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Palatini P, Kollias A, Saladini F, Asmar R, Bilo G, Kyriakoulis KG, Parati G, Stergiou GS, Grassi G, Kreutz R, Mancia G, Jordan J, Biaggioni I, de la Sierra A. Assessment and management of exaggerated blood pressure response to standing and orthostatic hypertension: consensus statement by the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. J Hypertens 2024; 42:939-947. [PMID: 38647124 DOI: 10.1097/hjh.0000000000003704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Recent evidence suggests that an exaggerated blood pressure (BP) response to standing (ERTS) is associated with an increased risk of adverse outcomes, both in young and old individuals. In addition, ERTS has been shown to be an independent predictor of masked hypertension. In the vast majority of studies reporting on the prognostic value of orthostatic hypertension (OHT), the definition was based only on systolic office BP measurements. This consensus statement provides recommendations on the assessment and management of individuals with ERTS and/or OHT. ERTS is defined as an orthostatic increase in SBP at least 20 mmHg and OHT as an ERTS with standing SBP at least 140 mmHg. This statement recommends a standardized methodology to assess ERTS, by considering body and arm position, and the number and timing of BP measurements. ERTS/OHT should be confirmed in a second visit, to account for its limited reproducibility. The second assessment should evaluate BP changes from the supine to the standing posture. Ambulatory BP monitoring is recommended in most individuals with ERTS/OHT, especially if they have high-normal seated office BP. Implementation of lifestyle changes and close follow-up are recommended in individuals with ERTS/OHT and normotensive seated office BP. Whether antihypertensive treatment should be administered in the latter is unknown. Hypertensive patients with ERTS/OHT should be managed as any other hypertensive patient. Standardized standing BP measurement should be implemented in future epidemiological and interventional studies.
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Affiliation(s)
- Paolo Palatini
- Studium Patavinum, Department of Medicine. University of Padova, Padua, Italy
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Francesca Saladini
- Cardiology Unit, Cittadella Town Hospital, Padova. Department of Medicine, University of Padova, Padova, Italy
| | - Roland Asmar
- Foundation-Medical Research Institutes, Geneva, Switzerland
| | - Grzegorz Bilo
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS
- Department of Medicine and Surgery, University of Milano-Bicocca
| | - Konstantinos G Kyriakoulis
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Gianfranco Parati
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS
- Department of Medicine and Surgery, University of Milano-Bicocca
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Monza, Italy
| | | | | | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Linder Hoehe
- Medical Faculty, University of Cologne, Cologne, Germany
| | - Italo Biaggioni
- Autonomic Dysfunction Center and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alejandro de la Sierra
- Hypertension Unit, Department of Internal Medicine, Hospital Mútua Terrassa, University of Barcelona, Barcelona, Spain
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Strumia M, Vidal JS, Cestac P, Sallerin B, Hanon O, Rouch L. Orthostatic hypotension and orthostatic hypertension are both associated with lower cognitive function: The S.AGES cohort. J Am Geriatr Soc 2023; 71:3721-3730. [PMID: 37655948 DOI: 10.1111/jgs.18571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/22/2023] [Accepted: 07/02/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Blood pressure (BP) postural changes, both orthostatic hypotension (OHYPO) and orthostatic hypertension (OHYPER) are common in older adults. Few studies have investigated their association with cognition, particularly for OHYPER, an emerging cardiovascular risk factor. We aimed to assess the association between OHYPO, OHYPER and cognition in non-institutionalized older subjects. METHODS The S.AGES (Sujets ÂGES, Aged Subjects) cohort followed every 6 months for 3 years non-institutionalized subjects aged ≥65 years without dementia at inclusion, in France. OHYPO and OHYPER were respectively defined as a fall or an increase of ≥20 mmHg in systolic BP and/or ≥10 mmHg in diastolic BP after standing from a sitting position. Cognition was assessed using the Mini-Mental State Examination (MMSE). Linear mixed models were used for the analyses. RESULTS Among the 3170 subjects included (mean age 78 years, 56% women), 209 (6.5%) had OHYPO and 226 (7.1%) had OHYPER at baseline. After adjustment for demographics, cardiovascular risk factors and disease, seated SBP/DBP and BP lowering treatment, mean MMSE was 0.52 point lower in participants with OHYPER compared to those with normal BP postural changes (β adjusted [95% CI] = -0.52 [-0.96; -0.09], p = 0.02) and 0.50 point lower in participants with OHYPO compared to those with normal BP postural changes (β adjusted [95% CI] = -0.50 [-0.95; -0.06], p = 0.03). Sensitivity analyses showed a dose-response relationship between OHYPO and cognition. CONCLUSION Although the absolute differences in MMSE were small, both OHYPO and OHYPER were associated with lower cognition. Orthostatic BP measurements could help identify patients with risk of cognitive impairment. Further studies are needed to assess whether controlling orthostatic BP could be a promising interventional target in preserving cognition among older adults.
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Affiliation(s)
- M Strumia
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Département de pharmacie Clinique, pôle gériatrie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - J S Vidal
- EA 4468, Université de Paris, Paris, France
- Service de gériatrie, Hôpital Broca, AP-HP, Hôpitaux Universitaires Paris Centre, Paris, France
| | - P Cestac
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Département de pharmacie Clinique, pôle gériatrie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - B Sallerin
- Département de pharmacie Clinique, pôle gériatrie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- RESTORE UMR 1301, Inserm 5070, CNRS EFS, équipe FLAMES, Université Paul Sabatier, Toulouse, France
| | - O Hanon
- EA 4468, Université de Paris, Paris, France
- Service de gériatrie, Hôpital Broca, AP-HP, Hôpitaux Universitaires Paris Centre, Paris, France
| | - L Rouch
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Département de pharmacie Clinique, pôle gériatrie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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Abstract
The prognostic role and the clinical significance of orthostatic hypertension (OHT) remained undefined for long because data were sparse and often inconsistent. In recent years, evidence has been accumulating that OHT is associated with an increased risk of masked and sustained hypertension, hypertension-mediated organ damage, cardiovascular disease, and mortality. Most evidence came from studies in which OHT was defined using systolic blood pressure (BP) whereas the clinical relevance of diastolic OHT is still unclear. Recently, the American Autonomic Society and the Japanese Society of Hypertension defined OHT as an orthostatic systolic BP increase ≥20 mm Hg associated with a systolic BP of at least 140 mm Hg while standing. However, also smaller orthostatic BP increases have shown clinical relevance especially in people ≤45 years of age. A possible limitation of the BP response to standing is poor reproducibility. OHT concordance is better when the between-assessment interval is shorter, when OHT is evaluated using a larger number of BP readings, and if home BP measurement is used. The pathogenetic mechanisms leading to OHT are still controversial and may vary according to age. Excessive neurohumoral activation seems to be the main determinant in younger adults whereas vascular stiffness plays a more important role in older individuals. Conditions associated with higher activity of the sympathetic nervous system and/or baroreflex dysregulation, such as diabetes, essential hypertension, and aging have been found to be often associated with OHT. Measurement of orthostatic BP should be included in routine clinical practice especially in people with high-normal BP.
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Affiliation(s)
- Paolo Palatini
- Studium Patavinum, Department of Medicine, University of Padova, Italy
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Giacona JM, Kositanurit W, Wang J, Petric UB, Khan G, Pittman D, Williamson JW, Smith SA, Vongpatanasin W. Utility of standing office blood pressure in detecting hypertension in healthy adults. Sci Rep 2023; 13:15572. [PMID: 37730821 PMCID: PMC10511521 DOI: 10.1038/s41598-023-42297-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/07/2023] [Indexed: 09/22/2023] Open
Abstract
Current guidelines recommend office blood pressures (BP) be taken in a seated position when screening for hypertension (HTN). Seated BP is known to have limited accuracy in detecting high BP, while the utility of standing BP in diagnosing HTN is unknown. We conducted a cross-sectional study to determine the incremental value of standing BP in diagnosing HTN. Seated, standing, and 24-h ambulatory BPs (ABPM) were obtained in adults without known cardiovascular disease, HTN, or BP medication use. Presence of HTN was defined by the 2017 ACC/AHA and the 2023 ESH HTN guidelines based on ABPM. Area under the receiver-operating-characteristic curve (AUROC) was used to evaluate the diagnostic accuracy of seated and standing BP. Sensitivity and specificity of standing BP was determined using cut-offs derived from Youden's Index, while sensitivity and specificity of seated BP was determined using the cut-off of 130/80 mmHg and by 140/90 mmHg. Among 125 participants (mean age 49 ± 17 years; 62% female; 24% Black), 33.6% of them had HTN. Sensitivity and specificity of seated systolic BP (SBP) was 43% and 92%, respectively. Cut-offs selected by Youden's index for standing SBP/diastolic BP (DBP) were 124/81 mmHg according to the 2017 ACC/AHA HTN guidelines, and 123.5/83.5 mmHg according to the 2023 ESH HTN guidelines. Sensitivity and specificity of standing SBP was 71% and 67%, respectively. The AUROC of standing SBP (0.81 [0.71-0.92]) was significantly higher than seated SBP (0.70 [0.49-0.91]), when HTN was defined as average 24-h SBP ≥ 125 mmHg. Moreover, the addition of standing to seated SBP (0.80 [0.68-0.92]) improved HTN detection when compared to seated SBP. These patterns were consistent for both the 2017 ACC/AHA and the 2023 ESH definitions for HTN. In summary, standing BP, alone or in combination with seated BP, outperformed seated BP alone in diagnosing HTN in adults.
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Affiliation(s)
- John M Giacona
- Hypertension Section, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, USA
| | - Weerapat Kositanurit
- Hypertension Section, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA
- Department of Physiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jijia Wang
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, USA
| | - Ursa B Petric
- Hypertension Section, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA
| | - Ghazi Khan
- Hypertension Section, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA
| | - Danielle Pittman
- Hypertension Section, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA
| | - Jon W Williamson
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, USA
| | - Scott A Smith
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, USA
| | - Wanpen Vongpatanasin
- Hypertension Section, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA.
- Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., H4.130, Dallas, TX, 75390, USA.
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Bowo-Ngandji A, Kenmoe S, Ebogo-Belobo JT, Kenfack-Momo R, Takuissu GR, Kengne-Ndé C, Mbaga DS, Tchatchouang S, Kenfack-Zanguim J, Lontuo Fogang R, Zeuko'o Menkem E, Ndzie Ondigui JL, Kame-Ngasse GI, Magoudjou-Pekam JN, Wandji Nguedjo M, Assam Assam JP, Enyegue Mandob D, Ngondi JL. Prevalence of the metabolic syndrome in African populations: A systematic review and meta-analysis. PLoS One 2023; 18:e0289155. [PMID: 37498832 PMCID: PMC10374159 DOI: 10.1371/journal.pone.0289155] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/12/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The metabolic syndrome (MS) is a leading cause of death worldwide. Several studies have found MS to be prevalent in various African regions. However, no specific estimates of MS prevalence in African populations exist. The aim of this study was to estimate the overall prevalence of MS in the African populations. METHODS A systematic review was conducted in PubMed, Web of Science, Africa Index Medicus, and African Journal Online Scopus to find studies published up to the 15th of August 2022. Pooled prevalence was calculated based on six diagnostic methods. The pooled prevalence of MS was estimated using a random-effects model. Our risk of bias analysis was based on the Hoy et al. tool. A Heterogeneity (I2) assessment was performed, as well as an Egger test for publication bias. PROSPERO number CRD42021275176 was assigned to this study. RESULTS In total, 297 studies corresponding to 345 prevalence data from 29 African countries and involving 156 464 participants were included. The overall prevalence of MS in Africa was 32.4% (95% CI: 30.2-34.7) with significant heterogeneity (I2 = 98.9%; P<0.001). We obtained prevalence rates of 44.8% (95% CI: 24.8-65.7), 39.7% (95% CI: 31.7-48.1), 33.1% (95% CI: 28.5-37.8), 31.6% (95% CI: 27.8-35.6) and 29.3% (95% CI: 25.7-33) using the WHO, revised NCEP-ATP III, JIS, NCEP/ATP III and IDF definition criteria, respectively. The prevalence of MS was significantly higher in adults >18 years with 33.1% (95%CI: 30.8-35.5) compared to children <18 years with 13.3% (95%CI: 7.3-20.6) (P<0.001). MS prevalence was significantly higher in females with 36.9% (95%CI: 33.2-40.7) compared to males with 26.7% (95%CI: 23.1-30.5) (P<0.001). The prevalence of MS was highest among Type 2 diabetes patients with 66.9% (95%CI: 60.3-73.1), followed by patients with coronary artery disease with 55.2% (95%CI: 50.8-59.6) and cardiovascular diseases with 48.3% (95%CI: 33.5-63.3) (P<0.001). With 33.6% (95% CI: 28.3-39.1), the southern African region was the most affected, followed by upper-middle income economies with 35% (95% CI: 29.5-40.6). CONCLUSION This study, regardless of the definition used, reveals a high prevalence of MS in Africa, confirming the ongoing epidemiological transition in African countries. Early prevention and treatment strategies are urgently needed to reverse this trend.
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Affiliation(s)
- Arnol Bowo-Ngandji
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | - Sebastien Kenmoe
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Jean Thierry Ebogo-Belobo
- Institute of Medical Research and Medicinal Plants Studies, Medical Research Centre, Yaounde, Cameroon
| | - Raoul Kenfack-Momo
- Department of Biochemistry, The University of Yaounde I, Yaounde, Cameroon
| | - Guy Roussel Takuissu
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | - Cyprien Kengne-Ndé
- Epidemiological Surveillance, Evaluation and Research Unit, National AIDS Control Committee, Douala, Cameroon
| | | | | | | | | | | | | | - Ginette Irma Kame-Ngasse
- Institute of Medical Research and Medicinal Plants Studies, Medical Research Centre, Yaounde, Cameroon
| | | | - Maxwell Wandji Nguedjo
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
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Yuan Y, Lu B, Guo Q, Wang W, Feng Z, Jin X, Zhou H, Liu J, Lei H, Yang X, Liu J, Liu Y, Shao J, Gu P. Time in range, as an emerging metric of glycemic control, is associated with orthostatic blood pressure changes in type 2 diabetes. Diabetes Res Clin Pract 2022; 183:109179. [PMID: 34923020 DOI: 10.1016/j.diabres.2021.109179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/25/2021] [Accepted: 12/11/2021] [Indexed: 02/05/2023]
Abstract
AIMS To exlpore whether time in range(TIR) was associated with orthostatic blood pressure(BP) changes in type 2 diabetes(T2DM). METHODS A total of 342 T2DM patients were recruited. TIR was defined as the time percentage spent within the target range(3.9-10.0 mmol/L). Orthostatic hypotension(OH) and orthostatic hypertension(OHT) were defined as a decrease or an increase of at least 20 mmHg in SBP and/or 10 mmHg in DBP after standing for 3 min. RESULTS Compared with orthostatic normotension group, patients with OH or OHT showed lower levels of TIR (P < 0.001). The prevalences of OH and OHT both decreased with ascending TIR tertiles (OH, P < 0.001; OHT, P = 0.019), and both absolute SBP and DBP changes were negatively correlated with TIR (r = -0.171, -0.190, P < 0.05). After stratifying by BMI, only the prevalence of OH in the lower layer and the prevalence of OHT in the higher layer remained significant difference among tertiles of TIR. Multivariate logistics regression revealed that lower TIR and lower BMI were risk factors for OH, whereas lower TIR but higher BMI were risk factors for OHT. CONCLUSIONS We find a differential correlation dependent of BMI milieus between TIR and orthostatic BP status.
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Affiliation(s)
- Yanyu Yuan
- Department of Endocrinology, Jinling Hospital, Nanjing Medical University, Nanjing 210002, Jiangsu Province, China
| | - Bin Lu
- Department of Endocrinology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Qingyu Guo
- Department of Endocrinology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Wei Wang
- Department of Endocrinology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Zhouqin Feng
- Department of Endocrinology, Jinling Hospital, Southern Medical University, Nanjing 210002, Jiangsu Province, China
| | - Xuguang Jin
- Department of Endocrinology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Hui Zhou
- Department of Endocrinology, Jinling Hospital, Southern Medical University, Nanjing 210002, Jiangsu Province, China
| | - Jun Liu
- Department of Endocrinology, Jinling Hospital, Southern Medical University, Nanjing 210002, Jiangsu Province, China
| | - Haiyan Lei
- Department of Endocrinology, Jinling Hospital, Southern Medical University, Nanjing 210002, Jiangsu Province, China
| | - Xinyi Yang
- Department of Endocrinology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Jun Liu
- Department of Endocrinology, Jinling Hospital, Nanjing Medical University, Nanjing 210002, Jiangsu Province, China
| | - Yanyu Liu
- Department of Endocrinology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Jiaqing Shao
- Department of Endocrinology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, Jiangsu Province, China.
| | - Ping Gu
- Department of Endocrinology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, Jiangsu Province, China.
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Orthostatic hypertension and adverse clinical outcomes in adults and older people. J Geriatr Cardiol 2021; 18:779-782. [PMID: 34659384 PMCID: PMC8501383 DOI: 10.11909/j.issn.1671-5411.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Migisha R, Agaba DC, Katamba G, Manne-Goehler J, Muyingo A, Siedner MJ. Postural changes in blood pressure among patients with diabetes attending a referral hospital in southwestern Uganda: a cross-sectional study. BMC Cardiovasc Disord 2021; 21:213. [PMID: 33906603 PMCID: PMC8077796 DOI: 10.1186/s12872-021-02022-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/19/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Orthostatic hypotension (OH) and orthostatic hypertension (OHT) are often unrecognized in clinical care for diabetic individuals, yet they are associated with increased risk for adverse cardiovascular outcomes. We aimed to determine the prevalence of the abnormal orthostatic blood pressure (BP) responses, and associated factors among diabetic individuals in ambulatory care for diabetes in southwestern Uganda. METHODS We conducted a cross-sectional study among diabetic individuals aged 18-65 years at Mbarara Regional Referral Hospital, southwestern Uganda from November 2018 to April 2019. We obtained demographic and clinical data including a detailed medical history, and glycemic profile. BP measurements were taken in supine position and within 3 min of standing. We defined OH in participants with either ≥ 20 mmHg drop in systolic BP (SBP) or ≥ 10 mmHg drop in diastolic BP (DBP) after assuming an upright position. OHT was defined in participants with either a ≥ 20 mmHg rise in SBP, or ≥ 10 mmHg rise in DBP after assuming an upright position. Multivariate logistic regression was used to identify factors associated with OH and OHT. RESULTS We enrolled 299 participants, with a mean age of 50 years (SD ± 9.8), and mean HbA1c of 9.7% (SD ± 2.6); 70% were female. Of the 299 participants, 52 (17.4%; 95% CI 13.3-22.2%) met the definition of OH and 43 (14.4%; 95% CI 10.6-18.9%) were classified as having OHT. In multivariable models, factors associated with diabetic OH were older age (OR = 2.40 for 51-65 years vs 18-50 years, 95% CI 1.02-5.67, P = 0.046), diabetic retinopathy (OR = 2.51; 95% CI 1.14-5.53, P = 0.022), higher resting SBP ≥ 140 mmHg (OR = 3.14; 95% CI 1.31-8.7.56, P = 0.011), and history of palpitations (OR = 2.31; 95% CI 1.08-4.92, P = 0.031). Self-report of palpitations (OR = 3.14; 95% CI 1.42-6.95, P = 0.005), and higher resting SBP ≥ 140 mmHg (OR = 22.01; 95% CI 1.10-4.42, P = 0.043) were associated with OHT. CONCLUSION OH and OHT are common among diabetic individuals in ambulatory diabetes care in southwestern Uganda. Orthostatic BP measurements should be considered as part of routine physical examination to improve detection of OH and OHT, especially among older diabetics with complications of the disease. Future studies to assess the health and prognostic implications of OH and OHT among diabetics in the region are warranted.
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Affiliation(s)
- Richard Migisha
- Department of Physiology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda.
| | - David Collins Agaba
- Department of Physiology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Godfrey Katamba
- Department of Physiology, King Ceasor University, Kampala, Uganda
| | - Jennifer Manne-Goehler
- Divsion of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Anthony Muyingo
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark J Siedner
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Medicine, Massachusetts General Hospital, Boston, USA
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Zou RM, Li F, Lin P, Xu Y, Wang C. [T wave and ST segment amplitude changes in the supine and standing electrocardiograms of children with orthostatic hypertension and their clinical significance]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:696-700. [PMID: 31315771 PMCID: PMC7389098 DOI: 10.7499/j.issn.1008-8830.2019.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To examine the changes in T wave and ST segment amplitude in the supine and standing electrocardiograms (ECG) of children with orthostatic hypertension (OHT) and to determine their clinical significance. METHODS A total of 49 children with OHT were included in the OHT group. Forty-three age- and sex-matched healthy children were included in the control group. Heart rate and T wave and ST segment amplitude were measured in both groups. T wave amplitude and ST segment amplitude in supine ECG were compared with those in standing ECG within each group. The differences in supine vs standing T wave amplitude and ST segment amplitude were compared between the OHT and control groups. RESULTS In the control group, T wave amplitude in leads aVR, V1, and V4-V6 were significantly lower in standing ECG than in supine ECG (P<0.05); ST segment amplitude in leads V4 and V5 were significantly higher in standing ECG than in supine ECG (P<0.05). In the OHT group, T wave amplitude in leads II, aVR, aVF, and V4-V6 were significantly lower in standing ECG than in supine ECG (P<0.05); ST segment amplitude in lead II was significantly higher in standing ECG than in supine ECG (P<0.05). The differences in T wave amplitude in lead II and V6 between supine and standing ECG were significantly higher in the OHT group than in the control group (P<0.05). Difference in T wave amplitude in lead V6 between supine and standing ECG was a significant diagnostic marker for OHT (P<0.05). This marker had 72.10% sensitivity and 57.10% specificity for the diagnosis of OHT at the optimal cut-off value of 0.105 mV. CONCLUSIONS Difference in T wave amplitude in lead V6 between supine and standing ECG has certain diagnostic value for OHT.
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Affiliation(s)
- Run-Mei Zou
- Department of Pediatric Cardiovasology, Children's Medical Center, Second Xiangya Hospital, Central South University, Changsha 410011, China.
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Association of orthostatic hypertension with mortality in the Systolic Hypertension in the Elderly Program. J Hum Hypertens 2019; 33:735-740. [PMID: 30804464 PMCID: PMC6892410 DOI: 10.1038/s41371-019-0180-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/04/2019] [Accepted: 02/08/2019] [Indexed: 12/26/2022]
Abstract
We examined the association of orthostatic hypertension with all-cause mortality in the active treatment and placebo randomized groups of the Systolic Hypertension in the Elderly Program (SHEP). SHEP was a multicenter, randomized, double-blind, placebo-controlled clinical trial of the effect of chlorthalidone-based antihypertensive treatment on the rate of occurrence of stroke among older persons with isolated systolic hypertension (ISH). Men and women aged 60 years and above with ISH defined by a systolic blood pressure (SBP) of 160 mm Hg or higher and diastolic blood pressure lower than 90 mm Hg were randomized to chlorthalidone-based stepped care therapy or matching placebo. Among 4736 SHEP participants, 4073 had a normal orthostatic response, 203 had orthostatic hypertension, and 438 had orthostatic hypotension. Compared with normal response, orthostatic hypertension was associated with higher all-cause mortality at 4.5 and 17 years in analyses adjusted for age, gender, treatment, SBP, and pulse pressure (PP, HR 1.87, 95% CI 1.30–2.69, p = 0.0007; HR 1.40, 95% CI 1.17–1.68, p = 0.0003, respectively). These associations remained significant after additional adjustment for risk factors and comorbidities (HR 1.43, 95% CI 0.99–0.08, p = 0.0566 at 4.5 years, and HR 1.27, 95% CI 1.06–1.53, p = 0.0096 at 17 years). The increased risk of all-cause mortality associated with orthostatic hypertension was observed in both the active and placebo groups without significant interaction between randomization group and the effect on mortality. Orthostatic hypertension is associated with future mortality risk, is easily detected, and can be used in refining cardiovascular risk assessment.
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Magkas N, Tsioufis C, Thomopoulos C, Dilaveris P, Georgiopoulos G, Doumas M, Papadopoulos D, Tousoulis D. Orthostatic hypertension: From pathophysiology to clinical applications and therapeutic considerations. J Clin Hypertens (Greenwich) 2019; 21:426-433. [PMID: 30724451 DOI: 10.1111/jch.13491] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/16/2018] [Accepted: 12/24/2018] [Indexed: 12/12/2022]
Abstract
Orthostatic hypertension (OHT), that is, sustained increase in blood pressure after standing, is an increasingly recognized cardiovascular disorder having been examined in much fewer studies compared with orthostatic hypotension (OH). However, in both OHT and OH, dysfunction of the autonomous nervous system is considered to be the primary pathophysiological disturbance, while significant associations with essential hypertension have been observed. Although in many studies OHT has been related to subclinical or clinical target organ damage, there is also evidence denying such an association. Because OHT is defined variably across different studies, the comparison of relevant outcomes is at least problematic. Since evidence about OHT treatment is exclusively based on limited non-randomized studies, no specific recommendations have been developed. Therefore, both the prognostic role and the clinical significance of OHT remain largely undefined. The aim of the present review is to summarize the available evidence regarding the definition, diagnosis, pathophysiology, prognostic role and treatment of OHT and highlight potential clinical implications of this underestimated condition.
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Affiliation(s)
- Nikolaos Magkas
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Costas Tsioufis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | | | - Polychronis Dilaveris
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Georgios Georgiopoulos
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Michael Doumas
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | - Dimitris Papadopoulos
- Hypertension Excellence Centre-ESH, Department of Cardiology, LAIKO General Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
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