Aging Clinical and Experimental Research

, Volume 25, Issue 6, pp 659–665 | Cite as

Gender differences in orthostatic tolerance in the elderly

  • Marte Rognstad MellingsæterEmail author
  • Vegard Bruun Wyller
  • Torgeir Bruun Wyller
  • Anette Hylen Ranhoff
Original Article



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.


Orthostatic 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.


  1. 1.
    Ferrer A, Formiga F, Plana-Ripoll O, Tobella MA, Gil A, Pujol R (2012) Risk of falls in 85-year-olds is associated with functional and cognitive status: the Octabaix Study. Arch Gerontol Geriatr 54:352–356PubMedCrossRefGoogle Scholar
  2. 2.
    Lehtola S, Koistinen P, Luukinen H (2006) Falls and injurious falls late in home-dwelling life. Arch Gerontol Geriatr 42:217–224PubMedCrossRefGoogle Scholar
  3. 3.
    Wofford JL, Heuser MD, Moran WP, Schwartz E, Mittelmark MB (1994) Community surveillance of falls among the elderly using computerized EMS transport data. Am J Emerg Med 12:433–437PubMedCrossRefGoogle Scholar
  4. 4.
    Lofthus CM, Osnes EK, Falch JA, Kaastad TS, Kristiansen IS, Nordsletten L, Stensvold I, Meyer HE (2001) Epidemiology of hip fractures in Oslo, Norway. Bone 29:413–418PubMedCrossRefGoogle Scholar
  5. 5.
    Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319:1701–1707PubMedCrossRefGoogle Scholar
  6. 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
  7. 7.
    Brignole M (2006) Distinguishing syncopal from non-syncopal causes of fall in older people. Age Ageing 35(Suppl 2):ii46–ii50PubMedCrossRefGoogle Scholar
  8. 8.
    Ungar A, Mussi C, Del RA, Noro G, Abete P, Ghirelli L, Cellai T, Landi A, Salvioli G, Rengo F, Marchionni N, Masotti G (2006) Diagnosis and characteristics of syncope in older patients referred to geriatric departments. J Am Geriatr Soc 54:1531–1536PubMedCrossRefGoogle Scholar
  9. 9.
    Jonsson PV, Lipsitz LA, Kelley M, Koestner J (1990) Hypotensive responses to common daily activities in institutionalized elderly. A potential risk for recurrent falls. Arch Intern Med 150:1518–1524PubMedCrossRefGoogle Scholar
  10. 10.
    Shaw FE, Kenny RA (1997) The overlap between syncope and falls in the elderly. Postgrad Med J 73:635–639PubMedCrossRefGoogle Scholar
  11. 11.
    Grenon SM, Xiao X, Hurwitz S, Sheynberg N, Kim C, Seely EW, Cohen RJ, Williams GH (2006) Why is orthostatic tolerance lower in women than in men? Renal and cardiovascular responses to simulated microgravity and the role of midodrine. J Investig Med 54:180–190PubMedCrossRefGoogle Scholar
  12. 12.
    Convertino VA (1998) Gender differences in autonomic functions associated with blood pressure regulation. Am J Physiol 275:R1909–R1920PubMedGoogle Scholar
  13. 13.
    Franke WD, Johnson CP, Steinkamp JA, Wang R, Halliwill JR (2003) Cardiovascular and autonomic responses to lower body negative pressure: do not explain gender differences in orthostatic tolerance. Clin Auton Res 13:36–44PubMedCrossRefGoogle Scholar
  14. 14.
    Laitinen T, Niskanen L, Geelen G, Lansimies E, Hartikainen J (2004) Age dependency of cardiovascular autonomic responses to head-up tilt in healthy subjects. J Appl Physiol 96:2333–2340PubMedCrossRefGoogle Scholar
  15. 15.
    Barnett SR, Morin RJ, Kiely DK, Gagnon M, Azhar G, Knight EL, Nelson JC, Lipsitz LA (1999) Effects of age and gender on autonomic control of blood pressure dynamics. Hypertension 33:1195–1200PubMedCrossRefGoogle Scholar
  16. 16.
    Romero-Ortuno R, Cogan L, Foran T, Fan CW, Kenny RA (2010) Using the Finometer to examine sex differences in hemodynamic responses to orthostasis in older people. Blood Press Monit. 15:8–17PubMedCrossRefGoogle Scholar
  17. 17.
    Barantke M, Krauss T, Ortak J, Lieb W, Reppel M, Burgdorf C, Pramstaller PP, Schunkert H, Bonnemeier H (2008) Effects of gender and aging on differential autonomic responses to orthostatic maneuvers. J Cardiovasc Electrophysiol 19:1296–1303PubMedCrossRefGoogle Scholar
  18. 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
  19. 19.
    Imholz BP, Wieling W, van Montfrans GA, Wesseling KH (1998) Fifteen years experience with finger arterial pressure monitoring: assessment of the technology. Cardiovasc Res 38:605–616PubMedCrossRefGoogle Scholar
  20. 20.
    Malik et al (1996) Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation 93:1043–1065CrossRefGoogle Scholar
  21. 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
  22. 22.
    Parry SW, Reeve P, Lawson J, Shaw FE, Davison J, Norton M, Frearson R, Kerr S, Newton JL (2009) The Newcastle protocols 2008: an update on head-up tilt table testing and the management of vasovagal syncope and related disorders. Heart 95:416–420PubMedCrossRefGoogle Scholar
  23. 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. 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. 25.
    Levy MN, Pappano AJ (2007) Cardiovascular physiology, 9th edn. Mosby Elsevier, AmsterdamGoogle Scholar
  26. 26.
    Parry SW, Norton M, Pairman J, Baptist M, Wilton K, Reeve P, Sutcliffe K, Newton JL (2009) Impedance cardiography: a role in vasovagal syncope diagnosis? Age Ageing 38:718–723PubMedCrossRefGoogle Scholar
  27. 27.
    Monahan KD, Ray CA (2004) Gender affects calf venous compliance at rest and during baroreceptor unloading in humans. Am J Physiol Heart Circ Physiol 286:H895–H901PubMedCrossRefGoogle Scholar
  28. 28.
    Lindenberger M, Lanne T (2007) Decreased capillary filtration but maintained venous compliance in the lower limb of aging women. Am J Physiol Heart Circ Physiol 293:H3568–H3574PubMedCrossRefGoogle Scholar
  29. 29.
    Tomiyama H, Yamashina A, Arai T, Hirose K, Koji Y, Chikamori T, Hori S, Yamamoto Y, Doba N, Hinohara S (2003) Influences of age and gender on results of noninvasive brachial-ankle pulse wave velocity measurement–a survey of 12517 subjects. Atherosclerosis 166:303–309PubMedCrossRefGoogle Scholar
  30. 30.
    Smith JJ, Porth CJ (1991) Posture and the circulation: the age effect. Exp Gerontol 26:141–162PubMedCrossRefGoogle Scholar
  31. 31.
    Ludwig DA, Vernikos J, Wade CE, Convertino VA (2001) Blood pressure changes during orthostatic stress: evidence of gender differences in neuroeffector distribution. Aviat Space Environ Med 72:892–898PubMedGoogle Scholar
  32. 32.
    Groothuis JT, Thijssen DH, Kooijman M, Paulus R, Hopman MT (2008) Attenuated peripheral vasoconstriction during an orthostatic challenge in older men. Age Ageing 37:680–684PubMedCrossRefGoogle Scholar
  33. 33.
    Gelman S (2008) Venous function and central venous pressure: a physiologic story. Anesthesiology 108:735–748PubMedCrossRefGoogle Scholar
  34. 34.
    Shibao C, Grijalva CG, Raj SR, Biaggioni I, Griffin MR (2007) Orthostatic hypotension-related hospitalizations in the United States. Am J Med 120:975–980PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Marte Rognstad Mellingsæter
    • 1
    • 2
    Email author
  • Vegard Bruun Wyller
    • 2
    • 3
  • Torgeir Bruun Wyller
    • 1
    • 2
  • Anette Hylen Ranhoff
    • 4
    • 5
  1. 1.Department of Geriatric MedicineOslo University HospitalOsloNorway
  2. 2.Institute of Clinical MedicineUniversity of OsloOsloNorway
  3. 3.Department of PaediatricsAkershus University HospitalNordbyhagenNorway
  4. 4.Department of Clinical ScienceUniversity of BergenBergenNorway
  5. 5.Diakonhjemmet HospitalOsloNorway

Personalised recommendations