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Hariom SK, Nelson EJR. Cardiovascular adaptations in microgravity conditions. LIFE SCIENCES IN SPACE RESEARCH 2024; 42:64-71. [PMID: 39067992 DOI: 10.1016/j.lssr.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 07/30/2024]
Abstract
Gravity has had a significant impact on the evolution of life on Earth with organisms developing necessary biological adaptations over billions of years to counter this ever-existing force. There has been an exponential increase in experiments using real and simulated gravity environments in the recent years. Although an understanding followed by discovery of counter measures to negate diminished gravity in space had been the driving force of research initially, there has since been a phenomenal leap wherein a force unearthly as microgravity is beginning to show promising potential. The current review summarizes pathophysiological changes that occur in multiple aspects of the cardiovascular system when exposed to an altered gravity environment leading to cardiovascular deconditioning and orthostatic intolerance. Gravity influences not just the complex multicellular systems but even the survival of organisms at the molecular level by intervening fundamental cellular processes, directly affecting those linked to actin and microtubule organization via mechano-transduction pathways. The reach of gravity ranges from cytoskeletal rearrangement that regulates cell adhesion and migration to intracellular dynamics that dictate cell fate commitment and differentiation. An understanding that microgravity itself is not present on Earth propels the scope of simulated gravity conditions to be a unique and useful environment that could be explored for enhancing the potential of stem cells for a wide range of applications as has been highlighted here.
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Affiliation(s)
- Senthil Kumar Hariom
- Gene Therapy Laboratory, Department of Integrative Biology, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore 632 014, TN, India
| | - Everette Jacob Remington Nelson
- Gene Therapy Laboratory, Department of Integrative Biology, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore 632 014, TN, India.
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2
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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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Barzkar F, Myint PK, Kwok CS, Metcalf AK, Potter JF, Baradaran HR. Prevalence of orthostatic hypertension and its association with cerebrovascular diagnoses in patients with suspected TIA and minor stroke. BMC Cardiovasc Disord 2022; 22:161. [PMID: 35397488 PMCID: PMC8994299 DOI: 10.1186/s12872-022-02600-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose We aimed to compare the rate of stroke, transient ischemic attack, and cerebrovascular disease diagnoses across groups of patients based on their orthostatic blood pressure response in a transients ischemic attack clinic setting. Materials and Methods We retrospectively analysed prospectively collected data from 3201 patients referred to a transient ischemic attack (TIA)/minor stroke outpatients clinic. Trained nurses measured supine and standing blood pressure using an automated blood pressure device and the patients were categorized based on their orthostatic blood pressure change into four groups: no orthostatic blood pressure rise, systolic orthostatic hypertension, diastolic orthostatic hypertension, and combined orthostatic hypertension. Then, four stroke physicians, who were unaware of patients' orthostatic BP response, assessed the patients and made diagnoses based on clinical and imaging data. We compared the rate of stroke, TIA, and cerebrovascular disease (either stroke or TIA) diagnoses across the study groups using Pearson's χ2 test. The effect of confounders was adjusted using a multivariate logistic regression analysis. Results Cerebrovascular disease was significantly less common in patients with combined systolic and diastolic orthostatic hypertension compared to the "no rise" group [OR = 0.56 (95% CI 0.35–0.89]. The odds were even lower among the subgroups of patients with obesity [OR = 0.31 (0.12–0.80)], without history of smoking [OR 0.34 (0.15–0.80)], and without hypertension [OR = 0.42 (95% CI 0.19–0.92)]. We found no significant relationship between orthostatic blood pressure rise with the diagnosis of stroke. However, the odds of TIA were significantly lower in patients with diastolic [OR 0.82 (0.68–0.98)] and combined types of orthostatic hypertension [OR = 0.54 (0.32–0.93)]; especially in patients younger than 65 years [OR = 0.17 (0.04–0.73)] without a history of hypertension [OR = 0.34 (0.13–0.91)], and patients who did not take antihypertensive therapy [OR = 0.35 (0.14–0.86)]. Conclusion Our data suggest that orthostatic hypertension may be a protective factor for TIA among younger and normotensive patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02600-1.
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4
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Increased pulse wave velocity in patients with an orthostatic blood pressure rise independent of other cardiovascular risk factors. J Hypertens 2021; 39:1352-1360. [PMID: 33470734 DOI: 10.1097/hjh.0000000000002787] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Positional changes in blood pressure (BP) have been shown to have effects on long-term outcomes. Although a BP drop with upright posture is frequently observed, an orthostatic rise in BP can also occur. Here, we aimed to investigate whether the phenotype of orthostatic hypertension is associated with more pronounced vascular hypertension-mediated organ damage (HMOD) and whether this is associated with other cardiovascular risk factors. METHODS In a cohort of 200 patients referred to our tertiary hypertension clinic, we prospectively assessed unattended seated automated office BP and the response to 1 min of upright posture. The difference in BP after standing up was calculated and pulse wave velocity (PWV) was assessed as a marker of vascular HMOD. Routine clinical cardiovascular risk markers were also assessed. Regression models were used to assess the association between orthostatic BP changes and pulse wave velocity. RESULTS Baseline characteristics and clinic cardiovascular risk factors were similar between orthostatic BP response groups. A U-shaped association was evident between PWV and orthostatic BP changes with elevated PWV in patients with either a fall or a rise in BP in response to upright posture. The regression models remained significant after adjusting for other cardiovascular risk factors, including 24 h ambulatory BP. CONCLUSION Both an orthostatic BP drop and rise were associated with elevated PWV. Although standing BP is commonly measured in elderly hypertensive patients to exclude significant orthostatic hypotension, this simple measurement may provide an additional independent risk factor for vascular HMOD at any age.
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Petersen Á, Salas-Herrera C, Lerma C, Brown-Escobar C, Kostin A, Sierra-Beltrán M, González-Hermosillo JA. Transient Orthostatic Hypertension During Head-Up Tilt Test in Young Adults: A Phenotype of Blood Pressure Variability. J Clin Neurophysiol 2021; 38:242-249. [PMID: 32028279 DOI: 10.1097/wnp.0000000000000685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The mechanisms underlying orthostatic hypertension (OHT) remain poorly understood. The authors evaluated the cardiovascular, cerebrovascular dynamics, and autonomic response to head-up tilt test (HUTT) in young adults with symptoms of orthostatic intolerance and transient OHT. METHODS Forty-four female subjects were included (34 ± 13 years old) and categorized in three groups after a 30-minute 70° passive HUTT: symptomatic patients with OHT (surge of systolic blood pressure ≥20 mm Hg for at least 5 minutes at any given time during HUTT), orthostatic intolerance (symptomatic patients without orthostatic blood pressure changes), and healthy asymptomatic control subjects. RESULTS At baseline, OHT patients had lower systolic blood pressure than orthostatic intolerance patients (103 ± 8 vs. 116 ± 10 mm Hg, p < 0.01) and lower baroreflex sensitivity than control subjects (15.8 ± 8.3 vs. 27.1 ± 11.7 ms/mm Hg, p = 0.01). On tilt, cardiac output decreased in OHT patients from 6.1 ± 1.4 L/minute during baseline to 5.2 ± 0.8 L/minute after 10 minutes of HUTT (p = 0.01). In OHT patients at 30 minutes of HUTT, sympathetic efferent heart activity was higher (77.4 ± 14.9 normalized units or nu) than orthostatic intolerant patients (63.5 ± 11.8 nu, p = 0.02) and control subjects (65.8 ± 11.2 nu, p = 0.05). Cerebrovascular resistance in OHT was higher than control subjects after 30 minutes (2.2 ± 0.8 vs. 1.6 ± 0.3 cm/second, respectively, p = 0.02). CONCLUSIONS This study demonstrates that transient OHT can occur at any given time during HUTT. These patients exhibit a decrease in cardiac output and a hyperadrenergic response to tilt.
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Affiliation(s)
- Álvaro Petersen
- Department of Cardiovascular Dysautonomia, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Cecy Salas-Herrera
- Department of Cardiovascular Dysautonomia, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
- InstitutoTecnologico y de Estudios Superiores de Monterrey, Mexico City, Mexico ; and
| | - Claudia Lerma
- Department of Electromechanical Instrumentation, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Christopher Brown-Escobar
- Department of Cardiovascular Dysautonomia, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Andrei Kostin
- Department of Cardiovascular Dysautonomia, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Manuel Sierra-Beltrán
- Department of Cardiovascular Dysautonomia, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
- InstitutoTecnologico y de Estudios Superiores de Monterrey, Mexico City, Mexico ; and
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6
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Zhang R, Liu B, Bi J, Chen Y. Relationship Between Chronic Conditions and Balance Disorders in Outpatients with Dizziness: A Hospital-Based Cross-Sectional Study. Med Sci Monit 2021; 27:e928719. [PMID: 33611335 PMCID: PMC7905961 DOI: 10.12659/msm.928719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Balance dysfunction is common in adult outpatients with dizziness, especially those who are older, which can lead to catastrophic outcomes such as falls. The aim of this study was to investigate the association between chronic conditions and balance disorders in patients with dizziness, especially those who are elderly. Material/Methods A cross-sectional study was conducted in adult outpatients diagnosed with dizziness referred to the Department of Otolaryngology at Beijing Tongren Hospital from September 2017 to August 2018. All of the patients completed a self-administered, structured questionnaire. Demographic data and information on history of chronic conditions were collected and the patients were divided into 2 groups based on whether their balance was normal or abnormal. Results Three hundred and thirty-two patients were included in this study, 168 in the normal balance group and 164 in the abnormal balance group. The incidence of chronic conditions, including hypertension and diabetes, in the abnormal balance group was higher than that in the normal balance group (all P<0.05). In subgroup analysis based on age, in those who were aged ≥60 years, the prevalence of chronic diseases was higher in the abnormal balance group than in the normal balance group (P=0.002), while there was no difference in age between the groups with abnormal and normal balance. Hypertension (OR: 2.268; 95%CI: 1.038–4.957; P<0.05) was a risk factor for balance disorders in elderly patients rather than those who were younger (P>0.05). Conclusions Our results show that chronic conditions are associated with balance function in older patients with dizziness. Thus, specialists should consider chronic conditions, especially hypertension, in elderly patients with dizziness.
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Affiliation(s)
- Ruihua Zhang
- Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, China (mainland)
| | - Bo Liu
- Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Ministry of Education, Beijing, China (mainland).,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China (mainland)
| | - Jingtao Bi
- Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Ministry of Education, Beijing, China (mainland).,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China (mainland)
| | - Yiwen Chen
- Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, China (mainland)
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von Bartheld MB, Duffels MGJ, Handoko ML. Too much of a good thing: a case report of traumatic drop attacks and syncope due to orthostatic hypertension. Eur Heart J Case Rep 2021; 5:ytaa479. [PMID: 33554018 PMCID: PMC7850609 DOI: 10.1093/ehjcr/ytaa479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/04/2020] [Accepted: 11/02/2020] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Orthostatic hypertension (OHT) is the clinical opposite to orthostatic hypotension and is an under-recognized and poorly understood clinical phenomenon. Patients may experience disabling symptoms such as dizziness, chest pain, and shortness of breath. In addition, OHT is associated with important clinical outcomes such as silent cerebral infarcts and cognitive decline.
Case summary
We present the case of a 67-year-old female who experienced frequent drop attacks with and without transient loss of consciousness causing various injuries. A range of standard diagnostic procedures did not yield an explanation for her symptoms but head-up tilt (HUT) testing showed OHT and induced most of her symptoms. Upon initiation of doxazosin, an alpha-blocking drug, she was free of symptoms and blood pressure response was normal on the repeat HUT test.
Discussion
To our knowledge, this is the first report of syncope due to OHT. Orthostatic hypertension is a heterogeneous condition and may occur in young, otherwise healthy individuals but also in older patients with cardiovascular comorbidities. It is thought that symptoms occur because of excessive venous pooling (causing a drop in cardiac output) or adrenergic hypersensitivity (resulting in cerebral vasoconstriction or acute rise in cardiac afterload). Since our patient had a marked response to an alpha-blocking agent, we think baroreflex hypersensitivity is the most likely cause of her complaints. Though syncope is probably rare, OHT should be regarded as a possible explanation of orthostatic symptoms.
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Affiliation(s)
- Martin B von Bartheld
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Post Office Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Mariëlle G J Duffels
- Department of Cardiology, Noord West Ziekenhuis Groep, Post Office Box 501, 1800 AM Alkmaar, the Netherlands
| | - M Louis Handoko
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Post Office Box 7057, 1007 MB Amsterdam, the Netherlands
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You S, Kim HA, Lee H. Association of Postural Instability with Autonomic Dysfunction in Early Parkinson’s Disease. J Clin Med 2020; 9:jcm9113786. [PMID: 33238599 PMCID: PMC7700469 DOI: 10.3390/jcm9113786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/14/2020] [Accepted: 11/22/2020] [Indexed: 11/23/2022] Open
Abstract
Background: There have been several pathologic data that support an association between postural instability (PI) and autonomic dysfunction in Parkinson’s disease (PD). The purpose of this study was to investigate the correlation of PI and autonomic deficits in early PD. Methods: We collected 17 patients with a diagnosis of early PD. PI was assessed by computerized dynamic posturography (CDP). Standardized autonomic function test (AFT) and time and frequency domain spectral analysis of heart rate variability (HRV) were performed. CDP data obtained from the 21 patients were compared to that from age- and sex-matched healthy controls. We collected HRV data from 18 other age- and sex-matched controls. All patients were evaluated in the “OFF” state. We used Mann–Whitney U-test to compare parameters of CDP between the early PD and control groups. Spearman correlation was used for correlation analysis between parameters of CDP and autonomic function test in PD patients. Results: Most patients (76.5%) showed mild or moderate autonomic dysfunction in the standardized AFT. In CDP, sensory ratios of equilibrium score (e.g., visual and vestibular) and composite scores were significantly lower in PD patients than in controls. In HRV, the low-frequency/high-frequency ratio during the tilt and the gap of low- frequency/high-frequency ratio from supine to tilt were significantly different in both groups. The parameters of time and frequency domains of HRV reflecting parasympathetic function were correlated with equilibrium scores for somatosensory organization test in CDP. Discussion: PI was associated with parasympathetic autonomic dysfunction in early PD. This result was in accordance with a previous assumption that PI in PD is related to parasympathetic cholinergic neuron loss in the brainstem.
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Affiliation(s)
| | | | - Hyung Lee
- Correspondence: ; Tel.: +82-53-258-7831
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9
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Rahman M, Pradhan N, Chen Z, Kanthety R, Townsend RR, Tatsuoka C, Wright JT. Orthostatic Hypertension and Intensive Blood Pressure Control; Post-Hoc Analyses of SPRINT. Hypertension 2020; 77:49-58. [PMID: 33161773 DOI: 10.1161/hypertensionaha.120.15887] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We evaluated the association between orthostatic hypertension and cardiovascular outcomes and the effect of intensive blood pressure (BP) control on cardiovascular outcomes in patients with orthostatic hypertension. Post hoc analyses of the SPRINT (Systolic Blood Pressure Intervention Trial) data were conducted; orthostatic hypertension was defined as increase in systolic BP≥20 mm Hg or increase in diastolic BP≥10 mm Hg with standing. Of 9329 participants, 1986 (21.2%) had orthostatic hypertension at baseline. Within the intensive treatment group, participants with orthostatic hypertension were at higher risk of developing the composite cardiovascular outcome (hazard ratio, 1.44 [95% CI, 1.1-1.87], P=0.007) compared with participants without orthostatic hypertension. Within the standard treatment group, there were no significant differences in cardiovascular outcome between participants with and without orthostatic hypertension. In participants with orthostatic hypertension, there was no statistically significant difference in risk of the composite cardiovascular outcome between the intensive and the standard BP treatment group (hazard ratio, 1.07 [95% CI, 0.78-1.47], P=0.68). In participants without orthostatic hypertension at baseline, the intensive treatment group was associated with a lower risk of the composite cardiovascular outcome (hazard ratio, 0.67 [95% CI, 0.56-0.79], P<0.0001). Orthostatic hypertension was associated with a higher risk of cardiovascular outcomes in the intensive and not in the standard treatment group; intensive treatment of BP did not reduce the risk of cardiovascular outcomes compared with standard treatment in patients with orthostatic hypertension. These post hoc analyses are hypothesis generating and will need to be confirmed in future studies.
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Affiliation(s)
- Mahboob Rahman
- From the Division of Nephrology and Hypertension (M.R., N.P., R.K., J.T.W.)
| | | | | | - Radhika Kanthety
- From the Division of Nephrology and Hypertension (M.R., N.P., R.K., J.T.W.)
| | - Raymond R Townsend
- University Hospitals Cleveland Medical Center, Case Western Reserve University, OH and University of Pennsylvania Perelman School of Medicine, Philadelphia (R.R.T.)
| | | | - Jackson T Wright
- From the Division of Nephrology and Hypertension (M.R., N.P., R.K., J.T.W.)
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10
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Jordan J, Ricci F, Hoffmann F, Hamrefors V, Fedorowski A. Orthostatic Hypertension: Critical Appraisal of an Overlooked Condition. Hypertension 2020; 75:1151-1158. [PMID: 32223382 DOI: 10.1161/hypertensionaha.120.14340] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Orthostatic hypertension, which appears to be mediated through excess neurohumoral activation while standing, is a common blood pressure trait among patients with and without arterial hypertension. However, lack of consensus regarding the definition of orthostatic hypertension makes it difficult to assess the true prevalence of this condition. Orthostatic hypertension appears to predict the risk for progression to arterial hypertension in younger and risk of cardiovascular morbidity and mortality in older persons. Yet, the risk may differ between populations. Whether orthostatic hypertension indicates a generally increased risk of death, constitutes an intermediate variable in the causal pathway of cardiovascular risk factors, a simple measure of disease severity, or an independently acting mechanism is not known. Since both orthostatic hypotension and orthostatic hypertension herald increased risk of cardiovascular disease, it appears reasonable to screen the patients for abnormal orthostatic blood pressure responses using simple orthostatic testing. However, how presence of orthostatic hypertension may affect clinical management decisions such as the choice of antihypertensive drugs is currently difficult to ascertain. Clearly, this issue deserves more attention.
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Affiliation(s)
- Jens Jordan
- From the Institute of Aerospace Medicine, German Aerospace Center (DLR) and Chair of Aerospace Medicine (J.J., F.H.), University of Cologne, Germany.,University Hypertension Center (J.J., F.H.), University of Cologne, Germany
| | - Fabrizio Ricci
- Department of Clinical Sciences, Lund University, Malmö, Sweden (F.R., V.H., A.F.).,Department of Neuroscience, Imaging and Clinical Sciences, "G.d'Annunzio" University, Chieti-Pescara, Italy (F.R.)
| | - Fabian Hoffmann
- From the Institute of Aerospace Medicine, German Aerospace Center (DLR) and Chair of Aerospace Medicine (J.J., F.H.), University of Cologne, Germany.,University Hypertension Center (J.J., F.H.), University of Cologne, Germany
| | - Viktor Hamrefors
- Department of Clinical Sciences, Lund University, Malmö, Sweden (F.R., V.H., A.F.).,Department of Internal Medicine (V.H.), Skåne University Hospital, Malmö, Sweden
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Malmö, Sweden (F.R., V.H., A.F.).,Department of Cardiology (A.F.), Skåne University Hospital, Malmö, Sweden
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Hu Y, Wang Y, He B, Wang Y, Han Z, Tao C, Li H, Jiang Y, Tang C, Du J. Sympathetic Overactivation From Supine to Upright Is Associated With Orthostatic Hypertension in Children and Adolescents. Front Pediatr 2020; 8:54. [PMID: 32154199 PMCID: PMC7047410 DOI: 10.3389/fped.2020.00054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/05/2020] [Indexed: 12/03/2022] Open
Abstract
There are no prior publications or submissions with any overlapping information, including studies and patients. The study data have not been presented as an abstract or poster before the submission. Objectives: The study was conducted to analyze the changes of baroreflex sensitivity and heart rate variability from supine to upright standing in children and adolescents with orthostatic hypertension to explore whether and how the autonomic nerve regulation was involved in the development of pediatric orthostatic hypertension. Methods: This case-control study included twenty-five children with orthostatic hypertension (the patient group) and twenty-six healthy controls (the control group). All subjects underwent a standing test, during which their hemodynamic parameters were continuously monitored by a Finapres Medical System, and baroreflex sensitivity and heart rate variability were calculated. Results: The demographic characteristics, supine baroreflex sensitivity, and supine heart rate variability including time domain and frequency domain indices did not differ between the patients with orthostatic hypertension and healthy subjects (P > 0.05). However, a more obvious drop of baroreflex sensitivity and a greater increase of low frequency/high frequency ratio from supine to upright were observed in subjects with orthostatic hypertension compared with those in the healthy children (P < 0.001 and P < 0.01, respectively). Changes of baroreflex sensitivity were negatively related to mean arterial pressure changes from supine to upright in all subjects (P < 0.01), and the increases in low frequency/high frequency ratio from supine to standing were positively correlated with those in mean arterial pressure in the study subjects (P < 0.001). Conclusion: Upright sympathetic overactivation is associated with pediatric orthostatic hypertension.
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Affiliation(s)
- Yang Hu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Research Unit of Clinical Diagnosis and Treatment of Pediatric Syncope and Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuanyuan Wang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Bing He
- Department of Pediatrics, People's Hospital of Wuhan University, Hubei, China
| | - Yaru Wang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Zhenhui Han
- Department of Pediatrics, Children's Hospital of Kaifeng, Henan, China
| | - Chunyan Tao
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Hongxia Li
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yi Jiang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Chaoshu Tang
- Key Laboratory of Cardiovascular Sciences, Ministry of Education, Beijing, China
| | - Junbao Du
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Key Laboratory of Cardiovascular Sciences, Ministry of Education, Beijing, China
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12
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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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Hortelano M, Reilly RB, Castells F, Cervigón R. Refined Multiscale Fuzzy Entropy to Analyse Post-Exercise Cardiovascular Response in Older Adults With Orthostatic Intolerance. ENTROPY 2018; 20:e20110860. [PMID: 33266584 PMCID: PMC7512426 DOI: 10.3390/e20110860] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/20/2018] [Accepted: 10/30/2018] [Indexed: 12/15/2022]
Abstract
Orthostatic intolerance syndrome occurs when the autonomic nervous system is incapacitated and fails to respond to the demands associated with the upright position. Assessing this syndrome among the elderly population is important in order to prevent falls. However, this problem is still challenging. The goal of this work was to determine the relationship between orthostatic intolerance (OI) and the cardiovascular response to exercise from the analysis of heart rate and blood pressure. More specifically, the behavior of these cardiovascular variables was evaluated in terms of refined composite multiscale fuzzy entropy (RCMFE), measured at different scales. The dataset was composed by 65 older subjects, 44.6% (n = 29) were OI symptomatic and 55.4% (n = 36) were not. Insignificant differences were found in age and gender between symptomatic and asymptomatic OI participants. When heart rate was evaluated, higher differences between groups were observed during the recovery period immediately after exercise. With respect to the blood pressure and other hemodynamic parameters, most significant results were obtained in the post-exercise stage. In any case, the symptomatic OI group exhibited higher irregularity in the measured parameters, as higher RCMFE levels in all time scales were obtained. This information could be very helpful for a better understanding of cardiovascular instability, as well as to recognize risk factors for falls and impairment of functional status.
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Affiliation(s)
- Marcos Hortelano
- Escuela Politécnica, UCLM Camino del Pozuelo sn, 16071 Cuenca, Spain
| | - Richard B. Reilly
- School of Engineering, Trinity College, The University of Dublin, Dublin 2 D02 PN40, Ireland
- School of Medicine, Trinity College, The University of Dublin, Dublin 2 D02 PN40, Ireland
- Trinity Centre for Bioengineering, Trinity College, The University of Dublin, Dublin 2 D02 PN40, Ireland
| | - Francisco Castells
- Instituto ITACA, Universitat Politècnica de València, 46022 Valencia, Spain
| | - Raquel Cervigón
- Escuela Politécnica, UCLM Camino del Pozuelo sn, 16071 Cuenca, Spain
- Correspondence: ; Tel.: +34-969-179100
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Lee H, Low PA, Kim HA. Patients with Orthostatic Intolerance: Relationship to Autonomic Function Tests results and Reproducibility of Symptoms on Tilt. Sci Rep 2017; 7:5706. [PMID: 28720881 PMCID: PMC5515942 DOI: 10.1038/s41598-017-05668-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 06/01/2017] [Indexed: 11/09/2022] Open
Abstract
This study was designed to investigate the frequency and pattern of orthostatic symptoms during head-up tilt (HUT) in patients with orthostatic intolerance during daily life, and to identify the relationship between the orthostatic symptoms during HUT and autonomic parameters. We prospectively collected autonomic data from 464 patients with orthostatic symptoms. Adrenergic and cardiovagal function tests including HUT were performed. Based on HUT results, we divided patients into orthostatic hypotension (OH), postural tachycardia syndrome (POTS), or normal HUT groups. We also investigated orthostatic symptoms during HUT. Only 25% of the patients reported orthostatic symptoms during HUT and 75% were asymptomatic. Typical orthostatic symptoms such as orthostatic dizziness and blurred vision, and atypical symptoms like chest tightness and headache occurred in 86% and 66%, respectively. Patients with POTS had symptoms more frequently than patients with OH during HUT. There were no differences in degrees of BP or HR changes between symptomatic and asymptomatic groups within the OH and POTS groups. HUT fails to reproduce symptoms of orthostatic intolerance in the majority of patients. Clinicians need to be aware that most patients with OH are asymptomatic during HUT and patients with POTS are more likely to be symptomatic than patients with OH.
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Affiliation(s)
- Hyung Lee
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea.,Brain Research Institute, Keimyung University School of Medicine, Daegu, South Korea
| | - Phillip A Low
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Hyun Ah Kim
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea. .,Brain Research Institute, Keimyung University School of Medicine, Daegu, South Korea.
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15
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Ali NJ, Grossman SA. Geriatric Syncope and Cardiovascular Risk in the Emergency Department. J Emerg Med 2017; 52:438-448.e3. [DOI: 10.1016/j.jemermed.2016.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 10/27/2016] [Accepted: 12/02/2016] [Indexed: 11/16/2022]
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Wijkman M, Länne T, Östgren CJ, Nystrom FH. Diastolic orthostatic hypertension and cardiovascular prognosis in type 2 diabetes: a prospective cohort study. Cardiovasc Diabetol 2016; 15:83. [PMID: 27255168 PMCID: PMC4890262 DOI: 10.1186/s12933-016-0399-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In patients with type 2 diabetes, the prognostic impact of an orthostatic rise in blood pressure is not known. Therefore, the aim of this study was to determine the prognostic implications of the diastolic orthostatic blood pressure response in a cohort of patients with type 2 diabetes. We also evaluated associations between different orthostatic blood pressure responses and markers of subclinical cardiovascular organ damage. METHODS Office blood pressures were measured in the sitting and in the standing position in 749 patients with type 2 diabetes who participated in the CARDIPP study (Cardiovascular Risk factors in Patients with Diabetes-a Prospective study in Primary care). Diastolic orthostatic hypertension was defined as a rise of diastolic blood pressure ≥10 mmHg and diastolic orthostatic hypotension was defined as a drop of diastolic blood pressure ≥10 mmHg. Recruitment took place between the years 2005-2008, and patients were followed until any of the primary outcome events (cardiovascular death or hospitalization for either myocardial infarction or stroke) occurred or until December 31st, 2014. Measurements of aortic pulse wave velocity and of carotid intima-media thickness were performed at base-line. RESULTS Diastolic orthostatic hypertension was found in 140 patients (18.7 %) and was associated with significantly lower risk of cardiovascular events (crude hazard ratio compared with patients with normal systolic and diastolic orthostatic blood pressure response: 0.450, 95 % C.I. 0.206-0.987, P = 0.046). Diastolic orthostatic hypotension was found in 31 patients (4.1 %) and was associated with higher values for aortic pulse wave velocity and carotid intima-media thickness, compared with patients with normal systolic and diastolic orthostatic blood pressure response. CONCLUSIONS Diastolic orthostatic hypertension is common in patients with type 2 diabetes, and may be a novel marker for decreased cardiovascular risk in these patients.
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Affiliation(s)
- Magnus Wijkman
- Department of Internal Medicine and Department of Medical and Health Sciences, Linköping University, Norrköping, Sweden. .,Department of Internal Medicine, Vrinnevi Hospital, Gamla Övägen 25, 603 79, Norrköping, Sweden.
| | - Toste Länne
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Carl Johan Östgren
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Fredrik H Nystrom
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Liao D, Xu Y, Zou R, Wu L, Luo X, Li F, Lin P, Wang X, Xie Z, Wang C. The circadian rhythm of syncopal episodes in patients with neurally mediated syncope. Int J Cardiol 2016; 215:186-92. [PMID: 27128529 DOI: 10.1016/j.ijcard.2016.04.086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To explore the circadian rhythm of neurally mediated syncope (NMS). METHODS 411 patients with NMS (165 males and 246 females aged from 3 to 68years) were included in the study. All subjects underwent head-up tilt test (HUTT) and were carefully asked about the number of syncopal attacks and the periods (morning 06:00am-12:00am, afternoon 12:00am-18:00pm, evening 18:00pm-24:00pm, night 00:00am-06:00am) in which episodes occurred in. RESULTS (1) Syncopal attacks of all patients tended to occur in the morning (P=0.010); there was a statistical difference in the frequency of episodes in four periods through the day in HUTT positive patients (P=0.001), but there was no significant change of episodes within a day in HUTT negative group; and there was no statistical difference in circadian syncope distribution between HUTT negative and HUTT positive group or among patients with different HUTT responses (the orthostatic hypotension (OH) and orthostatic hypertension (OHT) patients were excluded). (2) The syncopal attacks of morning hours occurred more in males than females, but the episodes in the evening occurred more in females than males (P=0.034). (3) The younger the patients were, the chance of syncopal attacks in the morning increased; the older the patients were, they may have more episodes at night (P<0.001). CONCLUSIONS A distinct circadian variation in the frequency of syncopal episodes exists, with a peak in the morning, and there were statistical differences in circadian rhythm of syncopal episodes regarding gender and age.
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Affiliation(s)
- Donglei Liao
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital of Central South University, Institute of Pediatrics of Central South University, Changsha 410011, Hunan, China
| | - Yi Xu
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital of Central South University, Institute of Pediatrics of Central South University, Changsha 410011, Hunan, China
| | - Runmei Zou
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital of Central South University, Institute of Pediatrics of Central South University, Changsha 410011, Hunan, China
| | - Lijia Wu
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital of Central South University, Institute of Pediatrics of Central South University, Changsha 410011, Hunan, China
| | - Xuemei Luo
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital of Central South University, Institute of Pediatrics of Central South University, Changsha 410011, Hunan, China
| | - Fang Li
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital of Central South University, Institute of Pediatrics of Central South University, Changsha 410011, Hunan, China
| | - Ping Lin
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital of Central South University, Institute of Pediatrics of Central South University, Changsha 410011, Hunan, China
| | - Xiuying Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital of Central South University, Institute of Pediatrics of Central South University, Changsha 410011, Hunan, China
| | - Zhenwu Xie
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital of Central South University, Institute of Pediatrics of Central South University, Changsha 410011, Hunan, China
| | - Cheng Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital of Central South University, Institute of Pediatrics of Central South University, Changsha 410011, Hunan, China.
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