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Initial drop of blood pressure during head-up tilt in patients with cerebrovascular accidents

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Environmental Health and Preventive Medicine Aims and scope

Abstract

Objective

To investigate cardiovascular responses to orthostatic stress in patients with cerebrovascular accidents (CVA).

Methods

Twelve male patients with CVA, 11 healthy elderly and 12 healthy young males participated in the present study. The CVA patients had suffered stroke with hemiplegia at least 11 months prior to the study, their medical conditions were stable, and no subjects were taking medications affecting the cardiovascular system. Heart rate (HR) was determined using RR intervals from the ECG. Stroke volume (SV) was estimated by an impedance method, and cardiac output (CO) was calculated by multiplying SV by HR. Blood pressure (BP) was determined by the auscultatory method. SV, HR, CO and BP were measured every 2 min before and during 7 min of 60-degree head-up tilt (HUT).

Results

SV decreased and HR increased immediately after starting HUT in all groups. CO in healthy elderly and young subjects immediately decreased during HUT also, and the decrease was sustained throughout the head-up period. However, CO in CVA patients remained constant throughout the experiment. HUT immediately decreased SBP in all groups and the magnitude of initial SBP reduction in CVA patients was greater than that in the other groups.

Conclusions

We identified an initial reduction of BP during HUT in CVA patients and the recovery of BP by 3 min of head-up tilt. We emphasize that adjustment to orthostatic stress in CVA patients should be practiced by HUT, as our findings showed that CVA patients maintained physiological orthostatic tolerance except for the initial fall in BP.

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Authors and Affiliations

  1. Department of Physical Therapy, Seijoh University, School of Care and Rehabilitation, 2-172 Fukinodai, 476-8588, Tokai, Aichi, Japan

    Kazunari Enishi

  2. Department of Physical Medicine and Rehabilitation, Wakayama Medical University, School of Medicine, Wakayama, Japan

    Fumihiro Tajima

  3. Department of Physical Therapy, Hirosaki University, School of Health-Science, Hirosaki, Japan

    Hiroyuki Akimoto

  4. Department of Public Health, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan

    Kazunari Enishi & Reizo Mita

Authors
  1. Kazunari Enishi
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  2. Fumihiro Tajima
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  3. Hiroyuki Akimoto
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  4. Reizo Mita
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Correspondence to Kazunari Enishi.

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Enishi, K., Tajima, F., Akimoto, H. et al. Initial drop of blood pressure during head-up tilt in patients with cerebrovascular accidents. Environ Health Prev Med 9, 228–233 (2004). https://doi.org/10.1007/BF02898104

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  • DOI: https://doi.org/10.1007/BF02898104

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