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Orthostatic Hypotension: Clinical Features

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Orthostatic Hypotension in Older Adults

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Abstract

Orthostatic hypotension (OH) is heterogeneous and multifactorial disorder which is commonly encountered in older adults. Age-related diminished physiological reserve, loss of baroreceptor sensitivity, increased arterial stiffness, autonomic dysfunction, systemic diseases, sarcopenia, and drugs may blunt the compensatory response to orthostatic challenge. OH not only has close relationship with debilitating diseases such as Parkinson’s disease, amyloidosis, cancer, diabetes, but also carries poor prognosis in itself. Although vast majority of patients are asymptomatic, it places huge burden on healthcare system and is an important risk factor for hospitalization in older adults. Emerging evidences have indicated that OH is associated with falls, syncope, heart failure, stroke, global cognitive impairment, and even mortality. OH prevalence increases with age and comorbidities; it is one key fact that patients admitted to healthcare have been often overlooked. Diagnosis and treatment of OH may improve long-term prognosis. Therefore, it should be considered especially when assessing symptomatic older adults.

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References

  1. Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21(2):69–72.

    Article  PubMed  Google Scholar 

  2. Brignole M, Moya A, de Lange FJ, Deharo J-C, Elliott PM, Fanciulli A, et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J. 2018;39(21):1883–948.

    Article  PubMed  Google Scholar 

  3. Aydin AE, Soysal P, Isik AT. Which is preferable for orthostatic hypotension diagnosis in older adults: active standing test or head-up tilt table test? Clin Interv Aging. 2017;12:207–12.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Mol A, Reijnierse EM, Bui Hoang PTS, van Wezel RJA, Meskers CGM, Maier AB. Orthostatic hypotension and physical functioning in older adults: A systematic review and meta-analysis. Ageing Res Rev. 2018;48:122–44.

    Article  PubMed  Google Scholar 

  5. Isik AT, Kocyigit SE, Smith L, Aydin AE, Soysal P. A comparison of the prevalence of orthostatic hypotension between older patients with Alzheimer's Disease, Lewy body dementia, and without dementia. Exp Gerontol. 2019;124:110628.

    Article  PubMed  Google Scholar 

  6. Chisholm P, Anpalahan M. Orthostatic hypotension: pathophysiology, assessment, treatment and the paradox of supine hypertension. Intern Med J. 2017;47(4):370–9.

    Article  PubMed  Google Scholar 

  7. Duggan E, Romero-Ortuno R, Kenny RA. Admissions for orthostatic hypotension: an analysis of NHS England Hospital Episode Statistics data. BMJ Open. 2019;9(11):e034087.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Fedorowski A, Ricci F, Sutton R. Orthostatic hypotension and cardiovascular risk. Kardiol Pol. 2019;77(11):1020–7.

    Article  PubMed  Google Scholar 

  9. Kocyigit SE, Soysal P, Isik AT, Ates Bulut E. Malnutrition and malnutrition risk can be associated with systolic orthostatic hypotension in older adults. J Nutr Health Aging. 2018;22(8):928–33.

    Article  CAS  PubMed  Google Scholar 

  10. Kenny RA, Bhangu J. Syncope in older adults. In: Brocklehurst's textbook of geriatric medicine and gerontology. 8th ed. Amsterdam: Elsevier; 2017. p. 335–46.

    Google Scholar 

  11. Kocyigit SE, Soysal P, Bulut EA, Aydin AE, Dokuzlar O, Isik AT. What is the relationship between frailty and orthostatic hypotension in older adults? J Geriatr Cardiol. 2019;16(3):272–9.

    PubMed  PubMed Central  Google Scholar 

  12. Robertson D. The epidemic of orthostatic tachycardia and orthostatic intolerance. Am J Med Sci. 1999;317(2):75–7.

    Article  CAS  PubMed  Google Scholar 

  13. Fedorowski A. ESC CardioMed. In: Orthostatic intolerance: orthostatic hypotension and postural orthostatic tachycardia syndrome. Oxford: Oxford University Press; 2018.

    Google Scholar 

  14. Fedorowski A, Melander O. Syndromes of orthostatic intolerance: a hidden danger. J Intern Med. 2013;273(4):322–35.

    Article  CAS  PubMed  Google Scholar 

  15. Joseph A, Wanono R, Flamant M, Vidal-Petiot E. Orthostatic hypotension: a review. Nephrol Ther. 2017;13(Suppl 1):S55–s67.

    Article  PubMed  Google Scholar 

  16. Benvenuto LJ, Krakoff LR. Morbidity and mortality of orthostatic hypotension: implications for management of cardiovascular disease. Am J Hypertens. 2011;24(2):135–44.

    Article  PubMed  Google Scholar 

  17. Robertson D, Robertson RM. Causes of chronic orthostatic hypotension. Arch Intern Med. 1994;154(14):1620–4.

    Article  CAS  PubMed  Google Scholar 

  18. Shibao C, Grijalva CG, Raj SR, Biaggioni I, Griffin MR. Orthostatic hypotension-related hospitalizations in the United States. Am J Med. 2007;120(11):975–80.

    Article  PubMed  Google Scholar 

  19. Gibbons CH, Schmidt P, Biaggioni I, Frazier-Mills C, Freeman R, Isaacson S, et al. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol. 2017;264(8):1567–82.

    Article  PubMed  PubMed Central  Google Scholar 

  20. McDonell KE, Shibao CA, Claassen DO. Clinical relevance of orthostatic hypotension in neurodegenerative disease. Curr Neurol Neurosci Rep. 2015;15(12):78.

    Article  PubMed  CAS  Google Scholar 

  21. Luciano GL, Brennan MJ, Rothberg MB. Postprandial hypotension. Am J Med. 2010;123(3):281.e1–6.

    Article  Google Scholar 

  22. Kanjwal K, George A, Figueredo VM, Grubb BP. Orthostatic hypotension: definition, diagnosis and management. J Cardiovasc Med (Hagerstown). 2015;16(2):75–81.

    Article  Google Scholar 

  23. Regan CO, Kearney PM, Cronin H, Savva GM, Lawlor BA, Kenny R. Oscillometric measure of blood pressure detects association between orthostatic hypotension and depression in population based study of older adults. BMC Psychiatry. 2013;13:266.

    Article  PubMed  Google Scholar 

  24. Luukinen H, Koski K, Laippala P, Kivela SL. Prognosis of diastolic and systolic orthostatic hypotension in older persons. Arch Intern Med. 1999;159(3):273–80.

    Article  CAS  PubMed  Google Scholar 

  25. Rawlings AM, Juraschek SP, Heiss G, Hughes T, Meyer ML, Selvin E, et al. Association of orthostatic hypotension with incident dementia, stroke, and cognitive decline. Neurology. 2018;91(8):e759–e68.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Mol A, Bui Hoang PTS, Sharmin S, Reijnierse EM, van Wezel RJA, Meskers CGM, et al. Orthostatic hypotension and falls in older adults: a systematic review and meta-analysis. J Am Med Dir Assoc. 2019;20(5):589–97.e5.

    Article  PubMed  Google Scholar 

  27. Soysal P, Veronese N, Smith L, Torbahn G, Jackson SE, Yang L, et al. Orthostatic hypotension and health outcomes: an umbrella review of observational studies. Eur Geriatr Med. 2019;10(6):863–70.

    Article  PubMed  Google Scholar 

  28. Verwoert GC, Mattace-Raso FU, Hofman A, Heeringa J, Stricker BH, Breteler MM, et al. Orthostatic hypotension and risk of cardiovascular disease in elderly people: the Rotterdam study. J Am Geriatr Soc. 2008;56(10):1816–20.

    Article  PubMed  Google Scholar 

  29. Al-Aama T. Falls in the elderly: spectrum and prevention. Can Fam Physician. 2011;57(7):771–6.

    PubMed  PubMed Central  Google Scholar 

  30. Finucane C, O'Connell MD, Donoghue O, Richardson K, Savva GM, Kenny RA. Impaired orthostatic blood pressure recovery is associated with unexplained and injurious falls. J Am Geriatr Soc. 2017;65(3):474–82.

    Article  PubMed  Google Scholar 

  31. Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011;59(1):148–57.

    Article  Google Scholar 

  32. Sarasin FP, Louis-Simonet M, Carballo D, Slama S, Junod AF, Unger PF. Prevalence of orthostatic hypotension among patients presenting with syncope in the ED. Am J Emerg Med. 2002;20(6):497–501.

    Article  PubMed  Google Scholar 

  33. Ungar A, Mussi C, Ceccofiglio A, Bellelli G, Nicosia F, Bo M, et al. Etiology of Syncope and Unexplained Falls in Elderly Adults with Dementia: Syncope and Dementia (SYD) Study. J Am Geriatr Soc. 2016;64(8):1567–73.

    Article  PubMed  Google Scholar 

  34. Peters R, Anstey KJ, Booth A, Beckett N, Warwick J, Antikainen R, et al. Orthostatic hypotension and symptomatic subclinical orthostatic hypotension increase risk of cognitive impairment: an integrated evidence review and analysis of a large older adult hypertensive cohort. Eur Heart J. 2018;39(33):3135–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Qiu C, Winblad B, Fratiglioni L. The age-dependent relation of blood pressure to cognitive function and dementia. Lancet Neurol. 2005;4(8):487–99.

    Article  PubMed  Google Scholar 

  36. Sambati L, Calandra-Buonaura G, Poda R, Guaraldi P, Cortelli P. Orthostatic hypotension and cognitive impairment: a dangerous association? Neurol Sci. 2014;35(6):951–7.

    Article  PubMed  Google Scholar 

  37. Rose KM, Couper D, Eigenbrodt ML, Mosley TH, Sharrett AR, Gottesman RF. Orthostatic hypotension and cognitive function: the Atherosclerosis Risk in Communities Study. Neuroepidemiology. 2010;34(1):1–7.

    Article  PubMed  Google Scholar 

  38. Feeney J, O'Leary N, Kenny RA. Impaired orthostatic blood pressure recovery and cognitive performance at two-year follow up in older adults: The Irish Longitudinal Study on Ageing. Clin Auton Res. 2016;26(2):127–33.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Andersson M, Hansson O, Minthon L, Ballard CG, Londos E. The period of hypotension following orthostatic challenge is prolonged in dementia with Lewy bodies. Int J Geriatr Psychiatry. 2008;23(2):192–8.

    Article  CAS  PubMed  Google Scholar 

  40. Kleipool EEF, Trappenburg MC, Rhodius-Meester HFM, Lemstra AW, van der Flier WM, Peters MJL, et al. Orthostatic hypotension: an important risk factor for clinical progression to mild cognitive impairment or dementia. the amsterdam dementia cohort. J Alzheimers Dis. 2019;71(1):317–25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. van Twist DJL, Mostard GJM, Sipers W. Delayed recovery from initial orthostatic hypotension: an expression of frailty in the elderly. Clin Auton Res. 2020;30(2):105–6.

    Article  PubMed  Google Scholar 

  42. Min M, Shi T, Sun C, Liang M, Zhang Y, Bo G, et al. Orthostatic hypotension and the risk of atrial fibrillation and other cardiovascular diseases: An updated meta-analysis of prospective cohort studies. J Clin Hypertens (Greenwich). 2019;21(8):1221–7.

    Article  Google Scholar 

  43. Fedorowski A, Burri P, Melander O. Orthostatic hypotension in genetically related hypertensive and normotensive individuals. J Hypertens. 2009;27(5):976–82.

    Article  CAS  PubMed  Google Scholar 

  44. SPRINT Research Group, Wright JT Jr, Williamson JD, Whelton PK. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373(22):2103–16.

    Article  CAS  Google Scholar 

  45. Juraschek SP, Simpson LM, Davis BR, Beach JL, Ishak A, Mukamal KJ. Effects of antihypertensive class on falls, syncope, and orthostatic hypotension in older adults: the allhat trial. Hypertension. 2019;74(4):1033–40.

    Article  CAS  PubMed  Google Scholar 

  46. Juraschek SP, Appel LJ, Miller ER 3rd, Mukamal KJ, Lipsitz LA. Hypertension treatment effects on orthostatic hypotension and its relationship with cardiovascular disease. Hypertension. 2018;72(4):986–93.

    Article  CAS  PubMed  Google Scholar 

  47. Ricci F, Fedorowski A, Radico F, Romanello M, Tatasciore A, Di Nicola M, et al. Cardiovascular morbidity and mortality related to orthostatic hypotension: a meta-analysis of prospective observational studies. Eur Heart J. 2015;36(25):1609–17.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Geriatric Medicine, Adana State Training and Research Hospital, Adana, Turkey

    Esra Ates Bulut

  2. Department of Internal Medicine, Division of Medical Intensive Care, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey

    Bilgin Comert

Authors
  1. Esra Ates Bulut
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  2. Bilgin Comert
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Editors and Affiliations

  1. Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey

    Ahmet Turan Isik

  2. Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey

    Pinar Soysal

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Ates Bulut, E., Comert, B. (2021). Orthostatic Hypotension: Clinical Features. In: Isik, A.T., Soysal, P. (eds) Orthostatic Hypotension in Older Adults. Springer, Cham. https://doi.org/10.1007/978-3-030-62493-4_4

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  • DOI: https://doi.org/10.1007/978-3-030-62493-4_4

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