scholarly journals Supine Hypertension Is Associated With an Impaired Cerebral Oxygenation Response to Orthostasis: Finding From The Irish Longitudinal Study on Ageing

Hypertension ◽  
2021 ◽  
Author(s):  
Louise Newman ◽  
John D. O’Connor ◽  
Roman Romero-Ortuno ◽  
Richard B. Reilly ◽  
Rose Anne Kenny
Keyword(s):  
Longitudinal Study ◽  
Orthostatic Hypotension ◽  
Sex Education ◽  
Cerebral Autoregulation ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Vascular System ◽  
Organ Damage ◽  
Antihypertensive Medications ◽  
Supine Hypertension

The cerebrovascular effects of supine hypertension (SH) are still poorly understood. With aging and atherosclerosis of the vascular system, it is not uncommon for SH and non-neurogenic orthostatic hypotension to co-occur. Given evidence for end organ damage and more extreme cerebral dysfunction in those with SH-orthostatic hypotension, we hypothesized that SH would be associated with impaired cerebral autoregulation. The aim of this study was to characterize the cerebrovascular response to orthostasis. Near-infrared spectroscopy was used to quantify the cerebrovascular response. We analyzed data from Wave 3 of TILDA (The Irish Longitudinal Study on Ageing; n=2750). Cerebral oxygenation and blood pressure (BP) were monitored continuously during an active stand. Responses were modeled using multilevel mixed-effects models and adjusted for important covariates such as age, sex, education, antihypertensive medications, and comorbidities. Forty-nine percent of the sample had SH. Those with SH demonstrated an impaired BP response and a slower recovery of BP after standing, graded by severity of SH. The cerebral oxygenation response was similar for both groups, but when standardized to mean arterial BP, the response was impaired in those with SH. A deficit of −0.83% (95% CI, −0.93 to −0.74) remained after 3 minutes of standing. Our study determined that cerebral oxygenation and cerebral autoregulation are impaired in those with SH. In older patients, consideration should be given to measuring SH and screening for orthostatic hypotension. Therapeutic studies are needed to better understand the relationship between cerebral oxygenation, medications, supine BP, and orthostatic hypotension.

scholarly journals Insights into the clinical management of the syndrome of supine hypertension – orthostatic hypotension (SH-OH): The Irish Longitudinal Study on Ageing (TILDA)

2013 ◽  
Vol 13 (1) ◽  
Author(s):  
Roman Romero-Ortuno ◽  
Matthew DL O’Connell ◽  
Ciaran Finucane ◽  
Christopher Soraghan ◽  
Chie Wei Fan ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Orthostatic Hypotension ◽  
Clinical Management ◽  
Supine Hypertension

scholarly journals The impact of supine hypertension on target organ damage and survival in patients with synucleinopathies and neurogenic orthostatic hypotension

2020 ◽  
Vol 75 ◽  
pp. 97-104 ◽  
Author(s):  
Jose-Alberto Palma ◽  
Gabriel Redel-Traub ◽  
Angelo Porciuncula ◽  
Daniela Samaniego-Toro ◽  
Patricio Millar Vernetti ◽  
...  
Keyword(s):  
Orthostatic Hypotension ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Target Organ ◽  
Neurogenic Orthostatic Hypotension ◽  
Supine Hypertension ◽  
The Impact

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.

scholarly journals Impaired Stabilisation of Orthostatic Cerebral Oxygenation is Associated with Slower Gait Speed: Evidence from The Irish Longitudinal Study on Ageing

2021 ◽  
Author(s):  
John D O'Connor ◽  
Matthew D L O’Connell ◽  
Silvin P Knight ◽  
Louise Newman ◽  
Orna A Donoghue ◽  
...  
Keyword(s):  
Older Adults ◽  
Longitudinal Study ◽  
Gait Speed ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Saturation Index ◽  
Small Sample ◽  
Community Dwelling ◽  
Clinical Tool ◽  
Wide Range

Abstract Background Cerebral autoregulation (CAR) systems maintain blood flow to the brain across a wide range of blood pressures. Deficits in CAR have been linked to gait speed but previous studies had small sample sizes and used specialised equipment which impede clinical translation. The purpose of this work was to assess the association between gait speed and orthostatic cerebral oxygenation in a large, community-dwelling sample of older adults. Methods Data for this study came from the Irish Longitudinal Study on Ageing. A near infrared spectroscopy (NIRS) device attached to the forehead of each participant (n=2708) was used to track tissue saturation index (TSI; the ratio of oxygenated to total haemoglobin) during standing. Gait speed (GS) was assessed using a portable walkway. Results Recovery was impaired in slower GS participants with a TSI value at 20 seconds (after standing) of -0.55% (95% CI: -0.67, -0.42) below baseline in the slowest GS quartile versus -0.14% (95% CI: -0.25, -0.04) in the fastest quartile. Slower GS predicted a lower TSI throughout the 3-minute monitoring period. Results were not substantially altered by adjusting for orthostatic hypotension. Adjustment for clinical and demographic covariates attenuated the association between but differences remained between GS quartiles from 20 seconds to 3 minutes after standing. Conclusion This study reported evidence for impaired recovery of orthostatic cerebral oxygenation depending on gait speed in community-dwelling older adults. Future work assessing NIRS as a clinical tool for monitoring the relationship between gait speed and cerebral regulation is warranted.

scholarly journals Management of Orthostatic Hypotension in Parkinson’s Disease

2020 ◽  
Vol 10 (s1) ◽  
pp. S57-S64
Author(s):  
Alessandra Fanciulli ◽  
Fabian Leys ◽  
Cristian Falup-Pecurariu ◽  
Roland Thijs ◽  
Gregor K. Wenning
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Orthostatic Hypotension ◽  
Organ Damage ◽  
Lifestyle Changes ◽  
Behavioral Measures ◽  
Blurred Vision ◽  
Supine Hypertension ◽  
Nocturnal Hypertension ◽  
Short And Long Term

Orthostatic hypotension (OH) is a common non-motor feature of Parkinson’s disease that may cause unexplained falls, syncope, lightheadedness, cognitive impairment, dyspnea, fatigue, blurred vision, shoulder, neck, or low-back pain upon standing. Blood pressure (BP) measurements supine and after 3 minutes upon standing screen for OH at bedside. The medical history and cardiovascular autonomic function tests ultimately distinguish neurogenic OH, which is due to impaired sympathetic nerve activity, from non-neurogenic causes of OH, such as hypovolemia and BP lowering drugs. The correction of non-neurogenic causes and exacerbating factors, lifestyle changes and non-pharmacological measures are the cornerstone of OH treatment. If these measures fail, pharmacological interventions (sympathomimetic agents and/or fludrocortisone) should be introduced stepwise depending on the severity of symptoms. About 50% of patients with neurogenic OH also suffer from supine and nocturnal hypertension, which should be monitored for with in-office, home and 24 h-ambulatory BP measurements. Behavioral measures help prevent supine hypertension, which is eventually treated with non-pharmacological measures and bedtime administration of short-acting anti-hypertensive drugs in severe cases. If left untreated, OH impacts on activity of daily living and increases the risk of syncope and falls. Supine hypertension is asymptomatic, but often limits an effective treatment of OH, increases the risk of hypertensive emergencies and, combined with OH, facilitates end-organ damage. A timely management of both OH and supine hypertension ameliorates quality of life and prevents short and long-term complications in patients with Parkinson’s disease.

scholarly journals Cerebral perfusion responses to active standing are attenuated in patients with vasovagal syncope

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
L Perez-Denia ◽  
P Claffey ◽  
A O"reilly ◽  
M Delgado-Ortet ◽  
C Rice ◽  
...  
Keyword(s):  
Recovery Rate ◽  
Cerebral Autoregulation ◽  
Cerebral Perfusion ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Vasovagal Syncope ◽  
Young Patients ◽  
Community Dwelling ◽  
Cerebral Hypoperfusion ◽  
Convenience Sample

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Irish Research Council (IRC): Government of Ireland Postgraduate Scholarship Programme 2018, Dublin, Ireland Fundació Universitària Agustí Pedro i Pons, Universitat de Barcelona, Barcelona, Spain Background Syncope is a transient loss of consciousness due to cerebral hypoperfusion. While traditionally peripheral haemodynamics are monitored during clinical assessment of syncope, relatively little is known about cerebrovascular haemodynamics during orthostasis in patients with syncope. Purpose Here we investigated whether young patients with syncope present an altered cerebral perfusion when compared to healthy controls. Given potential hyper-reactivity of the autonomic nervous system previously reported in these patients, we hypothesise that an overly active cerebral autoregulation will be present in patients with syncope. Methods Consecutive patients were prospectively recruited from a National Falls and Syncope Unit, and a convenience sample of young healthy community dwelling adults was recruited from a local university (16-30 years). Participants performed a 3 minute active stand test with continuous measurement of beat-to-beat peripheral haemodynamics (blood pressure (BP), heart rate (HR)) and changes in concentration of oxygenated Δ[O2Hb] and deoxygenated Δ[HHb] haemoglobin were derived from a near-infrared spectroscopy (NIRS) monitor. Baseline, steady state and other time domain features were derived for Δ[O2Hb] (nadir, overshoot, overshoot-to-nadir, overshoot-to-nadir recovery rate) and Δ[HHb] (peak, trough, peak-to-trough, peak-to-trough recovery rate) and multiple linear regression was used to compare differences between the two groups correcting for covariates (p < 0.05 significant). Results Patients (n = 40) were younger (20(5.5) vs 23(1) years, p = 0.003) than controls (n = 17) and were well matched in gender, weight, height, BMI and resting haemodynamics. Patients had a smaller Δ[O2Hb] overshoot-to-nadir difference (β: -0.749, CI:(-1.593 0.094), p = 0.08), a slower Δ[O2Hb] recovery rate (β: -0.186, CI:(-0.388 0.016), p = 0.071), and smaller Δ[HHb] peak-to-trough difference (β: -0.530, CI:( -0.921 0.138), p = 0.018) and slower Δ[HHb] recovery rate (β: -0.151, CI: (0.244 0.057), p = 0.008). Conclusion Patients with syncope had signs of an attenuated cerebral oxygenation response to an AS when compared to controls. We hypothesise that this is due to hyper-reactive cerebral autoregulation mechanism, which might be related to a hyper-sensitive autonomic system. Furthering our understanding of vasovagal syncope physiology can help inform future interventions and treatments. This study shows the clinical value of measuring cerebral perfusion using NIRS, an easy to use and readily applicable tool, in the assessment of syncope. Abstract Figure. Cerebral oxygenation upon standing

scholarly journals Local Passive Heat for the Treatment of Hypertension in Autonomic Failure

2021 ◽  
Author(s):  
Luis E. Okamoto ◽  
Jorge E. Celedonio ◽  
Emily C. Smith ◽  
Alfredo Gamboa ◽  
Cyndya A. Shibao ◽  
...  
Keyword(s):  
Orthostatic Hypotension ◽  
Autonomic Failure ◽  
Local Heat ◽  
Organ Damage ◽  
Crossover Fashion ◽  
Fluid Loss ◽  
Supine Hypertension ◽  
Novel Approach ◽  
Treatment Of Hypertension

BackgroundSupine hypertension affects a majority of patients with autonomic failure; it is associated with end‐organ damage and can worsen daytime orthostatic hypotension by inducing pressure diuresis and volume loss during the night. Because sympathetic activation prevents blood pressure (BP) from falling in healthy subjects exposed to heat, we hypothesized that passive heat had a BP‐lowering effect in patients with autonomic failure and could be used to treat their supine hypertension.Methods and ResultsIn Protocol 1 (n=22), the acute effects of local heat (40–42°C applied with a heating pad placed over the abdomen for 2 hours) versus sham control were assessed in a randomized crossover fashion. Heat acutely decreased systolic BP by −19±4 mm Hg (versus 3±4 with sham,P<0.001) owing to decreases in stroke volume (−18±5% versus −4±4%,P=0.013 ) and cardiac output (−15±5% versus −2±4%,P=0.013). In Protocol 2 (proof‐of‐concept overnight study; n=12), we compared the effects of local heat (38°C applied with a water‐perfused heating pad placed under the torso from 10 pmto 6 am) versus placebo pill. Heat decreased nighttime systolic BP (maximal change −28±6 versus −2±6 mm Hg,P<0.001). BP returned to baseline by 8 am. The nocturnal systolic BP decrease correlated with a decrease in urinary volume (r=0.57,P=0.072) and an improvement in the morning upright systolic BP (r=−0.76,P=0.007).ConclusionsLocal heat therapy effectively lowered overnight BP in patients with autonomic failure and supine hypertension and offers a novel approach to treat this condition. Future studies are needed to assess the long‐term safety and efficacy in improving nighttime fluid loss and daytime orthostatic hypotension.RegistrationURL:https://www.clinicaltrials.gov; Unique identifiers: NCT02417415 and NCT03042988.

scholarly journals Neuroprotection of the Perinatal Brain by Early Information of Cerebral Oxygenation and Perfusion Patterns

2021 ◽  
Vol 22 (10) ◽  
pp. 5389
Author(s):  
Filipe Gonçalves Costa ◽  
Naser Hakimi ◽  
Frank Van Bel
Keyword(s):  
Cerebral Autoregulation ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Neuronal Damage ◽  
White Matter Injury ◽  
Preterm Neonates ◽  
Simultaneous Estimation ◽  
Early Assessment ◽  
Brain Oxygenation ◽  
Term Infants

Abnormal patterns of cerebral perfusion/oxygenation are associated with neuronal damage. In preterm neonates, hypoxemia, hypo-/hypercapnia and lack of cerebral autoregulation are related to peri-intraventricular hemorrhages and white matter injury. Reperfusion damage after perinatal hypoxic ischemia in term neonates seems related with cerebral hyperoxygenation. Since biological tissue is transparent for near infrared (NIR) light, NIR-spectroscopy (NIRS) is a noninvasive bedside tool to monitor brain oxygenation and perfusion. This review focuses on early assessment and guiding abnormal cerebral oxygenation/perfusion patterns to possibly reduce brain injury. In term infants, early patterns of brain oxygenation helps to decide whether or not therapy (hypothermia) and add-on therapies should be considered. Further NIRS-related technical advances such as the use of (functional) NIRS allowing simultaneous estimation and integrating of heart rate, respiration rate and monitoring cerebral autoregulation will be discussed.

Initial orthostatic hypotension is unrelated to orthostatic tolerance in healthy young subjects

2009 ◽  
Vol 107 (2) ◽  
pp. 506-517 ◽  
Author(s):  
Kate N. Thomas ◽  
James D. Cotter ◽  
Sean D. Galvin ◽  
Michael J. A. Williams ◽  
Chris K. Willie ◽  
...  
Keyword(s):  
Orthostatic Hypotension ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Lower Body Negative Pressure ◽  
Cerebral Vasoconstriction ◽  
Transient Nature ◽  
Head Up Tilt ◽  
Young Subjects ◽  
Initial Orthostatic Hypotension ◽  
End Tidal

The physiological challenge of standing upright is evidenced by temporary symptoms of light-headedness, dizziness, and nausea. It is not known, however, if initial orthostatic hypotension (IOH) and related symptoms associated with standing are related to the occurrence of syncope. Since IOH reflects immediate and temporary adjustments compared with the sustained adjustments during orthostatic stress, we anticipated that the severity of IOH would be unrelated to syncope. Following a standardized period of supine rest, healthy volunteers [ n = 46; 25 ± 5 yr old (mean ± SD)] were instructed to stand upright for 3 min, followed by 60° head-up tilt with lower-body negative pressure in 5-min increments of −10 mmHg, until presyncope. Beat-to-beat blood pressure (radial arterial or Finometer), middle cerebral artery blood velocity (MCAv), end-tidal Pco2, and cerebral oxygenation (near-infrared spectroscopy) were recorded continuously. At presyncope, although the reductions in mean arterial pressure, MCAv, and cerebral oxygenation were similar to those during IOH (40 ± 11 vs. 43 ± 12%; 36 ± 18 vs. 35 ± 13%; and 6 ± 5 vs. 4 ± 2%, respectively), the reduction in end-tidal CO2 was greater (−7 ± 6 vs. −4 ± 3 mmHg) and was related to the decline in MCAv ( R2 = 0.4; P < 0.05). While MCAv pulsatility was elevated with IOH, it was reduced at presyncope ( P < 0.05). The cardiorespiratory and cerebrovascular changes during IOH were unrelated to those at presyncope, and interestingly, there was no relationship between the hemodynamic changes and the incidence of subjective symptoms in either scenario. During IOH, the transient nature of physiological changes can be well tolerated; however, potentially mediated by a reduced MCAv pulsatility and greater degree of hypocapnic-induced cerebral vasoconstriction, when comparable changes are sustained, the development of syncope is imminent.

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