Orthostatic Hypotension: Therapeutic Alternatives for Geriatric Patients

DICP ◽  
1989 ◽  
Vol 23 (10) ◽  
pp. 750-756
Author(s):  
T. Allen Davis ◽  
Jeffrey C. Delafuente
Keyword(s):  
Orthostatic Hypotension ◽  
Diastolic Pressure ◽  
Single Agent ◽  
Systolic Pressure ◽  
The Elderly ◽  
Myocardial Infarctions ◽  
Circulating Blood Volume ◽  
Age Related ◽  
Appropriate Therapy ◽  
Therapeutic Alternatives

Symptomatic orthostatic hypotension is a serious problem in the elderly because it can precipitate falls and fractures, myocardial infarctions, and strokes. Several disorders may cause symptomatic orthostatic hypotension including age-related changes in physiology, disorders of the autonomic nervous system, drugs, and a decrease in circulating blood volume. Orthostatic hypotension is defined as a fall in systolic pressure of at least 20–30 mm Hg and a fall in diastolic pressure of at least 10–15 mm Hg upon rising, with symptoms of cerebral ischemia. Management includes a search for reversible causes as well as nonpharmacologic and pharmacologic therapies. No single agent has been universally successful in relieving the symptoms of orthostatic hypotension. Trials of single agents or combinations of agents are needed to identify the most appropriate therapy for individual patients.

scholarly journals Electromechanical and structural alterations in the aging rabbit heart and aorta

2012 ◽  
Vol 302 (8) ◽  
pp. H1625-H1635 ◽  
Author(s):  
Leroy L. Cooper ◽  
Katja E. Odening ◽  
Min-Sig Hwang ◽  
Leonard Chaves ◽  
Lorraine Schofield ◽  
...  
Keyword(s):  
Conduction Velocity ◽  
Structural Changes ◽  
Optical Mapping ◽  
Diastolic Pressure ◽  
Ex Vivo ◽  
Rabbit Model ◽  
Systolic Pressure ◽  
Age Related ◽  
Sheet Structure

Aging increases the risk for arrhythmias and sudden cardiac death (SCD). We aimed at elucidating aging-related electrical, functional, and structural changes in the heart and vasculature that account for this heightened arrhythmogenic risk. Young (5–9 mo) and old (3.5–6 yr) female New Zealand White (NZW) rabbits were subjected to in vivo hemodynamic, electrophysiological, and echocardiographic studies as well as ex vivo optical mapping, high-field magnetic resonance imaging (MRI), and histochemical experiments. Aging increased aortic stiffness (baseline pulse wave velocity: young, 3.54 ± 0.36 vs. old, 4.35 ± 0.28 m/s, P < 0.002) and diastolic (end diastolic pressure-volume relations: 3.28 ± 0.5 vs. 4.95 ± 1.5 mmHg/ml, P < 0.05) and systolic (end systolic pressure-volume relations: 20.56 ± 4.2 vs. 33.14 ± 8.4 mmHg/ml, P < 0.01) myocardial elastances in old rabbits. Electrophysiological and optical mapping studies revealed age-related slowing of ventricular and His-Purkinje conduction (His-to-ventricle interval: 23 ± 2.5 vs. 31.9 ± 2.9 ms, P < 0.0001), altered conduction anisotropy, and a greater inducibility of ventricular fibrillation (VF, 3/12 vs. 7/9, P < 0.05) in old rabbits. Histochemical studies confirmed an aging-related increased fibrosis in the ventricles. MRI showed a deterioration of the free-running Purkinje fiber network in ventricular and septal walls in old hearts as well as aging-related alterations of the myofibrillar orientation and myocardial sheet structure that may account for this slowed conduction velocity. Aging leads to parallel stiffening of the aorta and the heart, including an increase in systolic stiffness and contractility and diastolic stiffness. Increasingly, anisotropic conduction velocity due to fibrosis and altered myofibrillar orientation and myocardial sheet structure may contribute to the pathogenesis of VF in old hearts. The aging rabbit model represents a useful tool for elucidating age-related changes that predispose the aging heart to arrhythmias and SCD.

Effect of Age on Vascular α-Adrenoceptor Responsiveness in Man

1982 ◽  
Vol 63 (s8) ◽  
pp. 305s-308s ◽  
Author(s):  
Henry L. Elliott ◽  
David J. Sumner ◽  
Kathleen McLean ◽  
Peter C. Rubin ◽  
John L. Reid
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Systolic Pressure ◽  
The Elderly ◽  
Elderly Subjects ◽  
Comparable Amount ◽  
Healthy Elderly ◽  
Age Related ◽  
Significant Difference ◽  
Mean Heart Rate

1. The responsiveness of α-receptors was compared in six young and six healthy elderly subjects by evaluating the haemodynamic effects of the a, antagonist prazosin and the pressor responses to the a, agonist phenylephrine. 2. Oral prazosin (1 mg) lowered erect (but not supine) blood pressure in both groups by a comparable amount: in young and old groups the respective maximal falls in systolic pressure were 19.5 ± 15.7 and 29.3 ± 11.4 mmHg (mean ± sd) and for diastolic pressure the maximal falls were 13 ± 13.3 and 18 ± 11.1 mmHg. 3. This similar fall in blood pressure occurred in association with a significantly different heart rate response: in the young group mean heart rate increased to 103 beats/min but there was no corresponding increase in the elderly group, which had a mean heart rate of 80 beats/min. 4. Log dose-response curves were derived from incremental intravenous infusions of phenylephrine, and the doses required to raise mean arterial pressure by 20 mmHg (PD20) were compared: the mean PD20 was significantly different in the two groups: 2.5 ± 1.6 in the young compared with 4.6 ± 2.3 μg min−1 kg−1 in the elderly, consistent with reduced pressor responsiveness in the elderly. 5. No significant difference in PD20 was apparent when pressor responsiveness was determined after prazosin, but the elderly required a significantly smaller increase in phenylephrine dosage to overcome prazosin's α-receptor-blocking effects. 6. Although there is no evidence of an age-related increase in the sensitivity of α-adrenoceptor-mediated vasoconstriction, the results are not inconsistent with an age-related reduction in α-adrenoceptor responsiveness.

Not all elderly hypertensives need treatment

1978 ◽  
Vol 16 (19) ◽  
pp. 75-76
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Arterial Pressure ◽  
Cardiovascular Mortality ◽  
Middle Age ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
The Elderly ◽  
Healthy People ◽  
Elderly Hypertensives

In all patients in whom it has been studied arterial pressure rises with age but systolic pressure rises more than diastolic pressure because arteries become less elastic. Raised systolic and diastolic pressures are both associated with higher cardiovascular mortality at all pressures and at all ages up to about 70.1 Systolic pressures predict risk better in the elderly as well as in middle age.2 The association with stroke and heart failure is much stronger than with myocardial infarction, especially in the elderly.2 However in otherwise healthy people over 70, neither systolic nor diastolic pressures are related to subsequent survival.3

Age-Related Changes in the Biomechanical Cyclic Strain of the Human Thoracic Aorta

2008 ◽  
Author(s):  
Tina M. Morrison ◽  
Gilwoo Choi ◽  
Polina A. Segalova ◽  
Christopher K. Zarins ◽  
Charles A. Taylor
Keyword(s):  
Cardiovascular Health ◽  
Vascular System ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Cyclic Strain ◽  
Human Aorta ◽  
Vascular Compliance ◽  
Age Related ◽  
Progression Of Disease ◽  
And Function

Large vessels in the vascular system undergo progressive degeneration with aging. The widely accepted theory is the aorta enlarges and stiffens with age [1] and vascular compliance decreases [2], which increases systolic pressure, decreases diastolic pressure, and greatly affects cardiovascular health and function. Quantifying the dynamics of an aging human aorta yields insight into changes in the vascular compliance and is vital in understanding pathogenesis and progression of disease, such as atherosclerosis and aneurysm formation [3], along with medical device implantation and design.

scholarly journals Paracetamol: A Review of Guideline Recommendations

2021 ◽  
Vol 10 (15) ◽  
pp. 3420
Author(s):  
Ulderico Freo ◽  
Chiara Ruocco ◽  
Alessandra Valerio ◽  
Irene Scagnol ◽  
Enzo Nisoli
Keyword(s):  
Chronic Pain ◽  
Population Aging ◽  
Current Trend ◽  
Single Agent ◽  
The Elderly ◽  
Efficacy And Safety ◽  
Age Related ◽  
Intravenous Paracetamol ◽  
Significant Efficacy ◽  
Favorable Safety

Musculoskeletal pain conditions are age-related, leading contributors to chronic pain and pain-related disability, which are expected to rise with the rapid global population aging. Current medical treatments provide only partial relief. Furthermore, non-steroidal anti-inflammatory drugs (NSAIDs) and opioids are effective in young and otherwise healthy individuals but are often contraindicated in elderly and frail patients. As a result of its favorable safety and tolerability record, paracetamol has long been the most common drug for treating pain. Strikingly, recent reports questioned its therapeutic value and safety. This review aims to present guideline recommendations. Paracetamol has been assessed in different conditions and demonstrated therapeutic efficacy on both acute and chronic pain. It is active as a single agent and is additive or synergistic with NSAIDs and opioids, improving their efficacy and safety. However, a lack of significant efficacy and hepatic toxicity have also been reported. Fast dissolving formulations of paracetamol provide superior and more extended pain relief that is similar to intravenous paracetamol. A dose reduction is recommended in patients with liver disease or malnourished. Genotyping may improve efficacy and safety. Within the current trend toward the minimization of opioid analgesia, it is consistently included in multimodal, non-opioid, or opioid-sparing therapies. Paracetamol is being recommended by guidelines as a first or second-line drug for acute pain and chronic pain, especially for patients with limited therapeutic options and for the elderly.

scholarly journals Management of Metastatic Nonsmall Cell Lung Cancer in Elderly

2021 ◽  
Vol 42 (03) ◽  
pp. 229-239
Author(s):  
Hardik Sheth ◽  
Prashant Kumar ◽  
Sewanti Limaye
Keyword(s):  
Lung Cancer ◽  
Cell Lung Cancer ◽  
Elderly Population ◽  
Single Agent ◽  
Nonsmall Cell Lung Cancer ◽  
The Elderly ◽  
Driver Mutation ◽  
Challenges And Opportunities ◽  
Appropriate Therapy ◽  
To Come

AbstractThere is limited data on management of metastatic nonsmall cell lung cancer (NSCLC) in the elderly population due to lack of representation of this subset in clinical trials. The projected representation of elderly population of patients globally is expected to rise significantly in the years to come. It is imperative to understand the specific challenges and opportunities in management of elderly with NSCLC. Even in the elderly, the medical management of advanced NSCLC begins with driver mutation testing on lung biopsy. Once the patient is classified as driver mutation positive or negative, they can either be treated with a single-agent-targeted therapy or with immunotherapy and chemotherapy or after programmed death ligand 1 (PDL-1) assessment, with immunotherapy alone. After starting the appropriate therapy, the disease needs to be monitored at every 3 months with reassessment scans. Treatment in elderly should be designed as per their functional and not chronological age, and geriatric assessment scales should be utilized wherever possible to understand the functional age of the patient.

Influence of age on cardiovascular reflex response in anesthetized rats

1985 ◽  
Vol 249 (1) ◽  
pp. R31-R38 ◽  
Author(s):  
J. Y. Wei ◽  
D. Mendelowitz ◽  
N. Anastasi ◽  
J. W. Rowe
Keyword(s):  
Arterial Pressure ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Systemic Arterial Pressure ◽  
Reflex Response ◽  
Base Line ◽  
Intravascular Volume ◽  
Postural Change ◽  
Nerve Activity ◽  
Age Related

To test the hypothesis that aging is associated with an altered hemodynamic response to physiological (nonpharmacological) stimuli, such as postural change and intravascular volume perturbations, we studied the adult (A, 6 mo) and senescent (S, 24 mo) Fischer 344 rat, a mammalian aging model not influenced by atherosclerosis or hypertension. Special emphasis was placed on the afferent limb of the baroreceptor reflex arc, an area not previously studied with respect to age. The base-line heart rate (HR), systemic arterial pressure (SAP), pulmonary arterial pressure (PAP), and carotid sinus nerve activity were not influenced by age. Following postural change (60 degrees upward tilt), the old animals demonstrated a greater drop in systolic pressure (-11 +/- 2, A; -21 +/- 4 mmHg, S; P less than 0.05), but there was no significant change in HR in either group. In response to a controlled withdrawal of 0.5 ml, the A had a greater reduction in systolic pressure (-29 +/- 4, A; -12 +/- 3 mmHg, S; P less than 0.01), whereas HR or PAP did not change; both groups showed a similar decrease in nerve activity. After infusions of 0.5 and 1.0 ml, the systolic and diastolic pressure changes were greater (P less than 0.02), and the changes in nerve activity appeared to be slightly more prolonged in the A compared with the S. Thus the response to changes in intravascular volume and posture are altered with age, and differences in volume-mediated venovasomotor reflex response may contribute to these age-related changes in the rat.

scholarly journals TINGKAT PENGETAHUAN LANSIA TENTANG HIPERTENSI BERHUBUNGAN DENGAN KEJADIAN HIPERTENSI

2021 ◽  
Vol 7 (4) ◽  
pp. 865-868
Author(s):  
Tesa Seftiana ◽  
Diyanah Kumalasary
Keyword(s):  
Healthy Lifestyle ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
The Elderly ◽  
P Value ◽  
Chi Square ◽  
Cross Sectional ◽  
East Kalimantan ◽  
Level Of Knowledge ◽  
Knowledge Levels

Background: Hypertension is a persistent increase in blood pressure with systolic pressure above 140 mmHg and diastolic pressure above 90 mmHg. According to WHO, around 972 million people worldwide or 26.4% worldwide suffer from hypertension, this figure is likely to increase to 29.2% in 2025. According to the 2013 Basic Health Research, it is known that the prevalence of hypertension in Indonesia is 25.8% with the highest prevalence in Bangka Belitung at 30.9%, followed by South Kalimantan at 30.8%, East Kalimantan at 29, 6%, and West Java is a province that places the fourth position at 29.4% (Ministry of Health, 2013). Notoatmodjo in 2010 explained that hypertension prevention behavior is an important part that must be considered by avoiding bad habits such as drinking coffee, smoking, irregular exercise, drinking alcohol and eating foods that contain fat. Hypertension can be overcome, one of which is a healthy lifestyle, this can be applied if people with hypertension have sufficient knowledgeThe purpose of the study: to determine the relationship between the level of knowledge of the elderly about hypertension with the incidence of hypertension in Lemahabang sub-district in 2020.Methods: This study uses an analytical method with a cross sectional approach. The subjects of this study were the elderly aged 60 years and over. Based on the results of the chi-square test, the P value (α=<0.05) was obtained.Results: The results of the study on the level of knowledge of respondents about hypertension obtained good knowledge levels as many as 11 respondents (22%), sufficient knowledge levels as many as 24 respondents (48%), and less knowledge levels as much as 15 (30%). 30 respondents (60%) had hypertension, while 20 respondents (40%).Conclusion There is no relationship between the knowledge of the elderly related to hypertension with the incidence of hypertension in Lemahabang sub-district Suggestion: it is hoped that the community will increase their level of knowledge regarding hypertension so that they can prioritize health services so that the community, especially the elderly, can choose and determine a good and correct way of life. Keywords: Knowledge, HypertensionKeywords Knowledge, Hypertension, Elderly ABSTRAK Latar belakang : Hipertensi adalah suatu peningkatan tekanan darah persisten dengan tekanan sistolik diatas 140 mmHg dan tekanan diastilok di atas 90 mmHg.Menurut WHO, di seluruh dunia sekitar 972 juta orang atau 26,4% di seluruh dunia mengidap hipertensi, angka ini kemungkinan akan meningkat menjadi 29,2% ditahun 2025. Menurut Riset Kesehatan Dasar 2013 diketahui prevalensi hipertensi di Indonesia sebesar 25,8% dengan prevalensi tertinggi terdapat di Bangka Belitung sebesar 30,9%, diikuti kalimantan selatan sebesar 30,8%, kalimantan timur sebesar 29,6%, dan jawa Barat merupakan provinsi yang menempatkan posisi ke empat sebesar 29,4% (Depkes RI, 2013). Notoatmodjo tahun 2010 menjelaskan bahwa perilaku pencegahan hipertensi adalah salah satu bagian penting yang harus diperhatikan dengan menjauhi kebiasaan yang kurang baik seperti minum kopi, merokok, olahraga tidak teratur, minum alkohol dan makan makanan yang mengandung lemak.  Hipertensi dapat di atasi salah satunya dengan pola hidup yang sehat, hal ini bisa diterapkan bila penderita hipertensi memiliki pengetahuan yang cukupTujuan penelitian : untuk mengetahui hubungan antara tingkat pengetahuan lansia mengenai hipertensi dengan kejadian hipertensi di kecamatan Lemahabang tahun 2020.Metode : Penelitian ini menggunakan metode analitik dengan pendekatan cross sectional. Subjek penelitian ini adalah lansia yang berumur 60 tahun ke atas. Berdasarkan hasil uji chi-square di dapatkan nilai P value ( =<0,05)Hasil : Hasil penelitian tingkat pengetahuan responden tentang hipertensi didapatkan tingkat pengetahuan baik sebanyak 11 responden (22%), tingkat pengetahuan cukup sebanyak 24 responden (48%), dan tingkat pengetahuan kurang sebanyak 15 (30%).Dari hasil penelitian kejadia hiprtensi pada lansia didapatkan yang mengalami hipertensi sebanyak 30 responden (60%) sedangkan yang tidak hipertensi sebanyak 20 responden (40%).Kesimpulan  Tidak terdapat hubungan antara pengetahuan lansia terkait hipertensi dengan kejadian hipertensi di kecamatan Lemahabang Saran: diharapkan masyarakat lebih meningkatkan tingkat pengetahuannya terkait hipertensi sehingga dapat memprioritaskan pelayanan kesehatan agar masyarakat khususnya lansia dapat memilih dan menentukan cara hidup yang baik dan benar.Kata kunci : Pengetahuan, HipertensiKata Kunci Pengetahuan,Hipertensi,Lansia

HUBUNGAN POLA MAKAN DENGAN KEJADIAN HIPERTENSI PADA LANSIA DI POLIKLINIK RAWAT JALAN RUMAH SAKIT DAERAH KOTA TIDORE KEPULAUAN

e-NERS ◽  
2013 ◽  
Vol 1 (1) ◽  
Author(s):  
Yunita Saban ◽  
Mona P. Wowor ◽  
Rivelino S. Hamel
Keyword(s):  
Analytical Study ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
The Elderly ◽  
Chi Square ◽  
Cross Sectional ◽  
Chi Square Test ◽  
Cross Sectional Design ◽  
The Relationship ◽  
Food Consumed

Abstract: Hypertension is a condition characterized by the increase of blood pressure in the arteries. In the elderly population, hypertension is defined as systolic pressure of 160 mmHg and a diastolic pressure of 90 mmHg. A description of diet consists of the kind, amount, and composition of food, consumed in a particular group of people. This study aimed to determine the relationship between diet and the incidence of hypertension among the elderly of outpatients clinic in Tidore Islands. This was a descriptive analytical study with a cross sectional design. The entire population (55 patients) were used as samples. Data were analyzed by using chi-square test, with a significant level α = 0.005. The results showed that the frequency of eating was not related to the incidence of hypertension (P = 0.392 >α = 0.05) while the kind of food was related to the incidence of hypertension (P = 0,021 <α = 0,05). Conclusion: there was a relationship between diet (kinds of food) and the incidence of hypertension in the elderly of outpatients clinic in Tidore Islands. Keywords: frequency of meals, food, hypertension, elderly.     Abstrak: Hipertensi adalah keadaan yang ditandai dengan terjadinya peningkatan tekanan darah dalam arteri. Pada populasi lansia, hipertensi didefinisikan sebagai tekanan sistolik 160 mmHg dan tekanan diastolik 90 mmHg. Pola makan adalah gambaran mengenai jenis, jumlah dan komposisi bahan makanan yang dimakan tiap hari oleh seseorang yang merupakan ciri khas dari suatu kelompok masyarakat tertentu. Penelitian ini bertujuan untuk mengetahui hubungan pola makan dan kejadian hipertensi pada lansia di Poliklinik Rawat Jalan Rumah Sakit Daerah Kota Tidore Kepulauan. Penelitian ini bersifat deskriptif analitik dengan rancangan cross sectional. Tekhnik pengambilan sampel yaitu total sampling sebanyak 55 orang. Analisis data dengan menggunakan uji chi-square dengan tingkat kemaknaan α = 0,05. Hasil penelitian memperlihatkan adanya hubungan jenis makanan dan kejadian hipertensi (P = 0,021 < α = 0,05), sedangkan frekuensi makan tidak berhubungan dengan kejadian hipertensi (P = 0,392 > α = 0,05). Simpulan: terdapat hubungan antara pola makan (jenis makanan) dan kejadian hipertensi pada lansia di Poliklinik Rawat Jalan Rumah Sakit Daerah Kota Tidore Kepulauan. Kata kunci: frekuensi makan, jenis makanan, hipertensi, lansia.

Arterial stiffness is a potential mechanism and promising indicator of orthostatic hypotension in the general population

VASA ◽  
2014 ◽  
Vol 43 (6) ◽  
pp. 423-432 ◽  
Author(s):  
Qingtao Meng ◽  
Si Wang ◽  
Yong Wang ◽  
Shixi Wan ◽  
Kai Liu ◽  
...  
Keyword(s):  
General Population ◽  
Arterial Stiffness ◽  
Orthostatic Hypotension ◽  
Operating Characteristic ◽  
Pulse Wave ◽  
Augmentation Index ◽  
Multiple Logistic Regression Analysis ◽  
The Elderly ◽  
Baroreceptor Sensitivity ◽  
Roc Curve Analysis

Background: Orthostatic hypotension (OH) is a disease prevalent among middle-aged men and the elderly. The association between arterial stiffness and OH is unclear. This study evaluates whether arterial stiffness is correlated with OH and tests the usefulness of brachial-ankle pulse wave velocity (baPWV), an arterial stiffness marker, with regard to identifying OH. Patients and methods: A sample of 1,010 participants was recruited from the general population (64.8 ± 7.7 years; 426 men) who attended health check-ups. BaPWV and the radial augmentation index (rAI) were both assessed as the arterial stiffness markers, and OH was determined using blood pressure (BP) measured in the supine position, as well as 30 seconds and 2 minutes after standing. Results: The prevalence of OH in this population was 4.9 %. Compared with the non-OH group, both baPWV (20.5 ± 4.5 vs 17.3 ± 3.7, p < 0.001) and rAI (88.1 ± 10.8 vs 84.2 ± 10.7, p < 0.05) were significantly higher in the OH group. In the multiple logistic regression analysis, baPWV (OR, 1.3; 95 % CI, 1.106–1.528; p < 0.05) remained associated with OH. Moreover, the degree of orthostatic BP reduction was related to arterial stiffness. In addition, increases in arterial stiffness predicted decreases in the degree of heart rate (HR) elevation. Finally, a receiver operating characteristic (ROC) curve analysis showed that baPWV was useful in discriminating OH (AUC, 0.721; p < 0.001), with the cut-off value of 18.58 m/s (sensitivity, 0.714; specificity, 0.686). Conclusions: Arterial stiffness determined via baPWV, rather than rAI, was significantly correlated with the attenuation of the orthostatic hemodynamic response and the resultant OH. The impaired baroreceptor sensitivity might be the mechanism. In addition, baPWV appears to be a relatively sensitive and reliable indicator of OH in routine clinical practice.

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