechanism for this association. Objective: To determine if higher doses of vitamin D supplementation reduce the risk of OH. Methods: The Study to Understand Fall Reduction and Vitamin D in You (STURDY) was a double-blind, randomized, response-adaptive trial that tested the effects of 4 doses of vitamin D3 (200, 1000, 2000, and 4000 IU/day) on fall risk in adults age 70 years and older with low serum vitamin D levels (10-29 ng/ml). OH was determined at baseline, 3, 12, and 24 months by taking the difference between seated and standing blood pressure. OH was defined as a drop in systolic or diastolic blood pressure of at least 20 or 10 mmHg, respectively, after 1 minute of standing. Participants were also asked about symptoms related to OH during the OH assessment and in the past month. Odds ratios were determined using generalized estimating equations to account for repeat measurements. Results: Among 387 participants with 924 OH assessments, mean age was 77 ± 5 years, 42% were women, and 17% black. Mean baseline systolic/diastolic blood pressure was 129 ± 19/67 ± 11 mm Hg; 2.3% had OH. Compared to 200 IU/day, 1000, 2000, and 4000 IU/day did not lower risk of OH during the trial ( Table ). Furthermore, vitamin D dose was not associated with orthostatic symptoms as participants stood up or after standing. In a subset with more detailed symptom assessments, there was no association between vitamin D dose and orthostatic symptoms or functional limitations in the preceding 30 days. Conclusions: Daily, higher dose vitamin D supplementation was not associated with OH or its symptoms. These findings do not support vitamin D as an intervention to prevent OH.

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

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.

scholarly journals Vitamin D Receptor Activation Mitigates the Impact of Uremia on Endothelial Function in the 5/6 Nephrectomized Rats

2010 ◽  
Vol 2010 ◽  
pp. 1-10 ◽  
Author(s):  
J. Ruth Wu-Wong ◽  
William Noonan ◽  
Masaki Nakane ◽  
Kristin A. Brooks ◽  
Jason A. Segreti ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Heart Rate ◽  
Vitamin D ◽  
Endothelial Function ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Receptor Activation ◽  
The Impact

Endothelial dysfunction increases cardiovascular disease risk in chronic kidney disease (CKD). This study investigates whether VDR activation affects endothelial function in CKD. The 5/6 nephrectomized (NX) rats with experimental chronic renal insufficiency were treated with or without paricalcitol, a VDR activator. Thoracic aortic rings were precontracted with phenylephrine and then treated with acetylcholine or sodium nitroprusside. Uremia significantly affected aortic relaxation (% in NX rats versus % in SHAM at 30 M acetylcholine). The endothelial-dependent relaxation was improved to –%, –%, and –% in NX rats treated with paricalcitol at 0.021, 0.042, and 0.083 g/kg for two weeks, respectively, while paricalcitol at 0.042 g/kg did not affect blood pressure and heart rate. Parathyroid hormone (PTH) suppression alone did not improve endothelial function since cinacalcet suppressed PTH without affecting endothelial-dependent vasorelaxation. N-omega-nitro-L-arginine methyl ester completely abolished the effect of paricalcitol on improving endothelial function. These results demonstrate that VDR activation improves endothelial function in CKD.

The Association of Orthostatic Hypotension with Ambulatory Blood Pressure Phenotypes in SPRINT

2020 ◽  
Author(s):  
Lama Ghazi ◽  
Paul E Drawz ◽  
Nicholas M Pajewski ◽  
Stephen P Juraschek
Keyword(s):  
Blood Pressure ◽  
Orthostatic Hypotension ◽  
Treatment Strategies ◽  
Ambulatory Bp Monitoring ◽  
Increased Risk ◽  
Trial Testing ◽  
The Difference ◽  
Pattern Versus ◽  
Reverse Dipping

Abstract Background Clinic blood pressure (BP) when measured in the seated position, can miss meaningful BP phenotypes, including low ambulatory BP (white coat effects [WCE]) or high supine BP (nocturnal non-dipping). Orthostatic hypotension (OH) measured via both seated (or supine) and standing BP, could identify phenotypes poorly captured by seated clinic BP alone. Methods We examined the association of OH with WCE and night-to-daytime systolic BP (SBP) in a subpopulation of SPRINT, a randomized trial testing the effects of intensive or standard (<120 versus <140mmHg) SBP treatment strategies in adults at increased risk of cardiovascular disease. OH was assessed during follow-up (6, 12, 24 months) and defined as a decrease in mean seated SBP ≥20 or diastolic BP ≥10 mmHg after 1 min of standing. WCE, based on 24-hour ambulatory BP monitoring performed at 27 months, was defined as the difference between 27-month seated clinic and daytime ambulatory BP ≥20/≥10 mmHg. Reverse dipping was defined as a ratio of night-to-daytime SBP >1. Results Of 897 adults (mean age 71.5±9.5 years, 29% female, 28% black), 128 had OH at least once. Among those with OH, 15% had WCE (versus 7% without OH). Moreover, 25% of those with OH demonstrated a non-dipping pattern (versus 14% without OH). OH was positively associated with both WCE (OR=2.24; 95% CI: 1.28,4.27) and reverse dipping (OR=2.29; 95% CI: 1.31, 3.99). Conclusions The identification of OH in clinic was associated with two BP phenotypes often missed with traditional seated BP assessments. Further studies on mechanisms of these relationships are needed.

scholarly journals Is orthostatic hypotension and co-existing supine and seated hypertension associated with future falls in community-dwelling older adults? Results from The Irish Longitudinal Study on Ageing (TILDA)

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252212
Author(s):  
Orna A. Donoghue ◽  
Matthew D. L. O’Connell ◽  
Robert Bourke ◽  
Rose Anne Kenny
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Longitudinal Study ◽  
Orthostatic Hypotension ◽  
Community Dwelling ◽  
Effect Sizes ◽  
Important Indicator ◽  
Supine Hypertension ◽  
Risk Of Falls ◽  
Community Dwelling Older Adults

Orthostatic hypotension (OH) often co-exists with hypertension. As increasing age affects baroreflex sensitivity, it loses its ability to reduce blood pressure when lying down. Therefore, supine hypertension may be an important indicator of baroreflex function. This study examines (i) the association between OH and future falls in community-dwelling older adults and (ii) if these associations persist in those with co-existing OH and baseline hypertension, measured supine and seated. Data from 1500 community-dwelling adults aged ≥65 years from The Irish Longitudinal Study on Ageing (TILDA) were used. Continuous beat-to-beat blood pressure was measured using digital photoplethysmography during an active stand procedure with OH defined as a drop in systolic blood pressure (SBP) ≥20 mmHg and/or ≥10 mm Hg in diastolic blood pressure (DBP) within 3 minutes of standing. OH at 40 seconds (OH40) was used as a marker of impaired early stabilisation and OH sustained over the second minute (sustained OH) was used to indicate a more persistent deficit, similar to traditional OH definitions. Seated and supine hypertension were defined as SBP ≥140 mm Hg or DBP ≥90 mm Hg. Modified Poisson models were used to estimate relative risk of falls (recurrent, injurious, unexplained) and syncope occurring over four year follow-up. OH40 was independently associated with recurrent (RR = 1.30, 95% CI = 1.02,1.65), injurious (RR = 1.43, 95% CI = 1.13,1.79) and unexplained falls (RR = 1.55, 95% CI = 1.13,2.13). Sustained OH was associated with injurious (RR = 1.55, 95% CI = 1.18,2.05) and unexplained falls (RR = 1.63, 95% CI = 1.06,2.50). OH and co-existing hypertension was associated with all falls outcomes but effect sizes were consistently larger with seated versus supine hypertension. OH, particularly when co-existing with hypertension, was independently associated with increased risk of future falls. Stronger effect sizes were observed with seated versus supine hypertension. This supports previous findings and highlights the importance of assessing orthostatic blood pressure behaviour in older adults at risk of falls and with hypertension. Observed associations may reflect underlying comorbidities, reduced cerebral perfusion or presence of white matter hyperintensities.

Abstract P172: Orthostatic Hypotension And 24-hr Ambulatory Blood Pressure Monitoring In The Sprint Trial

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Lama Ghazi ◽  
Paul Drawz ◽  
Nicholas Pajewski ◽  
Stephen P Juraschek
Keyword(s):  
Blood Pressure ◽  
Orthostatic Hypotension ◽  
Blood Pressure Monitoring ◽  
Treatment Strategies ◽  
White Coat ◽  
Clinic Blood Pressure ◽  
Pressure Monitoring ◽  
Ambulatory Bp Monitoring ◽  
Trial Testing ◽  
The Difference

Background: Clinic blood pressure (BP) is measured in the seated position, which can miss important home BP phenotypes such as low ambulatory BP (white coat effects) or high supine BP (nocturnal non-dippers). Orthostatic hypotension (OH) is determined based on BP measurements in both seated (or supine) and standing positions, and thus could theoretically identify these important phenotypes in clinic. Objective: To determine the association of OH with white coat effects or night-to-daytime systolic BP (SBP) Methods: SPRINT was a randomized trial testing the effects of intensive (<120 mmHg) or standard (<140 mmHg) SBP treatment strategies in adults at higher risk of cardiovascular disease. OH was assessed at 6, 12, or 24-mths and defined as a decrease in standing and mean seated SBP ≥20 or DBP ≥10 mmHg after 1 min of standing. White coat effects, based on 24-hr ambulatory BP monitoring performed at the 27-mth visit (every 30-minutes), were defined as the difference between 27-mth seated clinic and ambulatory BP ≥ 20/≥10 mmHg. SBP dipping ratio was defined as the ratio of night-to-daytime SBP >0.9. Results: Of 897 adults (mean age 71.5 [SD, 9.5] yrs, 28.7% female, 28.0% black), 128 had OH at least once. Among those with OH, 14.8% had white coat effects versus 7.2% among those without OH. Moreover, 68.8% of those with OH demonstrated non-dipping patterns versus only 52.0% of those without OH. OH was positively associated with both white coat effects (OR=2.24; 95% CI: 1.28, 4.27) and higher night-to-daytime SBP (β=0.04; 95% CI: 0.02, 0.06) ( Table ). Conclusions: Clinic-based assessments of OH may be a useful tool for identifying BP phenotypes often missed with traditional seated BP assessments.

scholarly journals Orthostatic hypotension. Part 2: diagnosis and treatment

2020 ◽  
pp. 77-85
Author(s):  
G. A. Golovina ◽  
O. N. Zhadan ◽  
K. A. Zargaryan ◽  
O. A. Kravchenko ◽  
N. Ye. Tripolskaya
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Blood Pressure ◽  
Orthostatic Hypotension ◽  
Single Case ◽  
Arterial Blood ◽  
Main Target ◽  
Orthostatic Symptoms ◽  
Innovative Medicine

Since orthostatic hypotension is largely asymptomatic, performing an orthostatic challenge is considered as the main mean to diagnose it. One should try to define the causes of orthostatic hypotension in every single case as treating illness that lead to orthostatic hypotension will improve patient’s health outcomes. The main target for therapy should be improving patient’s functional status, reducing orthostatic symptoms as well as risk for falls and syncopes, but not maintaining arterial blood pressure within certain limits. The higher the doctors’ awareness of the methods used to diagnose the orthostatic hypotension, the better patient’s quality of life will be. The first part of the systematic review was published in the Innovative Medicine of Kuban, nr. 4, 2018.

Postavení vitaminu D v primární a sekundární prevenci u ortopedických pacientů

2021 ◽  
Vol 70 (4) ◽  
pp. 127-135
Author(s):  
Michal Čečrle ◽  
Norbert Didič ◽  
Milada Halačová ◽  
Dalibor Černý
Keyword(s):  
Vitamin D ◽  
Total Joint Replacement ◽  
Hypovitaminosis D ◽  
Evidence Based ◽  
Vitamin D Status ◽  
Primary And Secondary Prevention ◽  
Common Procedure ◽  
Risk Of Falls ◽  
Medical Recommendations ◽  
The Impact

The article discusses the effect of vitamin D on primary and secondary prevention of fractures and its effect on conditions after selected orthopaedic procedures. Fractures can be divided into traumatic, fatigue and pathological according to the cause. One of the complications of fracture is the formation of a nonunion. In addition to dealing with fractures, a total joint replacement is another common procedure in orthopaedic surgery. Because insufficient muscle strength can increase the risk of falls and thus result in a fracture, these topics are also mentioned in this article. Due to the impact of vitamin D deficiency on various musculoskeletal disorders, orthopaedic surgeons should pay more attention to the patient’s vitamin D status and be familiar with different strategies for preventing hypovitaminosis D, although clear evidence-based medical recommendations are still insufficient.

The Impact of Diabetic Neuropathy on Activities of Daily Living, Postural Balance and Risk of Falls - A Systematic Review

2021 ◽  
pp. 193229682199792
Author(s):  
Karolina Snopek Khan ◽  
Henning Andersen
Keyword(s):  
Diabetic Neuropathy ◽  
Activities Of Daily Living ◽  
Postural Balance ◽  
Fall Risk ◽  
Daily Living ◽  
Postural Stability ◽  
Cross Sectional ◽  
Risk Of Falls ◽  
Cross Sectional Studies ◽  
The Impact

Objective: The objective of this review is to discuss a compilation of the currently available literature regarding the impact of diabetic neuropathy (DN) on activities of daily living (ADL), postural stability, and risk of falls. Methods: A systematic electronic search strategy was conducted on PubMed/MEDLINE database, Cochrane Library, and Embase in March 2020. This narrative review included clinical cross-sectional studies assessing ADL, postural balance, and falls in adults with DN. All studies underwent a quality assessment based on the Newcastle Ottawa scale developed to assess cross-sectional studies. Results: Forty-two studies were identified. A total of 37 studies evaluated postural stability in DN, 10 studies assessed fall accidents, and three studies assessed ADL in individuals with DN. Seven studies assessed both postural stability and fall accidents, and one study assessed postural stability and ADL. Each of the studied outcome variables was assessed separately. Based on a quality assessment, eight studies were excluded resulting in an evaluation of 34 studies. Conclusions: Diabetic neuropathy has a negative impact on postural balance and gait kinematics combined with an increased fall risk. Because of the few number of studies available, we were unable to evaluate the impact of DN on ADL. Our findings are in concordance with previous reviews, supporting the evidence for DN as a critical measure negatively impacting postural stability and fall risk in individuals with diabetes. Further clinical investigative studies are needed.

scholarly journals The Impact of Socioeconomic Characteristics and Lifestyles on Vitamin D Deficit in Mentally Ill Patients

2019 ◽  
Vol 20 (1) ◽  
pp. 25-31
Author(s):  
Sanja Kocic ◽  
Svetlana Ristic ◽  
Sandra Zivanovic ◽  
Natasa Mihailovic ◽  
Svetlana Curcic ◽  
...  
Keyword(s):  
Vitamin D ◽  
Mental Disorders ◽  
Vitamin D Deficiency ◽  
Coffee Consumption ◽  
Mental Illnesses ◽  
Socioeconomic Characteristics ◽  
The Past ◽  
Clinical Center ◽  
The Difference ◽  
The Impact

Abstract Mental illnesses put patients at high risk for vitamin D deficit. The aim of the research is to examine the impacts of socioeconomic characteristics and lifestyles on vitamin D deficiency in mentally diseased patients. In this crosssectional study we used blood samples from patients who were treated for mental disorders at Specialist-consultative unit of the Health Center and Clinical Center Kragujevac from May-June 2014. The study used a questionnaire for the assessment of vitamin D status. The study included 220 subjects with different types of mental disorders. Normal values of vitamin D were detected in 16% of patients whereas 64% of patients had vitamin D deficiency. The patients with vitamin D deficit were in average 3 years older than that but the difference is not statistically significant (p>0.05). The patients with vitamin D deficiency were primarily female (p=0.003), people with high-school education from urban environment who lived in bad life conditions (p>0.05). Between patients with and without vitamin D deficiency there is no difference in cigarette consumption, in the number of cigarettes per day, in alcohol usage, in coffee consumption and in nutrition. However, the patients without vitamin D deficiency spent more time outside; during the past year were more exposed to sun and during the past seven days spent more than 30 minutes a day exposed to sunlight (p<0.01). These facts indicate that there is a current need for further research in this area.

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