Gender differences in orthostatic tolerance in the elderly
- 179 Downloads
Gender differences in orthostatic tolerance in the elderly are poorly studied and understood.
48 healthy elderly over 65 years (24 women), free from medication and without chronic diseases, were subjected to head-up tilt (HUT) tests: 30° for 10 min and 70° for 40 min. Blood pressures, stroke volume, total peripheral resistance, blood pressure variability, heart rate variability and baroreceptor sensitivity were measured and test terminations due to vasovagal syncope or unbearable presyncopal symptoms were registered.
Mean age was 72; women and men differed in body mass index; 22.2 versus 24.8, respectively (p < 0.01). Mean blood pressures were lower among women, with 88 and 98 mmHg, respectively (p < 0.01) (rest) and 86 and 96 mmHg (p < 0.01) (tilt 30°). Mean total peripheral resistance index was significantly higher among women during 70° tilt, 13.5 versus 10.8 (p < 0.01); no gender differences in heart rate were seen. Women had lower LF/HF ratio (an index of sympathovagal balance) at rest and during 30° tilt (both p < 0.05); other heart rate variability measures and baroreceptor sensitivity did not differ. Two women, 9 %, and 8 men, 33 %, terminated head-up tilt test due to vasovagal syncope or presyncopal symptoms. Gender difference was marginally significant (p = 0.05, log-rank test). Higher heart rate at rest (p < 0.01) was the only variable significantly associated with the risk of syncope.
Our results indicate that elderly men have poorer orthostatic tolerance during protracted postural stress than women of the same age. The underlying reason might be differences in vascular rather than cardiac autonomic control.
KeywordsOrthostatic tolerance Gender Elderly Syncope
This work was supported by Oslo University Hospital
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
- 6.Moya A, Sutton R, Ammirati F, Blanc JJ, Brignole M, Dahm JB, Deharo JC, Gajek J, Gjesdal K, Krahn A, Massin M, Pepi M, Pezawas T, Ruiz GR, Sarasin F, Ungar A, van Dijk JG, Walma EP, Wieling W (2009) Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J 30:2631–2671PubMedCrossRefGoogle Scholar
- 18.Fortin J, Habenbacher W, Heller A, Hacker A, Grullenberger R, Innerhofer J, Passath H, Wagner C, Haitchi G, Flotzinger D, Pacher R, Wach P (2006) Non-invasive beat-to-beat cardiac output monitoring by an improved method of transthoracic bioimpedance measurement. Comput Biol Med 36:1185–1203PubMedCrossRefGoogle Scholar
- 21.Bertinieri G, di Rienzo M, Cavallazzi A, Ferrari AU, Pedotti A, Mancia G (1985) A new approach to analysis of the arterial baroreflex. J Hypertens 3(Suppl 3):S79–S81Google Scholar
- 23.Galizia G, Abete P, Mussi C, Noro G, Morrione A, Langellotto A, Landi A, Cacciatore F, Masotti G, Rengo F, Marchionni N, Ungar A (2008) Role of early symptoms in assessment of syncope in elderly people: results from the Italian Group for the Study of Syncope in the Elderly. J Am Geriatr Soc 57:18–23Google Scholar
- 24.Brignole M, Menozzi C, Del RA, Costa S, Gaggioli G, Bottoni N, Bartoli P, Sutton R (2000) New classification of haemodynamics of vasovagal syncope: beyond the VASIS classification. Analysis of the pre-syncopal phase of the tilt test without and with nitroglycerin challenge. Vasovagal Syncope International Study. Europace. 2:66–76PubMedCrossRefGoogle Scholar
- 25.Levy MN, Pappano AJ (2007) Cardiovascular physiology, 9th edn. Mosby Elsevier, AmsterdamGoogle Scholar