Artery blood pressure oscillation after active standing up: an indicator of sympathetic function in diabetic patients

Nonvestibular Dizziness

Dizziness is a common chief complaint with an extensive differential diagnosis that ranges from peripheral, central, to nonvestibular conditions. An understanding of nonvestibular conditions will aid accurate diagnosis and initiation of appropriate management. Thus, the objective of this article is to present an overview of nonvestibular etiologies that may plague a dizzy patient and the recommended treatment options.

Noninvasive beat-to-beat finger arterial pressure monitoring during orthostasis: a comprehensive review of normal and abnormal responses at different ages

Over the past 30 years, noninvasive beat-to-beat blood pressure (BP) monitoring has provided great insight into cardiovascular autonomic regulation during standing. Although traditional sphygmomanometric measurement of BP may be sufficient for detection of sustained orthostatic hypotension, it fails to capture the complexity of the underlying dynamic BP and heart rate responses. With the emerging use of noninvasive beat-to-beat BP monitoring for the assessment of orthostatic BP control in clinical and population studies, various definitions for abnormal orthostatic BP patterns have been used. Here, age-related changes in cardiovascular control in healthy subjects will be reviewed to define the spectrum of the most important abnormal orthostatic BP patterns within the first 180 s of standing. Abnormal orthostatic BP responses can be defined as initial orthostatic hypotension (a transient systolic BP fall of >40 mmHg within 15 s of standing), delayed BP recovery (an inability of systolic BP to recover to a value of >20 mmHg below baseline at 30 s after standing) and sustained orthostatic hypotension (a sustained decline in systolic BP of ≥20 mmHg occurring 60-180 s after standing). In the evaluation of patients with light-headedness, pre(syncope), (unexplained) falls or suspected autonomic dysfunction, it is essential to distinguish between normal cardiovascular autonomic regulation and these abnormal orthostatic BP responses. The prevalence, clinical relevance and underlying pathophysiological mechanisms of these patterns differ significantly across the lifespan. Initial orthostatic hypotension is important for identifying causes of syncope in younger adults, whereas delayed BP recovery and sustained orthostatic hypotension are essential for evaluating the risk of falls in older adults.

The association between orthostatic hypertension and all-cause mortality in hospitalized elderly persons

Background

Little is known about the prevalence of orthostatic hypertension (OHT) and its effect on long-term mortality in the elderly. We evaluated the prevalence of OHT and its effect on mortality in hospitalized elderly patients.

Methods

Out of 1852 patients admitted between 31/12/1999 and 31/12/2000 to an acute geriatric ward, 474 patients (48% males) with a mean age of 81.5 ± 6.8 years were enrolled in this study. Blood pressure (BP) was measured three times during the day in a supine and standing position. Patients with at least one increase in systolic or diastolic BP levels upon standing were diagnosed with OHT. Medical history, physical examination and laboratory parameters were retrieved from the medical records. Mortality data until 18^th June 2014 were retrieved from the computerized system of the Ministry of the Interior.

Results

Four hundred and seven patients (86%) were diagnosed with OHT. Those without OHT had a lower body mass index and were more likely males, smokers, had a higher rate of Parkinson's disease and less congestive heart failure compared with those with OHT. Patients with OHT had a better survival rate than those without OHT (P = 0.024). Hazard ratios (HRs) for mortality in those with OHT adjusted to age and multiple risk factors were: 0.67 [95% confidence interval (CI): 0.51−0.87] and 0.73 (95% CI: 0.55−0.97), respectively; a similar tendency was noticed in a sensitivity analysis by gender.

Conclusion

Hospitalized elderly patients with OHT had a better survival rate than those without OHT.

Arterial blood pressure oscillation after active standing up in kidney transplant recipients

Dynamic arterial blood pressure (FINAPRES) response to active standing up, normally consisting of initial rise, fall and recovery above the baseline (overshoot), was compared with the early steady-state arterial blood pressure level to measure sympathetic vasomotor function in healthy subjects [group 1: n=50, 10 female subjects, age 51+/-2.5 years; weight 78+/-2.3 kg; height 174+/-1.4 cm (mean+/-standard error of the mean)] and in kidney transplant recipients under basal (group 2a: n=50, age 51.7+/-1.7 years; weight 77+/-2.1 kg; height 174+/-1.5 cm) and under high (group 2b: same subjects as in group 2a) cyclosporine A whole blood levels. Furthermore, baroreflex sensitivity and the activity of the generating compounds of the sympathetic nervous systems (Mayer waves) were measured. Systolic and diastolic overshoot values did not differ statistically significant in the present study. In the control subjects, a systolic overshoot of 15.4+/-2.7 mmHg and a diastolic overshoot of 15.2+/-2 mmHg was detected. The systolic overshoot disappeared in 57% of group 2a (-7.1+/-2.7 mmHg; P<0.001) and in 50% of group 2b recipients (-8.0+/-2.7 mmHg; P<0.001). Systolic early steady-state level was not lower in kidney transplant recipients before cyclosporine (baseline+2 mmHg) intake, but after cyclosporine administration (baseline-3 mmHg; controls: baseline+3 mmHg; P<0.05). There was a strong association between the overshoot and steady-state levels (P for chi(2)<0.001, n=150). Overshoot of group 1 levels (r=0.428; P<0.01) and group 2 levels (r=0.714; P<0. 001) correlated to their respective steady-state blood pressure. Furthermore, recipients had reduced baroreceptor sensitivities estimated by sequence analysis as compared to controls (10+/-1 ms/mmHg vs. 7.5+/-1.4 ms/mmHg; P<0.05). Mayer waves amplitudes of the heart rate spectrum were elevated statistically significant in renal transplant recipients (44.4+/-0.2 vs. 43.8+/-2.2 A.U.). In conclusion, baroreceptor reflex-dependent overshoot of the arterial blood pressure after active standing up is diminished in kidney transplant recipients, whereas no association to the cyclosporine A whole blood level has been detected. The reduced overshoot may be due to the diminished baroreceptor sensitivity which could be shown in renal transplant recipients.