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Tang W, Gu H, Chen B, Hu S, Fan W, You Y. Validation of the Chinese orthostatic discriminant and Severity Scale (ODSS) for detection of orthostatic intolerance syndrome. Heliyon 2024; 10:e34724. [PMID: 39170152 PMCID: PMC11336335 DOI: 10.1016/j.heliyon.2024.e34724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 08/23/2024] Open
Abstract
Background Orthostatic intolerance (OI) is the inability to tolerate orthostatic stress during any postural change. The etiology of OI varies, and methods to obtain a specific diagnosis and plan appropriate treatment are important. The tools available within the Chinese context to swiftly identify orthostatic intolerance syndrome (OIS) are currently limited. Methods Patients with OI symptoms were included in this study and categorized into two groups based on the results of the supine-to-stand test. Those with abnormal test results were assigned to the OIS group, while those with normal test results were placed in the non-OIS group. We evaluated the internal consistency and predictive value of the Chinese Orthostatic Discriminant and Severity Scale (ODSS) by comparing patients' scores with their physiological measurements collected during orthostatic stress tests and the results of other available questionnaires, including the orthostatic Symptom Questionnaire and Orthostatic Grading Scale (OGS). Results Patients with OIS scored significantly higher on all three questionnaires and showed significant differences in autonomic responses during orthostatic stress tests compared with non-OIS patients. Receiver operating characteristic curve analysis showed that the orthostatic score from the ODSS had moderate predictive value for the supine test (area under the curve [AUC] = 0.754). Further subgroup analysis revealed that the orthostatic score from the ODSS had uniquely high specificity and sensitivity for identifying patients with orthostatic hypotension with abnormal cerebral blood flow (OH-U, AUC = 0.919). Conclusions We conclude that the Chinese version of the ODSS has sufficient reliability and validity to distinguish patients with OIS and could possibly be used as a diagnostic tool for OH-U patients. Thus, the Chinese ODSS offers a beneficial screening tool for quickly assessing whether patients have OIS that requires further clinical assessment.
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Affiliation(s)
- Weiting Tang
- Department of Neurology, Affiliated 2nd Hospital of Hainan Medical University, Haikou, 570100, China
| | - Hui Gu
- Department of Neurology, First People's Hospital of Changde City, Changde, 415003, China
| | - Bin Chen
- Department of Neurology, Affiliated 2nd Hospital of Hainan Medical University, Haikou, 570100, China
| | - Sheng Hu
- Department of Neurology, Affiliated 2nd Hospital of Hainan Medical University, Haikou, 570100, China
| | - Wenjie Fan
- Department of Pathology, The First Affiliated Hospital of Nanhua University, Hengyang, 421001, China
| | - Yong You
- Department of Neurology, Affiliated 2nd Hospital of Hainan Medical University, Haikou, 570100, China
- International Center for Aging and Cancer (ICAC), Hainan Medical University, Haikou, 570100, China
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Bradicich M, Schuurmans MM, Pazhenkottil AP, Steinack C, Hillinger S, Hage R. Orthostatic Hypotension and Antihypertensive Treatment in Lung Transplant Recipients: A Cross-Sectional Study. EXP CLIN TRANSPLANT 2024; 22:381-385. [PMID: 38970281 DOI: 10.6002/ect.2024.0006] [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: 07/08/2024]
Abstract
OBJECTIVES Lung transplant is the ultimate treatment of many end-stage lung diseases. Calcineurin inhibitors, crucial in immunosuppression for lung transplant recipients, are linked to secondary hypertension, necessitating antihypertensive treatment. In addition, lung transplant recipients frequently experience orthostatic hypotension, occasionally stemming from autonomic dysfunction, but also commonly attributed as a negative side effect of antihypertensive treatment. Our study aimed to evaluate the frequency of orthostatic blood pressure irregularities and investigate the involvement of antihypertensive treatment as a potential risk factor in the occurrence among lung transplant recipients. MATERIALS AND METHODS Fifty-six consecutive lung transplant recipients, both inpatient and outpatient, at the University Hospital Zurich (Switzerland) were monitored from 1999 to 2013. Transplant recipients underwent a Schellong test (an active standing test). Our evaluation encompassed their initial traits, such as the existence of supine hypertension. We computed the odds ratio for the comparison of the likelihood of experiencing orthostatic hypotension while using a minimum of 1 type of antihypertensive medication versus absence of antihypertensive drugs. RESULTS Of the lung transplant recipients, 25% showed a positive Schellong test. Within this group, 64% had supine hypertension, and 29% displayed symptoms of orthostatic hypotension. Among the patients, 71% were using at least 1 type of antihypertensive medication. The odds ratio for showing orthostatic hypotension while taking at least 1 type of antihypertensive drug versus the absence of antihypertensive medications was 1.64 (95% exact CI, 0.39-6.90) with P = .50. This finding remained consistent regardless of age, sex, inpatient or outpatient status, and the duration since transplant. CONCLUSIONS Orthostatic blood pressure dysregulation is prevalent among lung transplant recipients, frequently without noticeable symptoms. In our cohort, the use of antihypertensive medications did not elevate the risk of orthostatic hypotension.
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Affiliation(s)
- Matteo Bradicich
- >From the Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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3
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Hezam AAM, Shaghdar HBM, Chen L. The connection between hypertension and diabetes and their role in heart and kidney disease development. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2024; 29:22. [PMID: 38855561 PMCID: PMC11162087 DOI: 10.4103/jrms.jrms_470_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/24/2023] [Accepted: 01/25/2024] [Indexed: 06/11/2024]
Abstract
Hypertension and diabetes are two common metabolic disorders that often coexist in the same individual. Their concurrence increases the risk of cardiovascular disease, renal dysfunction, and other complications. Cardiovascular disease is the primary cause of morbidity and mortality in individuals with diabetes, and hypertension further aggravates this condition. Interestingly, hypertension and diabetes share several common pathophysiological mechanisms including insulin resistance, vascular inflammation, endothelial dysfunction, obesity, and oxidative stress suggesting a cross-talk between these two conditions that could potentially contribute to the development of other human diseases. Effective management of diabetes should include a multifaceted approach that addresses not only glycemic control but also blood pressure (BP) and lipid control. Treatment plans should be individualized to each patient's needs and should involve a combination of lifestyle modifications and medications to achieve optimal control. With the availability of newer antidiabetic medications such as SGLT inhibitors and GLP1 receptor agonists, it is crucial to consider their potential to reduce BP, enhance kidney function, and lower the risk of cardiovascular diseases when initiating treatment for glycemic control. A more profound comprehension of the shared underlying mechanisms between these conditions could pave the way for the development of innovative therapeutic approaches to tackle them. Our review offers an in-depth analysis of the literature, providing a holistic view of the mechanisms underlying diabetes-hypertension comorbidity and its implications on heart and kidney diseases. The present article concludes by discussing current approaches for managing hypertensive diabetic patients to create a set of comprehensive individualized recommendations.
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Affiliation(s)
- Ali Ahmed Mohammed Hezam
- Department of General Practice, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | | | - Liying Chen
- School of Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
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4
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Sainbhi AS, Vakitbilir N, Gomez A, Stein KY, Froese L, Zeiler FA. Non-Invasive Mapping of Cerebral Autoregulation Using Near-Infrared Spectroscopy: A Study Protocol. Methods Protoc 2023; 6:58. [PMID: 37368002 DOI: 10.3390/mps6030058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/18/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
The ability of cerebral vessels to maintain a fairly constant cerebral blood flow is referred to as cerebral autoregulation (CA). Using near-infrared spectroscopy (NIRS) paired with arterial blood pressure (ABP) monitoring, continuous CA can be assessed non-invasively. Recent advances in NIRS technology can help improve the understanding of continuously assessed CA in humans with high spatial and temporal resolutions. We describe a study protocol for creating a new wearable and portable imaging system that derives CA maps of the entire brain with high sampling rates at each point. The first objective is to evaluate the CA mapping system's performance during various perturbations using a block-trial design in 50 healthy volunteers. The second objective is to explore the impact of age and sex on regional disparities in CA using static recording and perturbation testing in 200 healthy volunteers. Using entirely non-invasive NIRS and ABP systems, we hope to prove the feasibility of deriving CA maps of the entire brain with high spatial and temporal resolutions. The development of this imaging system could potentially revolutionize the way we monitor brain physiology in humans since it would allow for an entirely non-invasive continuous assessment of regional differences in CA and improve our understanding of the impact of the aging process on cerebral vessel function.
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Affiliation(s)
- Amanjyot Singh Sainbhi
- Department of Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB R3T 5V6, Canada
| | - Nuray Vakitbilir
- Department of Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB R3T 5V6, Canada
| | - Alwyn Gomez
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3A 1R9, Canada
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
| | - Kevin Y Stein
- Department of Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB R3T 5V6, Canada
| | - Logan Froese
- Department of Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB R3T 5V6, Canada
| | - Frederick A Zeiler
- Department of Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB R3T 5V6, Canada
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3A 1R9, Canada
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
- Centre on Aging, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
- Division of Anaesthesia, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge CB2 0QQ, UK
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
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Moreno Velásquez I, Jaeschke L, Steinbrecher A, Boeing H, Keil T, Janke J, Pischon T. Association of general and abdominal adiposity with postural changes in systolic blood pressure: results from the NAKO pretest and MetScan studies. Hypertens Res 2022; 45:1964-1976. [PMID: 36180592 DOI: 10.1038/s41440-022-01029-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/20/2022] [Accepted: 08/13/2022] [Indexed: 11/09/2022]
Abstract
The association between anthropometric measurements and postural changes in systolic blood pressure (SBP) has not been frequently reported. This study aimed to investigate the association of body mass index (BMI) and waist circumference (WC) with postural changes in SBP in two German cross-sectional studies. Data were derived from 506 participants of the population-based German National Cohort (NAKO) pretest and from 511 participants of the convenience sample-based MetScan studies. Linear regression models were used to estimate the association between BMI and WC with the difference between standing and sitting SBP (dSBP). Odds ratios (ORs) for an increase (dSBP > 10 mmHg) or decrease (dSBP ≤ -10 mmHg) in dSBP were calculated using logistic regression. The results were pooled by meta-analysis using an inverse variance model. In pooled analysis, a 5 kg/m2 higher BMI was associated with a 1.46 mmHg (95% confidence interval (CI) 0.98-1.94) higher dSBP, while a 5 cm higher WC was associated with a 0.51 mmHg (95% CI 0.32-0.69) higher dSBP. BMI or WC were associated with a higher odds of an increase in dSBP (adjusted OR, 1.71; 95% CI 1.36-2.14 per 5 kg/m2 higher BMI and 1.22; 95% CI 1.05-1.40 per 5 cm higher WC) but with a reduced odds of a decline in dSBP (adjusted OR, 0.67; 95% CI 0.44-1.00 per 5 kg/m2 higher BMI and 0.84; 95% CI 0.72-0.99 per 5 cm higher WC). The associations between WC and dSBP were no longer statistically significant after BMI adjustments. In conclusion, higher BMI and higher WC were associated with higher postural increases in SBP; however, WC was not related to postural changes in SBP once adjusted for BMI.
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Affiliation(s)
- Ilais Moreno Velásquez
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany.
| | - Lina Jaeschke
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany
| | - Astrid Steinbrecher
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany
| | - Heiner Boeing
- Department of Epidemiology (closed), German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.,State Institute of Health, Bavarian Health and Food Safety Authority, Bad Kissingen, Germany
| | - Jürgen Janke
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany.,Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, Berlin, Germany.,Berlin Institute of Health (BIH) at Charité-Universitätsmedizin Berlin, Core Facility Biobank Berlin, Berlin, Germany
| | - Tobias Pischon
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany.,Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, Berlin, Germany.,Berlin Institute of Health (BIH) at Charité-Universitätsmedizin Berlin, Core Facility Biobank Berlin, Berlin, Germany.,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
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6
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Novak P. Qpack—a Python package for QASAT—quantitative scale for grading cerebral blood flow, autonomic testing, and skin biopsies. Neurol Sci 2022; 43:4821-4828. [DOI: 10.1007/s10072-022-06007-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/12/2022] [Indexed: 11/29/2022]
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7
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Barón-Esquivias G, Quintanilla M, Díaz-Martín AJ, Barón-Solís C, Almeida-González CV, García-Romero C, Paneque I, Rubio-Guerrero C, Rodríguez-Corredor R, Valle-Racero JI, Ordóñez A, Morillo CA. Long-term recurrences and mortality in patients with noncardiac syncope. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:568-575. [PMID: 34969644 DOI: 10.1016/j.rec.2021.10.020] [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: 04/21/2021] [Accepted: 10/07/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES There are no in-depth studies of the long-term outcome of patients with syncope after exclusion of cardiac etiology. We therefore analyzed the long-term outcome of this population. METHODS For 147 months, we included all patients with syncope referred to our syncope unit after exclusion of a cardiac cause. RESULTS We included 589 consecutive patients. There were 313 (53.1%) women, and the median age was 52 [34-66] years. Of these, 405 (68.8%) were diagnosed with vasovagal syncope (VVS), 65 (11%) with orthostatic hypotension syncope (OHS), and 119 (20.2%) with syncope of unknown etiology (SUE). During a median follow-up of 52 [28-89] months, 220 (37.4%) had recurrences (21.7% ≥ 2 recurrences), and 39 died (6.6%). Syncope recurred in 41% of patients with VVS, 35.4% with OHS, and 25.2% with SUE (P=.006). In the Cox multivariate analysis, recurrence was correlated with age (P=.002), female sex (P <.0001), and the number of previous episodes (< 5 vs ≥ 5; P <.0001). Death occurred in 15 (3.5%) patients with VVS, 11 (16.9%) with OHS, and 13 (10.9%) with SUE (P=.001). In the multivariate analysis, death was associated with age (P=.0001), diabetes (P=.007), and diagnosis of OHS (P=.026) and SUE (P=.020). CONCLUSIONS In patients with noncardiac syncope, the recurrence rate after 52 months of follow-up was 37.4% and mortality was 6.6% per year. Recurrence was higher in patients with a neuromedial profile and mortality was higher in patients with a nonneuromedial profile.
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Affiliation(s)
- Gonzalo Barón-Esquivias
- Servicio de Cardiología y Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain; Unidad Cardiovascular, Instituto de Biotecnología de Sevilla (IBIS), Seville, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Macarena Quintanilla
- Servicio de Cardiología y Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain
| | - Antonio J Díaz-Martín
- Servicio de Cardiología y Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain
| | - Carmen Barón-Solís
- Servicio de Cardiología y Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain
| | - Carmen V Almeida-González
- Unidad de Metodología, Estadística e Investigación, Instituto de Biotecnología de Sevilla (IBIS), Seville, Spain
| | - Carmen García-Romero
- Servicio de Cardiología y Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain
| | - Inmaculada Paneque
- Servicio de Cardiología y Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain
| | - Carmen Rubio-Guerrero
- Servicio de Cardiología y Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain
| | - Rosario Rodríguez-Corredor
- Servicio de Cardiología y Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain
| | - Juan I Valle-Racero
- Servicio de Cardiología y Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain
| | - Antonio Ordóñez
- Servicio de Cardiología y Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain; Unidad Cardiovascular, Instituto de Biotecnología de Sevilla (IBIS), Seville, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Carlos A Morillo
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
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8
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Barón-Esquivias G, Quintanilla M, Díaz-Martín AJ, Barón-Solís C, Almeida-González CV, García-Romero C, Paneque I, Rubio-Guerrero C, Rodríguez-Corredor R, Valle-Racero JI, Ordóñez A, Morillo CA. Recurrencia y mortalidad a largo plazo de los pacientes con síncope no cardiogénico. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Chaves LMDSM, Cabral JVB, Silveira MMBMD, Silva MCAD, Souza ACD, Oliveira DCD, Sobral Filho DC, Montarroyos UR. Orthostatic changes in blood pressure and survival in elderly cardiopaths. Rev Assoc Med Bras (1992) 2022; 68:19-23. [DOI: 10.1590/1806-9282.20210199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/01/2021] [Indexed: 11/22/2022] Open
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10
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Leddy JJ, Haider MN, Noble JM, Rieger B, Flanagan S, McPherson JI, Shubin-Stein K, Saleem GT, Corsaro L, Willer B. Clinical Assessment of Concussion and Persistent Post-Concussive Symptoms for Neurologists. Curr Neurol Neurosci Rep 2021; 21:70. [PMID: 34817724 DOI: 10.1007/s11910-021-01159-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Concussion produces a variety of signs and symptoms. Most patients recover within 2-4 weeks, but a significant minority experiences persistent post-concussive symptoms (PPCS), some of which may be from associated cervical or persistent neurologic sub-system (e.g., vestibular) dysfunction. This review provides evidence-based information for a pertinent history and physical examination of patients with concussion. RECENT FINDINGS The differential diagnosis of PPCS is based on the mechanism of injury, a thorough medical history and concussion-pertinent neurological and cervical physical examinations. The concussion physical examination focuses on elements of autonomic function, oculomotor and vestibular function, and the cervical spine. Abnormalities identified on physical examination can inform specific forms of rehabilitation to help speed recovery. Emerging data show that there are specific symptom generators after concussion that can be identified by a thorough history, a pertinent physical examination, and adjunct tests when indicated.
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Affiliation(s)
- John J Leddy
- UBMD, Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA.
| | - Mohammad Nadir Haider
- UBMD, Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA.,Department of Neuroscience, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA
| | - James M Noble
- Department of Neurology, Taub Institute for Research On Alzheimer's Disease and the Aging Brain, and G.H. Sergievsky Center, Columbia University, New York, NY, USA
| | - Brian Rieger
- Department of Physical Medicine and Rehabilitation, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Steven Flanagan
- Department of Rehabilitation Medicine, Rusk Institute of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Jacob I McPherson
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA
| | | | - Ghazala T Saleem
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA
| | - Louis Corsaro
- Northern Westchester and Southern Putnam County School Districts, New York, NY, USA
| | - Barry Willer
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA
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11
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Hohtari-Kivimäki U, Salminen M, Vahlberg T, Kivelä SL. Orthostatic Hypotension is a Risk Factor for Falls Among Older Adults: 3-Year Follow-Up. J Am Med Dir Assoc 2021; 22:2325-2330. [PMID: 34384767 DOI: 10.1016/j.jamda.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/05/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To assess the prevalence of orthostatic hypotension (OH) and the association of OH with the risk of falls among community-dwelling older adults with a previous fall. DESIGN Longitudinal study. SETTING AND PARTICIPANTS The subjects (n = 561) were participants in fall prevention conducted in western Finland. METHODS Blood pressure (BP) was measured in supine position and at 30 seconds and 3 minutes after standing. The participants were divided according to the consensus definition to an OH group (OHG) and a non-OH group (non-OHG). Falls were recorded by fall diaries during 12 months. Falls requiring treatment were gathered from health center and hospital registers during 12 and 36 months. RESULTS The prevalence of OH was 23.4% (30 seconds) and 7.3% (3 minutes). The 30-second measurement showed that the incidence of falls and that of falls requiring treatment were significantly higher in OHG compared with non-OHG during 12 months. After adjustments, the incidence of falls remained higher in all 5 adjusted models whereas that of falls requiring treatment remained higher only after adjustment for functional balance. The 3-minute measurement showed that the incidence of falls was higher in OHG compared with non-OHG during 12 months and remained higher after adjustments for functional balance and for age and functional balance. During the 36-month follow-up, OH measured at 30 seconds or 3 minutes after standing was not associated with the occurrence of falls leading to treatment. CONCLUSIONS AND IMPLICATIONS OH at 30 seconds or 3 minutes after standing is associated with a greater risk for falling within 12 months in older adults. The 30-second blood pressure measurement is more reliable to detect the risk than the 3-minute measurement. The results support the usability of 30-second measurement in determining OH and the risk for falling among older persons.
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Affiliation(s)
| | - Marika Salminen
- Faculty of Medicine, Unit of Family Medicine, University of Turku, Turku, Finland; City of Turku, Welfare Division/Turku City Hospital, Turku, Finland
| | - Tero Vahlberg
- Faculty of Medicine, Biostatistics, University of Turku, Turku, Finland
| | - Sirkka-Liisa Kivelä
- Faculty of Medicine, Unit of Family Medicine, University of Turku, Turku, Finland; Faculty of Pharmacy, University of Helsinki, Turku, Finland
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12
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Xia X, Wang R, Vetrano DL, Grande G, Laukka EJ, Ding M, Fratiglioni L, Qiu C. From Normal Cognition to Cognitive Impairment and Dementia: Impact of Orthostatic Hypotension. Hypertension 2021; 78:769-778. [PMID: 34225472 PMCID: PMC8357050 DOI: 10.1161/hypertensionaha.121.17454] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Supplemental Digital Content is available in the text. The role of orthostatic hypotension (OH) in the continuum of cognitive aging remains to be clarified. We sought to investigate the associations of OH with dementia, cognitive impairment, no dementia (CIND), and CIND progression to dementia in older adults while considering orthostatic symptoms. This population-based cohort study included 2532 baseline (2001–2004) dementia-free participants (age ≥60 years; 62.6% women) in the SNAC-K (Swedish National Study on Aging and Care in Kungsholmen) who were regularly examined over 12 years. We further divided the participants into a baseline CIND-free cohort and a CIND cohort. OH was defined as a decrease by ≥20/10 mm Hg in systolic/diastolic blood pressure upon standing and further divided into asymptomatic and symptomatic OH. Dementia was diagnosed following the international criteria. CIND was defined as scoring ≥1.5 SDs below age group-specific means in ≥1 cognitive domain. Data were analyzed with flexible parametric survival models, controlling for confounding factors. Of the 2532 participants, 615 were defined with OH at baseline, and 322 were diagnosed with dementia during the entire follow-up period. OH was associated with an adjusted hazard ratio of 1.40 for dementia (95% CI, 1.10–1.76), 1.15 (0.94–1.40) for CIND, and 1.54 (1.05–2.25) for CIND progression to dementia. The associations of dementia and CIND progression to dementia with asymptomatic OH were similar to overall OH, whereas symptomatic OH was only associated with CIND progression to dementia. Our study suggests that OH, even asymptomatic OH, is associated with increased risk of dementia and accelerated progression from CIND to dementia in older adults.
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Affiliation(s)
- Xin Xia
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet-Stockholm University, Sweden (X.X., R.W., D.L.V., G.G., E.J.L., M.D., L.F., C.Q.)
| | - Rui Wang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet-Stockholm University, Sweden (X.X., R.W., D.L.V., G.G., E.J.L., M.D., L.F., C.Q.).,The Swedish School of Sport and Health Sciences, GIH, Stockholm, Sweden (R.W.).,Department of Medicine and Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison (R.W.)
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet-Stockholm University, Sweden (X.X., R.W., D.L.V., G.G., E.J.L., M.D., L.F., C.Q.).,Department of Geriatrics, Catholic University of Rome, Italy (D.L.V.).,Centro di Medicina dell'Invecchiamento, Fondazione Policlinico A. Gemelli, Rome, Italy (D.L.V.)
| | - Giulia Grande
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet-Stockholm University, Sweden (X.X., R.W., D.L.V., G.G., E.J.L., M.D., L.F., C.Q.)
| | - Erika J Laukka
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet-Stockholm University, Sweden (X.X., R.W., D.L.V., G.G., E.J.L., M.D., L.F., C.Q.).,Stockholm Gerontology Research Center, Sweden (E.J.L., L.F.)
| | - Mozhu Ding
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet-Stockholm University, Sweden (X.X., R.W., D.L.V., G.G., E.J.L., M.D., L.F., C.Q.).,Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (M.D.)
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet-Stockholm University, Sweden (X.X., R.W., D.L.V., G.G., E.J.L., M.D., L.F., C.Q.).,Stockholm Gerontology Research Center, Sweden (E.J.L., L.F.)
| | - Chengxuan Qiu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet-Stockholm University, Sweden (X.X., R.W., D.L.V., G.G., E.J.L., M.D., L.F., C.Q.)
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Eight Orthostatic Haemodynamic Patterns in The Irish Longitudinal Study on Ageing (TILDA): Stability and Clinical Associations after 4 Years. Geriatrics (Basel) 2021; 6:geriatrics6020050. [PMID: 34064800 PMCID: PMC8162355 DOI: 10.3390/geriatrics6020050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 01/27/2023] Open
Abstract
Previous research cross-sectionally characterised eight morphological systolic blood pressure (SBP) active stand (AS) patterns using a clinical clustering approach at Wave 1 (W1) of the Irish Longitudinal Study on Ageing. We explored the longitudinal stability and clinical associations of these groupings at Wave 3 (W3), four years later. Eight AS groups had their clinical characteristics and AS patterns at W3 compared to W1. We explored longitudinal associations (new cognitive decline, falls, syncope, disability, and mortality) using multivariate logistic regression models. In total, 2938 participants (60% of Wave 1 sample) had adequate AS data from both W1 and 3 for analysis. We found no longitudinal stability of the eight AS groups or their morphological patterns between the waves. A pattern of impaired stabilisation and late deficit seemed more preserved and was seen in association with new cognitive decline (OR 1.63, 95% CI: 1.12–2.36, p = 0.011). An increase in antihypertensive usage seemed associated with reduced immediate SBP drops, improved AS patterns, and reduced orthostatic intolerance (OI). In pure longitudinal groups, AS patterns were not preserved after 4 years. AS patterns are longitudinally dynamic, and improvements after 4 years are possible even in the presence of higher antihypertensive burden.
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Christopoulos EM, Tran J, Hillebrand SL, Lange PW, Iseli RK, Meskers CGM, Maier AB. Initial orthostatic hypotension and orthostatic intolerance symptom prevalence in older adults: A systematic review. Int J Cardiol Hypertens 2021; 8:100071. [PMID: 33884364 PMCID: PMC7803043 DOI: 10.1016/j.ijchy.2020.100071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/13/2020] [Accepted: 12/04/2020] [Indexed: 11/25/2022] Open
Abstract
Background Initial orthostatic hypotension is a clinically relevant syndrome in older adults which has been associated with symptoms of orthostatic intolerance. The aim of this systematic review was to determine the prevalence of orthostatic intolerance symptoms in older adults with initial orthostatic hypotension. Methods MEDLINE (from 1946), EMBASE (from 1974) and Cochrane were searched to December 6th, 2019 using the terms "initial orthostatic hypotension", "postural hypotension" and "older adults". Study selection involved the following criteria: published in English; mean or median age ≥ 65 years and diagnosis of initial orthostatic hypotension encompassed a decrease in systolic blood pressure by ≥ 40 mmHg and/or diastolic blood pressure by ≥ 20 mmHg within a maximum of 1 min following a postural change. Results Of 8311 articles, 12 articles reporting initial orthostatic hypotension prevalence in 3446 participants with a mean age of 75 (6 SD) years (56.5% female) were included. Five initial orthostatic hypotension definition variations were utilised and symptoms were reported in six articles (968 participants, mean age 73.4 (6.1 SD) years, 56% female). The prevalence of symptoms in older adults with initial orthostatic hypotension ranged from 24 to 100% and was dependent on variations in timing or the inclusion of symptoms in the initial orthostatic hypotension definition. Conclusions Where orthostatic intolerance symptoms were reported, a large proportion of older adults with a diagnosis of initial orthostatic hypotension were symptomatic. However, the literature on initial orthostatic hypotension and orthostatic intolerance symptoms is scarce and a variety of definitions of initial orthostatic hypotension are utilised.
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Affiliation(s)
- Elena M Christopoulos
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Jennifer Tran
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Sarah L Hillebrand
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Peter W Lange
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Rebecca K Iseli
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.,Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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15
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Logan A, Freeman J, Pooler J, Kent B, Gunn H, Billings S, Cork E, Marsden J. Effectiveness of non-pharmacological interventions to treat orthostatic hypotension in elderly people and people with a neurological condition: a systematic review. JBI Evid Synth 2021; 18:2556-2617. [PMID: 32773495 DOI: 10.11124/jbisrir-d-18-00005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The objective of this review was to summarize the best available evidence regarding the effectiveness of non-pharmacological interventions to treat orthostatic hypotension (OH) in elderly people and people with a neurological condition. INTRODUCTION Orthostatic hypotension is common in elderly people and people with a neurological condition and can interfere with or limit rehabilitation. Non-pharmacological interventions to treat OH could allow for longer and earlier mobilization, which is recommended in national clinical guidelines for rehabilitation in the acute or sub-acute phase following stroke or other neurological conditions. INCLUSION CRITERIA The review considered people aged 50 years and older, and people aged 18 years and elderly people with a neurological condition. Non-pharmacological interventions to treat OH included compression garments, neuromuscular stimulation, physical counter-maneuvers, aerobic or resistance exercises, sleeping with head tilted up, increasing fluid and salt intake, and timing and size of meals. The comparator was usual care, no intervention, pharmacological interventions, or other non-pharmacological interventions. Outcome measures included systolic blood pressure, diastolic blood pressure, heart rate, cerebral blood flow, observed/perceived symptoms, duration of standing or sitting in minutes, tolerance of therapy, functional ability, and adverse events/effects. METHODS Databases for published and unpublished studies available in English up to April 2018 with no lower date limit were searched. Critical appraisal was conducted using standardized instruments from JBI. Data were extracted using standardized tools designed for quantitative studies. Where appropriate, studies were included in a meta-analysis; otherwise, data were presented in a narrative form due to heterogeneity. RESULTS Forty-three studies - a combination of randomized controlled trials (n = 13), quasi-experimental studies (n = 28), a case control study (n = 1), and a case report (n = 1) - with 1069 participants were included. Meta-analyses of three interventions (resistance exercise, electrical stimulation, and lower limb compression bandaging) showed no significant effect of these interventions. Results from individual studies indicated physical maneuvers such as leg crossing, leg muscle pumping/contractions, and bending forward improved orthostatic hypotension. Abdominal compression improved OH. Sleeping with head up in combination with pharmacological treatment was more effective than sleeping with head up alone. Eating smaller, more frequent meals was effective. Drinking 480 mL of water increased blood pressure. CONCLUSIONS The review found mixed results for the effectiveness of non-pharmacological interventions to treat OH in people aged 50 years and older, and people with a neurological condition. There are several non-pharmacological interventions that may be effective in treating OH, but not all have resulted in clinically meaningful changes in outcome. Some may not be suitable for people with moderate to severe disability; therefore, it is important for clinicians to consider the patient's abilities and impairments when considering which non-pharmacological interventions to implement.
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Affiliation(s)
- Angela Logan
- School of Health Professions, Faculty of Health, Peninsula Allied Health Centre, Plymouth University, Plymouth, UK.,Stroke and Neurology Therapy Team, Cornwall Partnership Foundation NHS Trust, Camborne Redruth Community Hospital, Cornwall, UK.,The University of Plymouth Centre for Innovations in Health and Social Care: A JBI Centre of Excellence
| | - Jennifer Freeman
- School of Health Professions, Faculty of Health, Peninsula Allied Health Centre, Plymouth University, Plymouth, UK.,The University of Plymouth Centre for Innovations in Health and Social Care: A JBI Centre of Excellence
| | - Jillian Pooler
- Faculty of Health, Peninsula Medical and Dentistry Schools, Plymouth, UK
| | - Bridie Kent
- The University of Plymouth Centre for Innovations in Health and Social Care: A JBI Centre of Excellence.,School of Nursing and Midwifery, Faculty of Health, Plymouth University, Plymouth, UK
| | - Hilary Gunn
- School of Health Professions, Faculty of Health, Peninsula Allied Health Centre, Plymouth University, Plymouth, UK
| | - Sarah Billings
- Stroke Rehabilitation Unit, Livewell Southwest, Mount Gould Hospital, Plymouth, UK
| | - Emma Cork
- Stroke Rehabilitation Department, Northern Devon Healthcare Trust, Northern Devon District Hospital, Barnstaple, UK
| | - Jonathan Marsden
- School of Health Professions, Faculty of Health, Peninsula Allied Health Centre, Plymouth University, Plymouth, UK.,The University of Plymouth Centre for Innovations in Health and Social Care: A JBI Centre of Excellence
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Gierthmühlen J, Baron R. [Syncopes]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2020; 88:532-546. [PMID: 32818974 DOI: 10.1055/a-1165-7184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Syncopes are defined as sudden and short unconsciousness with loss of muscular tonus which are reversible without further intervention. Differentiation from other short-lasting changes of consciousness as in seizures, blood flow abnormalities of brainstem, metabolic disorders, intoxication or traumatic loss of consciousness is important for further diagnostic and adequate treatment.
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Bond KM, Benson JC, Cutsforth-Gregory JK, Kim DK, Diehn FE, Carr CM. Spontaneous Intracranial Hypotension: Atypical Radiologic Appearances, Imaging Mimickers, and Clinical Look-Alikes. AJNR Am J Neuroradiol 2020; 41:1339-1347. [PMID: 32646948 DOI: 10.3174/ajnr.a6637] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/30/2020] [Indexed: 12/19/2022]
Abstract
Spontaneous intracranial hypotension is a condition characterized by low CSF volume secondary to leakage through a dural defect with no identifiable cause. Patients classically present with orthostatic headaches, but this symptom is not specific to spontaneous intracranial hypotension, and initial misdiagnosis is common. The most prominent features of spontaneous intracranial hypotension on intracranial MR imaging include "brain sag" and diffuse pachymeningeal enhancement, but these characteristics can be seen in several other conditions. Understanding the clinical and imaging features of spontaneous intracranial hypotension and its mimickers will lead to more prompt and accurate diagnoses. Here we discuss conditions that mimic the radiologic and clinical presentation of spontaneous intracranial hypotension as well as other disorders that CSF leaks can imitate.
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Affiliation(s)
- K M Bond
- From the Mayo Clinic School of Medicine (K.M.B.), Rochester, Minnesota
| | - J C Benson
- Departments of Radiology (J.C.B., D.K.K., F.E.D., C.M.C.)
| | | | - D K Kim
- Departments of Radiology (J.C.B., D.K.K., F.E.D., C.M.C.)
| | - F E Diehn
- Departments of Radiology (J.C.B., D.K.K., F.E.D., C.M.C.)
| | - C M Carr
- Departments of Radiology (J.C.B., D.K.K., F.E.D., C.M.C.)
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Kim HA, Bisdorff A, Bronstein AM, Lempert T, Rossi-Izquierdo M, Staab JP, Strupp M, Kim JS. Hemodynamic orthostatic dizziness/vertigo: Diagnostic criteria. J Vestib Res 2020; 29:45-56. [PMID: 30883381 PMCID: PMC9249281 DOI: 10.3233/ves-190655] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 02/25/2019] [Indexed: 11/15/2022]
Abstract
This paper presents the diagnostic criteria for hemodynamic orthostatic dizziness/vertigo to be included in the International Classification of Vestibular Disorders (ICVD). The aim of defining diagnostic criteria of hemodynamic orthostatic dizziness/vertigo is to help clinicians to understand the terminology related to orthostatic dizziness/vertigo and to distinguish orthostatic dizziness/vertigo due to global brain hypoperfusion from that caused by other etiologies. Diagnosis of hemodynamic orthostatic dizziness/vertigo requires: A) five or more episodes of dizziness, unsteadiness or vertigo triggered by arising or present during upright position, which subsides by sitting or lying down; B) orthostatic hypotension, postural tachycardia syndrome or syncope documented on standing or during head-up tilt test; and C) not better accounted for by another disease or disorder. Probable hemodynamic orthostatic dizziness/vertigo is defined as follows: A) five or more episodes of dizziness, unsteadiness or vertigo triggered by arising or present during upright position, which subsides by sitting or lying down; B) at least one of the following accompanying symptoms: generalized weakness/tiredness, difficulty in thinking/concentrating, blurred vision, and tachycardia/palpitations; and C) not better accounted for by another disease or disorder. These diagnostic criteria have been derived by expert consensus from an extensive review of 90 years of research on hemodynamic orthostatic dizziness/vertigo, postural hypotension or tachycardia, and autonomic dizziness. Measurements of orthostatic blood pressure and heart rate are important for the screening and documentation of orthostatic hypotension or postural tachycardia syndrome to establish the diagnosis of hemodynamic orthostatic dizziness/vertigo.
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Affiliation(s)
- Hyun Ah Kim
- Department of Neurology, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Alexandre Bisdorff
- Department of Neurology, Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, Luxembourg
| | - Adolfo M. Bronstein
- Department of Neuro-otology, Division of Brain Sciences, Imperial College London, Charing Cross Hospital Campus, London, UK
| | - Thomas Lempert
- Department of Neurology, Schlosspark-Klinik, Berlin, Germany
| | | | - Jeffrey P. Staab
- Departments of Psychiatry and Psychology and Otorhinolaryngology – Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Dizziness Center, Seoul National University Bundang Hospital, Seongnam, South Korea
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Bailey R, Mortimore G. Orthostatic hypotension: clinical review and case study. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:506-511. [PMID: 32407222 DOI: 10.12968/bjon.2020.29.9.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Transient loss of consciousness (TLOC) accounts for 3% of all attendance in emergency departments within the UK. More than 90% of TLOC presentations are due to epileptic seizures, psychogenic seizures or syncope. However, in England and Wales in 2002, it was estimated that 92 000 patients were incorrectly diagnosed with epilepsy, at an additional annual cost to the NHS of up to £189 million. This article will reflect on the case study of a 54-year-old female patient who presented with a possible TLOC, and had a background of long-term depression. Differential diagnoses will be discussed, but the article will focus on orthostatic hypotension. Being diagnosed with this condition is independently associated with an increased risk of all-cause mortality. Causes of orthostatic hypotension and the pathophysiology behind the condition will be discussed, highlighting the importance of obtaining an accurate clinical history. This is extremely pertinent if a patient collapses in an NHS setting and this is witnessed by nurses because they can contribute to the history of the type of collapse, to aid diagnosis and correct treatment. In addition, nurses have a valuable role to play in highlighting polypharmacy to doctors, and non-medical prescribers, as a contributing factor to orthostatic hypotension is polypharmacy. It is therefore important to accurately distinguish TLOC aetiology, not only to provide appropriate management, but to also identify patients at risk of morbidity/mortality related to underlying disease.
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Affiliation(s)
- Rachael Bailey
- Trainee Advanced Clinical Practitioner, Department of Health and Social Care, University of Derby
| | - Gerri Mortimore
- Lecturer in Advanced Practice, Department of Health and Social Care, University of Derby
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Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A, Fedorowski A, Furlan R, Kenny RA, Martín A, Probst V, Reed MJ, Rice CP, Sutton R, Ungar A, van Dijk JG. Practical Instructions for the 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 2019; 39:e43-e80. [PMID: 29562291 DOI: 10.1093/eurheartj/ehy071] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Papismadov B, Tzur I, Izhakian S, Barchel D, Swarka M, Phatel H, Livshiz-Riven I, Gorelik O. High compression leg bandaging prevents seated postural hypotension among elderly hospitalized patients. Geriatr Nurs 2019; 40:558-564. [DOI: 10.1016/j.gerinurse.2019.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/19/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
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Kirkham FA, Rankin P, Parekh N, Holt SG, Rajkumar C. Aortic stiffness and central systolic pressure are associated with ambulatory orthostatic BP fall in chronic kidney disease. J Nephrol 2019; 33:317-324. [PMID: 31598911 DOI: 10.1007/s40620-019-00655-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Orthostatic hypotension (OH) has a significant association with cardiovascular disease. OH becomes more common in older age, as does arterial stiffness, shown to be independently associated with impaired baroreflex sensitivity and OH. Measurement of arterial compliance and central blood pressures are increasingly important, with evidence that central BP more closely correlates to end-organ damage and mortality than peripheral measurements. Patients with chronic kidney disease (CKD) are high risk for cardiovascular events, which can be predicted through measures of arterial compliance. We hypothesised that OH is associated with arterial stiffness and central blood pressure in CKD patients. DESIGN/SETTING We tested this hypothesis within the arterial compliance and oxidant stress as predictors of loss of renal function, morbidity and mortality in chronic kidney disease (ACADEMIC) study, a single-centre prospective observational study of the progression of arterial stiffness and renal function. PARTICIPANTS One hundred and forty-six patients with CKD 3 or 4. MEASUREMENTS Twenty-four-hour ambulatory BP monitoring with postural sensing (DIASYS Integra 2, Novacor France); central systolic and diastolic BP (cSBP and cDBP) and aortic Augmentation Index using Sphygmocor® (Atcor, Australia); Carotid-femoral pulse wave velocity (cfPWV) using Complior® (ALAM Medical, France). RESULTS Twenty-three patients had a postural SBP fall (prevalence 15.8%), with mean drop 7 mmHg. Patients with OH had higher cfPWV (15.2 m/s vs 12.7 m/s in patients without OH, p < 0.001) and central SBP (147.5 vs 135.7, p = 0.012). Regression analysis gave an odds ratio (OR) of orthostatic SBP fall for cfPWV of 1.46 (95% CI 1.16-1.84, p = 0.001) and 1.03 for cSBP (95% CI 1.004-1.06, p = 0.024) after adjustment for cardiovascular risk factors. CONCLUSION Aortic stiffness and central SBP are independently associated with orthostatic SBP fall in CKD patients. This suggests that enhanced arterial stiffness may be an underlying mechanism in baroreflex dysfunction, and may partly explain the vascular risk in CKD patients.
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Affiliation(s)
- Frances A Kirkham
- Department of Elderly Care and Stroke Medicine, Brighton and Sussex University Hospitals Trust, Brighton, BN2 5BE, UK.
| | - Philip Rankin
- Department of Elderly Care and Stroke Medicine, Brighton and Sussex University Hospitals Trust, Brighton, BN2 5BE, UK
| | - Nikesh Parekh
- Department of Elderly Care and Stroke Medicine, Brighton and Sussex University Hospitals Trust, Brighton, BN2 5BE, UK.,Department of Medicine, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Stephen G Holt
- Department of Medicine, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,Department of Nephrology, Brighton and Sussex University Hospitals Trust, Brighton, UK
| | - Chakravarthi Rajkumar
- Department of Elderly Care and Stroke Medicine, Brighton and Sussex University Hospitals Trust, Brighton, BN2 5BE, UK.,Department of Medicine, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
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Han C, Lim YH, Lee KS, Hong YC. Acute effects of ambient temperature on hypotension hospital visits: A time-series analysis in seven metropolitan cities of Korea from 2011 to 2015. ENVIRONMENT INTERNATIONAL 2019; 131:104941. [PMID: 31288180 DOI: 10.1016/j.envint.2019.104941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/20/2019] [Accepted: 06/17/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Although blood pressure decreases in response to high ambient temperature, little is known about whether the ambient temperature can induce clinical hypotension events. Therefore, we conducted a time-series analysis to evaluate the association between hypotension hospital visits and ambient temperature in seven metropolitan cities of Korea. METHODS We used the National Health Insurance Database, which contains the complete hospital visit data of the entire Korean population. We collected hospital visit data of seven metropolitan cities and linked the number of daily hypotension hospital visits to city-level ambient temperature, relative humidity, and air pollution levels from 2011 to 2015. Time-series analysis using the Poisson generalized additive model was conducted for each metropolitan city and we meta-analyzed the time-series results using the random effect model. RESULTS There were 132,097 hospital visits for hypotension during our study period. A 1 degree Celsius (°C) increase in ambient temperature was associated with 1.1% increase in hospital visits for hypotension on lag day 0. Effects of ambient temperature lasted for 7 days, showing greater effects in shorter lag days. Subgroup analysis by sex and income groups showed similar results, but effects of ambient temperature on hypotension hospital visits was higher in the younger age group compared to older age group (aged over 65 years old). The results were unchanged when we applied cumulative lags, different case definitions, degrees of freedom per year, and multi-pollutant model adjusting for air pollutants. CONCLUSIONS Hospital visits for hypotension were positively associated with ambient temperature. Increased hypotension events in response to increased ambient temperature might explain the high cardiovascular mortality on hot days.
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Affiliation(s)
- Changwoo Han
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youn-Hee Lim
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea; Environmental Health Center, Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Kyung-Shin Lee
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea; Environmental Health Center, Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Yun-Chul Hong
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea; Environmental Health Center, Seoul National University, College of Medicine, Seoul, Republic of Korea.
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Pafili K, Trypsianis G, Papazoglou D, Maltezos E, Papanas N. Correlation of cardiac autonomic neuropathy with small and large peripheral nerve function in type 2 diabetes mellitus. Diabetes Res Clin Pract 2019; 156:107844. [PMID: 31520713 DOI: 10.1016/j.diabres.2019.107844] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 08/27/2019] [Accepted: 09/06/2019] [Indexed: 12/20/2022]
Abstract
AIMS To analyse the correlation of cardiac autonomic neuropathy (CAN), sympathetic and parasympathetic dysfunction with the different diagnostic tools for large and small peripheral nerve fibres in type 2 diabetes mellitus (T2DM). METHODS We included 153 T2DM subjects (92 men) with mean age of 64.4 years. CAN, as well as sympathetic and parasympathetic dysfunction were diagnosed by the Ewing's cardiovascular reflex tests. Vibration perception threshold (VPT), monofilament, Ipswich Touch test, automated sural nerve conduction study and neuropathy disability score (NDS) evaluated large and small peripheral nerve fibre function. RESULTS CAN (adjusted odds ratio [aOR]: 44.57), parasympathetic (aOR: 18.40) and sympathetic dysfunction (aOR: 5.50) correlated with measures of small fibre function evaluated by pinprick sensation and temperature perception. Among tools for large nerve fibres, positive correlation was shown between: (1) CAN and abnormal VPT (aOR: 16.78), (2) parasympathetic dysfunction and abnormal VPT (aOR: 39.47). CONCLUSIONS CAN and parasympathetic dysfunction correlate with peripheral neuropathy, especially when the latter is assessed through VPT and measures of small fibre function as evaluated by pinprick sensation and temperature perception. The latter additionally correlate with sympathetic nervous system impairment.
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Affiliation(s)
- K Pafili
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece.
| | - G Trypsianis
- Department of Medical Statistics, Medical Faculty, Democritus University of Thrace, Alexandroupolis, Greece
| | - D Papazoglou
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece
| | - E Maltezos
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece
| | - N Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece
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Napalkov DA, Sokolova AA, Kondratyuk MR, Kudryavtseva AA, Krupenin PM, Savkov GE, Savkova OD, Yagofarova SY, Buchneva AV, Kwedhi JM. Predictors of the development of non-cardiogenic syncopal conditions at a young age. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2019. [DOI: 10.15829/1728-8800-2019-3-69-74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. Syncopal condition in young people are a relatively frequent and poorly understood medical problem. Non-cardiogenic syncope is not sufficiently studied because often they are not raise fears among doctors or patients, and at the same time their causes are associated with many complex medical and diagnostic aspects. The aim of the presented work is to identify the most significant risk factors in the development of non-cardiogenic syncopal conditions, identify triggers and assess the relationship between these factors, the lifestyle and development of syncope.Material and methods. The article presents the results of a descriptive research, including 1031 young people with a history of syncope episodes. The study took into account the presence of chronic diseases which could become a syncope trigger. External triggers (prolonged upright staying, stuffy room, and so on) were also determined.Results. In a multifactor survey of students living in Russia and abroad, the more frequent occurrence of non-cardiogenic syncopal episodes in young girls compared with young men was found. The effect of longterm upright and oxygen corporal were most likely risk factors for syncope.Conclusion. A significant correlation was found between the onset of reflex syncope and the presence of anemia and autonomic dysfunction syndrome. We proved the absence of a correlation between the level of daily load and the frequency of syncope conditions.
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Affiliation(s)
| | | | | | | | | | - G. E. Savkov
- I. M. Sechenov First Moscow State Medical University
| | - O. D. Savkova
- I. M. Sechenov First Moscow State Medical University
| | | | | | - J. M. Kwedhi
- I. M. Sechenov First Moscow State Medical University
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Abstract
OBJECTIVES Most studies of orthostatic hypotension (OH) have focused on community-dwelling and institutionalized patient populations. Less is known about OH in hospitalized patients. Moreover, a comprehensive review of OH in internal medicine wards has not been published in the English literature. Our purpose is to provide current information regarding OH in internal medicine inpatients. METHODS A comprehensive search of medical databases was performed for potentially relevant articles, using the following keywords: postural or orthostatic hypotension, with the combination of hospitalization or internal medicine. Inclusion criteria were: population of patients hospitalized for acute disorders in internal medicine or geriatric wards with a sample size of ≥50 and publication as an original full-length article in the English language. Data from 14 selected studies are reviewed, including: pathophysiology, evaluation, prevalence, manifestations, risk factors, prognosis, and management. RESULTS OH is a common and often symptomatic disorder in elderly internal medicine patients. The prevalence of OH in this population ranges from 22-75%. There are substantial discrepancies between the studies reviewed regarding definitions and means of evaluating OH. OH in internal medicine wards is largely non-neurogenic and multifactorial. The main predisposing factors for OH are prolonged bed rest, hypertension, and heart failure. OH in internal medicine wards is managed mainly with non-pharmacologic interventions, and is frequently reversible. CONCLUSIONS In internal medicine inpatients, OH warrants attention because this disorder is common, potentially dangerous, and treatable. In the hospital setting, OH should be routinely assessed on ambulation, following the current guidelines for OH definition and meaning.
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Affiliation(s)
- Irma Tzur
- a Department of Internal Medicine "F" , Assaf Harofeh Medical Center , Zerifin , Israel (affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel)
| | - Shimon Izhakian
- a Department of Internal Medicine "F" , Assaf Harofeh Medical Center , Zerifin , Israel (affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel)
| | - Oleg Gorelik
- a Department of Internal Medicine "F" , Assaf Harofeh Medical Center , Zerifin , Israel (affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel)
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27
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Dzhioeva ON, Reznik EV, Nikitin IG. Differential diagnostics of syncopal conditions. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2019. [DOI: 10.15829/1728-8800-2019-2-76-83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- O. N. Dzhioeva
- Pirogov Russian National Research Medical University; Research and Educational Center of City Clinical Hospital № 24
| | - E. V. Reznik
- Pirogov Russian National Research Medical University
| | - I. G. Nikitin
- Pirogov Russian National Research Medical University
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Tzur I, Izhakian S, Gorelik O. Orthostatic hypotension: definition, classification and evaluation. Blood Press 2019; 28:146-156. [DOI: 10.1080/08037051.2019.1604067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Irma Tzur
- Department of Internal Medicine "F", Assaf Harofeh Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Shimon Izhakian
- Department of Internal Medicine "F", Assaf Harofeh Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Oleg Gorelik
- Department of Internal Medicine "F", Assaf Harofeh Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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29
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Peng AW, Appel LJ, Mueller NT, Tang O, Miller ER, Juraschek SP. Effects of sodium intake on postural lightheadedness: Results from the DASH-sodium trial. J Clin Hypertens (Greenwich) 2019; 21:355-362. [PMID: 30690866 PMCID: PMC6420359 DOI: 10.1111/jch.13487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/28/2018] [Accepted: 12/11/2018] [Indexed: 12/22/2022]
Abstract
Lightheadedness after standing contributes to adverse clinical events, including falls. Recommendations for higher sodium intake to treat postural lightheadedness have not been evaluated in a trial setting. The Dietary Approaches to Stop Hypertension (DASH)-Sodium trial (1998-1999) tested the effects of the DASH diet and sodium reduction on blood pressure (BP). Participants were randomly assigned to DASH or a typical Western diet (control). During either diet, participants ate three sodium levels (50, 100, 150 meq/d at 2100 kcal) in random order for 30-days, separated by 5-day breaks. Participants reported the presence and severity of postural lightheadedness at baseline and after each feeding period. There were 412 participants (mean age 48 years; 57% women; 57% black). Mean baseline SBP/DBP was 135/86 mm Hg; 9.5% reported baseline lightheadedness. Among those consuming the DASH diet, high vs low sodium increased lightheadedness (OR 1.71; 95% CI: 1.01, 2.90; P = 0.047) and severity of lightheadedness (P = 0.02), but did not affect lightheadedness in those consuming the control diet (OR 0.77; 95% CI: 0.46, 1.29; P = 0.32). Among those consuming high vs low sodium in the context of the DASH diet, adults <60 vs ≥60 years old experienced more lightheadedness (P-interaction = 0.04), along with obese vs non-obese adults (P-interaction = 0.01). In the context of the DASH diet, higher sodium intake was associated with more frequent and severe lightheadedness. These findings challenge traditional recommendations to increase sodium intake to prevent lightheadedness.
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Affiliation(s)
- Allison W. Peng
- The Johns Hopkins University School of MedicineThe Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical ResearchBaltimoreMaryland
| | - Lawrence J. Appel
- The Johns Hopkins University School of MedicineThe Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical ResearchBaltimoreMaryland
| | - Noel T. Mueller
- The Johns Hopkins University School of MedicineThe Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical ResearchBaltimoreMaryland
| | - Olive Tang
- The Johns Hopkins University School of MedicineThe Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical ResearchBaltimoreMaryland
| | - Edgar R. Miller
- The Johns Hopkins University School of MedicineThe Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical ResearchBaltimoreMaryland
| | - Stephen P. Juraschek
- Division of General Medicine and Primary CareBeth Israel Deaconess Medical Center, Harvard Medical SchoolBostonMassachusetts
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Goswami N, Blaber AP, Hinghofer-Szalkay H, Convertino VA. Lower Body Negative Pressure: Physiological Effects, Applications, and Implementation. Physiol Rev 2019; 99:807-851. [PMID: 30540225 DOI: 10.1152/physrev.00006.2018] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This review presents lower body negative pressure (LBNP) as a unique tool to investigate the physiology of integrated systemic compensatory responses to altered hemodynamic patterns during conditions of central hypovolemia in humans. An early review published in Physiological Reviews over 40 yr ago (Wolthuis et al. Physiol Rev 54: 566-595, 1974) focused on the use of LBNP as a tool to study effects of central hypovolemia, while more than a decade ago a review appeared that focused on LBNP as a model of hemorrhagic shock (Cooke et al. J Appl Physiol (1985) 96: 1249-1261, 2004). Since then there has been a great deal of new research that has applied LBNP to investigate complex physiological responses to a variety of challenges including orthostasis, hemorrhage, and other important stressors seen in humans such as microgravity encountered during spaceflight. The LBNP stimulus has provided novel insights into the physiology underlying areas such as intolerance to reduced central blood volume, sex differences concerning blood pressure regulation, autonomic dysfunctions, adaptations to exercise training, and effects of space flight. Furthermore, approaching cardiovascular assessment using prediction models for orthostatic capacity in healthy populations, derived from LBNP tolerance protocols, has provided important insights into the mechanisms of orthostatic hypotension and central hypovolemia, especially in some patient populations as well as in healthy subjects. This review also presents a concise discussion of mathematical modeling regarding compensatory responses induced by LBNP. Given the diverse applications of LBNP, it is to be expected that new and innovative applications of LBNP will be developed to explore the complex physiological mechanisms that underline health and disease.
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Affiliation(s)
- Nandu Goswami
- Physiology Section, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz , Graz , Austria ; Department of Biomedical Physiology and Kinesiology, Simon Fraser University , Burnaby, British Columbia , Canada ; Battlefield Health & Trauma Center for Human Integrative Physiology, Combat Casualty Care Research Program, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Andrew Philip Blaber
- Physiology Section, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz , Graz , Austria ; Department of Biomedical Physiology and Kinesiology, Simon Fraser University , Burnaby, British Columbia , Canada ; Battlefield Health & Trauma Center for Human Integrative Physiology, Combat Casualty Care Research Program, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Helmut Hinghofer-Szalkay
- Physiology Section, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz , Graz , Austria ; Department of Biomedical Physiology and Kinesiology, Simon Fraser University , Burnaby, British Columbia , Canada ; Battlefield Health & Trauma Center for Human Integrative Physiology, Combat Casualty Care Research Program, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Victor A Convertino
- Physiology Section, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz , Graz , Austria ; Department of Biomedical Physiology and Kinesiology, Simon Fraser University , Burnaby, British Columbia , Canada ; Battlefield Health & Trauma Center for Human Integrative Physiology, Combat Casualty Care Research Program, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
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Eriksen JR, Munk-Madsen P, Kehlet H, Gögenur I. Orthostatic intolerance in enhanced recovery laparoscopic colorectal resection. Acta Anaesthesiol Scand 2019; 63:171-177. [PMID: 30094811 DOI: 10.1111/aas.13238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 07/15/2018] [Accepted: 07/17/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Orthostatic hypotension (OH) and intolerance (OI) are common findings in the early postoperative period after major surgery and may delay early mobilization. The mechanism of impaired orthostatic competence and OI symptoms is not fully understood, and specific data after colorectal surgery with well-defined perioperative care regimens and mobilization protocols are lacking. The aim of this study was to investigate the prevalence, possible risk factors and the impact of OI in patients undergoing elective minimal invasive colorectal cancer resection. METHODS A prospective single-centre study with an optimal enhanced recovery program and multimodal analgesic treatment. OI and OH were evaluated using a well-defined mobilization protocol preoperatively and 6 hour and 24 hour postoperatively. RESULTS A total of 100 patients were included in the data analysis. The overall median length of stay was 3 days (1-38). OI was observed in 53% of the patients 6 hour postoperatively and in 24% at 24 hour. OI at 6 hour postoperatively was associated with younger age, lower BMI, and female gender. At 24 hour postoperatively, female gender and ASA class >1 was associated with OI. Opioid consumption and intravenous fluid during the first 24 hour was not associated with OI. Postoperative complications were equally observed between patients with and without OI. Although not statistically significant, patients with OI at 24 hour postoperatively had prolonged LOS (mean 4.0 vs 7.5 days, P = 0.069) compared with patients without OI. CONCLUSION Postoperative orthostatic intolerance is a common problem during the first 24 hour following laparoscopic colorectal resection and may be followed by delayed recovery.
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Affiliation(s)
- Jens R. Eriksen
- Department of Surgery; Colorectal Cancer Unit; Zealand University Hospital; Roskilde Denmark
| | - Pia Munk-Madsen
- Department of Surgery; Colorectal Cancer Unit; Zealand University Hospital; Roskilde Denmark
| | - Henrik Kehlet
- Section for Surgical Pathophysiology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Ismail Gögenur
- Department of Surgery; Colorectal Cancer Unit; Zealand University Hospital; Roskilde Denmark
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Kemps H, Kränkel N, Dörr M, Moholdt T, Wilhelm M, Paneni F, Serratosa L, Ekker Solberg E, Hansen D, Halle M, Guazzi M. Exercise training for patients with type 2 diabetes and cardiovascular disease: What to pursue and how to do it. A Position Paper of the European Association of Preventive Cardiology (EAPC). Eur J Prev Cardiol 2019; 26:709-727. [PMID: 30642190 DOI: 10.1177/2047487318820420] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patients with type 2 diabetes mellitus suffer from dysregulation of a plethora of cardiovascular and metabolic functions, including dysglycaemia, dyslipidaemia, arterial hypertension, obesity and a reduced cardiorespiratory fitness. Exercise training has the potential to improve many of these functions, such as insulin sensitivity, lipid profile, vascular reactivity and cardiorespiratory fitness, particularly in type 2 diabetes mellitus patients with cardiovascular comorbidities, such as patients that suffered from an acute myocardial infarction, or after a coronary intervention such as percutaneous coronary intervention or coronary artery bypass grafting. The present position paper aims to provide recommendations for prescription of exercise training in patients with both type 2 diabetes mellitus and cardiovascular disease. The first part discusses the relevance and practical applicability of treatment targets that may be pursued, and failure to respond to these targets. The second part provides recommendations on the contents and methods to prescribe exercise training tailored to these treatment targets as well as to an optimal preparation and dealing with barriers and risks specific to type 2 diabetes mellitus and cardiac comorbidity.
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Affiliation(s)
- Hareld Kemps
- 1 Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Nicolle Kränkel
- 2 Charité - Universitätsmedizin Berlin, Klinik für Kardiologie, Campus Benjamin Steglitz, Germany.,3 DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Marcus Dörr
- 4 University Medicine Greifswald, Department of Internal Medicine B, Germany.,5 DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany
| | - Trine Moholdt
- 6 Department of Circulation and Medical Imaging, Norwegian University of Science and Technology Trondheim, Norway.,7 St Olav's Hospital, Trondheim, Norway
| | - Matthias Wilhelm
- 8 Department of Cardiology, Bern University Hospital and University of Bern, Switzerland
| | - Francesco Paneni
- 9 Centre for Molecular Cardiology and Cardiology, Zurich University Hospital, University of Zurich, Switzerland
| | - Luis Serratosa
- 10 Hospital Universitario Quironsalud, Madrid, Spain.,11 Ripoll & De Prado Sport Clinic, FIFA Medical Centre of Excellence, Murcia, Spain
| | | | - Dominique Hansen
- 13 Hasselt University, Faculty of Rehabilitation Sciences, Diepenbeek, Belgium.,14 Heart Centre Hasselt, Jessa Hospital, Belgium
| | - Martin Halle
- 15 Technical University Munich, Department of Prevention, Rehabilitation and Sports Medicine, Germany.,16 DZHK (German Centre for Cardiovascular Research), partner site Munich, Germany
| | - Marco Guazzi
- 17 University Cardiology Department and Heart Failure Unit and Cardiopulmonary Laboratory, Cardiology, I.R.C.C.S., Milan, Italy.,18 Policlinico San Donato University Hospital, Milan, Italy
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Hauser RA, Biaggioni I, Hewitt LA, Vernino S. Integrated Analysis of Droxidopa for the Treatment of Neurogenic Orthostatic Hypotension in Patients with Parkinson Disease. Mov Disord Clin Pract 2018; 5:627-634. [PMID: 30637284 DOI: 10.1002/mdc3.12695] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 09/18/2018] [Accepted: 09/26/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction Neurogenic orthostatic hypotension (nOH) is associated with neurodegenerative conditions, may cause symptoms of end-organ hypoperfusion, increases fall risk, and can negatively impact quality of life. Droxidopa is approved for the treatment of symptomatic nOH in adults. As the largest subpopulation of patients with nOH has a diagnosis of Parkinson disease (PD), the efficacy and tolerability of droxidopa in patients with PD and nOH were examined using integrated clinical trial data. Methods Post hoc analyses included data from the phase 3, randomized, placebo-controlled clinical trials of droxidopa (two short-term [1-2 weeks] trials and one medium-term [8-10 weeks] trial) in the subset of participants with PD and symptomatic nOH. Efficacy was assessed using standing blood pressure (BP) measurements and the Orthostatic Hypotension Questionnaire (OHQ), a patient-reported evaluation of nOH symptoms (Orthostatic Hypotension Symptom Assessment [OHSA]), and their impact (Orthostatic Hypotension Daily Activity Scale [OHDAS]). Results The analysis included 307 patients with PD (droxidopa, n = 150; placebo, n = 157). Compared with placebo, droxidopa significantly improved the OHQ composite score (P = 0.014), the OHSA composite score (P = 0.022), and the OHDAS composite score (P = 0.029) from baseline to end of study/week one. We found significant increases in standing mean systolic/diastolic BP for droxidopa versus placebo (P = 0.003/0.002). Adverse event (AE) rates were qualitatively similar between groups; the most frequently reported AEs in the droxidopa groups included headache, dizziness, nausea, and hypertension. Conclusions These post hoc analyses suggest that droxidopa provides meaningful clinical benefits and is well tolerated in the treatment of symptomatic nOH in patients with PD.
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Affiliation(s)
- Robert A Hauser
- Department of Neurology, Molecular Pharmacology and Physiology University of South Florida Parkinson's Disease and Movement Disorders Center, National Parkinson Foundation Center of Excellence Tampa FL USA
| | - Italo Biaggioni
- Division of Clinical Pharmacology, Department of Medicine Vanderbilt University Medical Center Nashville TN USA
| | | | - Steven Vernino
- Department of Neurology and Neurotherapeutics UT Southwestern Medical Center Dallas TX USA
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Falls management framework for supporting an independent lifestyle for older adults: a systematic review. Aging Clin Exp Res 2018; 30:1275-1286. [PMID: 30196346 DOI: 10.1007/s40520-018-1026-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Abstract
Falls are one of the common health and well-being issues among the older adults. Internet of things (IoT)-based health monitoring systems have been developed over the past two decades for improving healthcare services for older adults to support an independent lifestyle. This research systematically reviews technological applications related to falls detection and falls management. The systematic review was conducted in accordance to the preferred reporting items for systematic reviews and meta-analysis statement (PRISMA). Twenty-four studies out of 806 articles published between 2015 and 2017 were identified and included in this review. Selected studies were related to pre-fall and post-fall applications using motion sensors (10; 41.67%), environment sensors (10; 41.67%) and few studies used the combination of these types of sensors (4; 16.67%). As an outcome of this review, we postulated a falls management framework (FMF). FMF considered pre- and post-fall strategies to support older adults live independently. A part of this approach involved active analysis of sensor data with the aim of helping the older adults manage their risk of fall and stay safe in their home. FMF aimed to serve the researchers, developers, clinicians and policy makers with pre- and post-falls management strategies to enhance the older adults' independent living and well-being.
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35
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Momeyer MA, Mion LC. Orthostatic hypotension: an often overlooked risk factor for falls. Geriatr Nurs 2018; 39:483-486. [PMID: 30017455 DOI: 10.1016/j.gerinurse.2018.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Mary Alice Momeyer
- OSU College of Nursing, Center of Excellence in Critical and Complex Care, Columbus, OH, USA
| | - Lorraine C Mion
- OSU College of Nursing, Center of Excellence in Critical and Complex Care, Columbus, OH, USA.
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36
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Different patterns of orthostatic hypotension in older patients with unexplained falls or syncope: orthostatic hypotension patterns in older people. Eur Geriatr Med 2018; 9:485-492. [DOI: 10.1007/s41999-018-0063-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/30/2018] [Indexed: 11/26/2022]
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Briggs R, Carey D, Kennelly SP, Kenny RA. Longitudinal Association Between Orthostatic Hypotension at 30 Seconds Post-Standing and Late-Life Depression. Hypertension 2018; 71:946-954. [DOI: 10.1161/hypertensionaha.117.10542] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 11/09/2017] [Accepted: 01/18/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Robert Briggs
- From the Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland (R.B., D.C., R.A.K.); Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland (R.B., R.A.K.); and Age-Related Health Care, Tallaght Hospital, Dublin, Ireland (R.B., S.P.K.)
| | - Daniel Carey
- From the Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland (R.B., D.C., R.A.K.); Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland (R.B., R.A.K.); and Age-Related Health Care, Tallaght Hospital, Dublin, Ireland (R.B., S.P.K.)
| | - Sean P. Kennelly
- From the Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland (R.B., D.C., R.A.K.); Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland (R.B., R.A.K.); and Age-Related Health Care, Tallaght Hospital, Dublin, Ireland (R.B., S.P.K.)
| | - Rose Anne Kenny
- From the Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland (R.B., D.C., R.A.K.); Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland (R.B., R.A.K.); and Age-Related Health Care, Tallaght Hospital, Dublin, Ireland (R.B., S.P.K.)
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Seok HY, Kim YH, Kim H, Kim BJ. Patterns of Orthostatic Blood Pressure Changes in Patients with Orthostatic Hypotension. J Clin Neurol 2018; 14:283-290. [PMID: 29856151 PMCID: PMC6031984 DOI: 10.3988/jcn.2018.14.3.283] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 01/05/2018] [Accepted: 01/09/2018] [Indexed: 01/07/2023] Open
Abstract
Background and Purpose The objective of this study was to determine the patterns of blood pressure (BP) changes during the head-up tilt (HUT) test, particularly in terms of its clinical significance for patients with orthostatic hypotension (OH). Methods OH was divided into four categories based on systolic BP changes occurring within the first 10 minutes of the HUT test: sustained orthostatic hypotension (SOH), progressive orthostatic hypotension (POH), orthostatic hypotension with partial recovery (OHPR), and transient orthostatic hypotension (TOH). Results In total, 151 patients were analyzed: 65 with SOH, 38 with POH, 21 with OHPR, and 27 with TOH. POH patients exhibited the greatest reduction in systolic BP after HUT and were also the most likely to develop symptoms requiring early termination of the HUT test (42.1%, p<0.001). Additionally, SOH patients exhibited smaller heart-rate variation with deep breathing values (p=0.003) and Valsalva ratios (p=0.022) compared to POH patients. The sweat volume was greatest in OHPR patients. Conclusions Clinical characteristics, including the findings of autonomic function tests, differed between the OH patient groups. This might reflect differences in the underlying pathophysiologic mechanisms. Determining the patterns of BP changes during the HUT test may facilitate the development of effective management strategies in patients with OH.
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Affiliation(s)
- Hung Youl Seok
- Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea.,Department of Neurology, Keimyung University School of Medicine, Daegu, Korea
| | - Yoo Hwan Kim
- Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea.,Department of Neurology, Hangang Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Hayom Kim
- Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Byung Jo Kim
- Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea.
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39
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Naschitz JE. Blood pressure management in older people: balancing the risks. Postgrad Med J 2018; 94:348-353. [PMID: 29555655 DOI: 10.1136/postgradmedj-2017-135493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/31/2018] [Accepted: 02/12/2018] [Indexed: 12/17/2022]
Abstract
Guidelines of arterial hypertension treatment based on individualised expected outcomes are not available for frail older persons. In this paper, we review the evidence, concerning management of arterial blood pressure (BP) in frail older patients. We focused on the best affordable methods for BP measurement; the age-related optimum BP; specific BP goals in agreement with the patients' general heath, frailty status, orthostatic and postprandial hypotension; balancing the benefits against risks of antihypertensive treatment. Lenient BP goals are generally recommended for older persons with moderate or severe frailty, multimorbidity and limited life expectancy. To this aim, there may be a need for deintensification of antihypertensive treatment.
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Affiliation(s)
- Jochanan E Naschitz
- Bait Balev Nesher and The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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40
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Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A, Fedorowski A, Furlan R, Kenny RA, Martín A, Probst V, Reed MJ, Rice CP, Sutton R, Ungar A, van Dijk JG. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 2018; 39:1883-1948. [PMID: 29562304 DOI: 10.1093/eurheartj/ehy037] [Citation(s) in RCA: 993] [Impact Index Per Article: 165.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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41
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Moein H, Jhalli R, Blaber AP, Claydon VE, Menon C. Evaluating the efficacy of an active compression brace on orthostatic cardiovascular responses. PLoS One 2017; 12:e0187885. [PMID: 29166666 PMCID: PMC5699848 DOI: 10.1371/journal.pone.0187885] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/28/2017] [Indexed: 11/19/2022] Open
Abstract
Orthostatic intolerance, one of the principle causes of syncope, can occur secondary to concomitant venous pooling and enhanced capillary filtration. We aimed to evaluate a prototype portable calf active compression brace (ACB) designed to improve orthostatic haemodynamic control. Fourteen healthy volunteers participated in a randomized, placebo controlled, cross-over, double-blind study. Testing consisted of head-upright tilting and walking on a treadmill conducted on two consecutive days with a pair of ACBs wrapped around both calves. The ACB was actuated on one test day, but not on the other (placebo). Wearability, comfort, and ambulatory use of the ACB were assessed using questionnaires. The average calf pressure exerted by the ACB was 46.3±2.2 mmHg and the actuation pressure was 20.7±1.7 mmHg. When considering the differences between ACB actuation and placebo during tilt after supine rest there were trends for a larger stroke volume (+5.20±2.34%, p = 0.05) and lower heart rate (-5.12±2.41%, p = 0.06) with ACB actuation, with no effect on systolic arterial pressure (+4.86±3.41%, p = 0.18). The decrease in stroke volume after ten minutes of tilting was positively correlated with the height:calf circumference (r = 0.464; p = 0.029; n = 22; both conditions combined). The increase in heart rate after ten minutes of tilting was negatively correlated with the height:calf circumference (r = -0.485; p = 0.022; n = 22; both conditions combined) and was positively correlated with the average calf circumference (r = 0.539; p = 0.009; n = 22; both conditions combined). Participants reported good ACB wearability and comfort during ambulatory use. These data verify that the ACB increased stroke volume during tilting in healthy controls. Active calf compression garments may be a viable option for the management of orthostatic intolerance.
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Affiliation(s)
- Hadi Moein
- Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Metro Vancouver, British Columbia, Canada
| | - Ramandeep Jhalli
- Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Metro Vancouver, British Columbia, Canada
| | - Andrew P. Blaber
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Metro Vancouver, British Columbia, Canada
| | - Victoria E. Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Metro Vancouver, British Columbia, Canada
| | - Carlo Menon
- Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Metro Vancouver, British Columbia, Canada
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Goswami N, Blaber AP, Hinghofer-Szalkay H, Montani JP. Orthostatic Intolerance in Older Persons: Etiology and Countermeasures. Front Physiol 2017; 8:803. [PMID: 29163185 PMCID: PMC5677785 DOI: 10.3389/fphys.2017.00803] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 09/29/2017] [Indexed: 12/16/2022] Open
Abstract
Orthostatic challenge produced by upright posture may lead to syncope if the cardiovascular system is unable to maintain adequate brain perfusion. This review outlines orthostatic intolerance related to the aging process, long-term bedrest confinement, drugs, and disease. Aging-associated illness or injury due to falls often leads to hospitalization. Older patients spend up to 83% of hospital admission lying in bed and thus the consequences of bedrest confinement such as physiological deconditioning, functional decline, and orthostatic intolerance represent a central challenge in the care of the vulnerable older population. This review examines current scientific knowledge regarding orthostatic intolerance and how it comes about and provides a framework for understanding of (patho-) physiological concepts of cardiovascular (in-) stability in ambulatory and bedrest confined senior citizens as well as in individuals with disease conditions [e.g., orthostatic intolerance in patients with diabetes mellitus, multiple sclerosis, Parkinson's, spinal cord injury (SCI)] or those on multiple medications (polypharmacy). Understanding these aspects, along with cardio-postural interactions, is particularly important as blood pressure destabilization leading to orthostatic intolerance affects 3-4% of the general population, and in 4 out of 10 cases the exact cause remains elusive. Reviewed also are countermeasures to orthostatic intolerance such as exercise, water drinking, mental arithmetic, cognitive training, and respiration training in SCI patients. We speculate that optimally applied countermeasures such as mental challenge maintain sympathetic activity, and improve venous return, stroke volume, and consequently, blood pressure during upright standing. Finally, this paper emphasizes the importance of an active life style in old age and why early re-mobilization following bedrest confinement or bedrest is crucial in preventing orthostatic intolerance, falls and falls-related injuries in older persons.
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Affiliation(s)
- Nandu Goswami
- Gravitational Physiology and Medicine Research Unit, Institute of Physiology, Medical University of Graz, Graz, Austria
| | - Andrew P Blaber
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Helmut Hinghofer-Szalkay
- Gravitational Physiology and Medicine Research Unit, Institute of Physiology, Medical University of Graz, Graz, Austria
| | - Jean-Pierre Montani
- Department of Medicine/Physiology, University of Fribourg, Fribourg, Switzerland
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Cieślik B, Podsiadły I, Kuczyński M, Ostrowska B. The effect of a single massage based on the tensegrity principle on postural stability in young women. J Back Musculoskelet Rehabil 2017; 30:1197-1202. [PMID: 29154264 DOI: 10.3233/bmr-140206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of normalized muscle tension via tensegrity-based massage on postural stability in a sample of female young adults. METHODS Nineteen females aged 21.8 ± 1.9 years were recruited presenting abnormal tension at muscles adhering to any of the following structural sites: superior iliac spine, lateral sacropelvic surface, linea aspera at 1/2 of femur length, and superior nuchal line of the occiput. Balance and postural control were assessed during bipedal stance using a force platform in multiple conditions: hard surface or soft foam surface with the head in either a neutral posture or tilted backward. Baseline and 3-min and 15-min post-treatment measures were collected while barefoot and eyes closed. Main outcomes measures included center of pressure variability, range, radius, and velocity in the anteroposterior (AP) mediolateral (ML) dimensions. RESULTS In the solid surface with neutral head posture condition only AP COP measures decreased significantly (p< 0.05). In the soft surface condition, significant differences were observed in the AP and ML dimensions among most measures (p< 0.05). CONCLUSIONS A single application of tensegrity-based massage positively influenced postural control in young adult females, particularly in the AP direction.
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Affiliation(s)
- Błażej Cieślik
- Institute of Physical Education, Tourism and Physiotherapy, Faculty of Pedagogy, Jan Długosz University, Czestochowa, Poland
| | - Ireneusz Podsiadły
- Department of Physiotherapy in Musculoskeletal Disorders, Faculty of Physiotherapy, The University of Physical Education, Wroclaw, Poland
| | - Michał Kuczyński
- Department of Physiotherapy in Musculoskeletal Disorders, Faculty of Physiotherapy, The University of Physical Education, Wroclaw, Poland
| | - Bożena Ostrowska
- Department of Physiotherapy in Musculoskeletal Disorders, Faculty of Physiotherapy, The University of Physical Education, Wroclaw, Poland
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O'Riordan S, Vasilakis N, Hussain L, Schoo R, Whitney J, Windsor J, Horton K, Martin F. Measurement of lying and standing blood pressure in hospital. Nurs Older People 2017; 29:20-26. [PMID: 29124913 DOI: 10.7748/nop.2017.e961] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2017] [Indexed: 06/07/2023]
Abstract
Measuring lying and standing blood pressure (BP) is an important clinical observation in older hospital inpatients. This is because a drop in BP on standing, known as orthostatic hypotension (OH) is common in older people and in acute illness and, therefore, in hospital patients. OH increases the risk of a fall in hospital. Simple measures such as changes in medication or rehydration can reduce this drop in BP and reduce the risk of falls. In a recent snapshot audit in England and Wales of 179 acute hospitals and 4,846 patients aged 65 years and over admitted with an acute illness, only 16% had a lying and standing BP recorded within 48 hours. A review of the literature showed that existing advice on how to measure and interpret lying and standing BP was often not appropriate for use on the ward with frail and unwell inpatients. An online survey of 275 clinicians' usual practice highlighted variation and the need for clarity and pragmatism. In the light of the survey findings, a clinical guide has been developed on when to measure lying and standing BP, how to measure it and what is considered a significant result.
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45
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Juraschek SP, Daya N, Rawlings AM, Appel LJ, Miller ER, Windham BG, Griswold ME, Heiss G, Selvin E. Association of History of Dizziness and Long-term Adverse Outcomes With Early vs Later Orthostatic Hypotension Assessment Times in Middle-aged Adults. JAMA Intern Med 2017; 177:1316-1323. [PMID: 28738139 PMCID: PMC5661881 DOI: 10.1001/jamainternmed.2017.2937] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Guidelines recommend assessing orthostatic hypotension (OH) 3 minutes after rising from supine to standing positions. It is not known whether measurements performed immediately after standing predict adverse events as strongly as measurements performed closer to 3 minutes. OBJECTIVE To compare early vs later OH measurements and their association with history of dizziness and longitudinal adverse outcomes. DESIGN, SETTING, AND PARTICIPANTS This was a prospective cohort study of middle-aged (range, 44-66 years) participants in the Atherosclerosis Risk in Communities Study (1987-1989). EXPOSURES Orthostatic hypotension, defined as a drop in blood pressure (BP) (systolic BP ≥20 mm Hg or diastolic BP ≥10 mm Hg) from the supine to standing position, was measured up to 5 times at 25-second intervals. MAIN OUTCOMES AND MEASURES We determined the association of each of the 5 OH measurements with history of dizziness on standing (logistic regression) and risk of fall, fracture, syncope, motor vehicle crashes, and all-cause mortality (Cox regression) over a median of 23 years of follow-up (through December 31, 2013). RESULTS In 11 429 participants (mean age, 54 years; 6220 [54%] were women; 2934 [26%] were black) with at least 4 OH measurements after standing, after adjustment OH assessed at measurement 1 (mean [SD], 28 [5.4] seconds; range, 21-62 seconds) was the only measurement associated with higher odds of dizziness (odds ratio [OR], 1.49; 95% CI, 1.18-1.89). Measurement 1 was associated with the highest rates of fracture, syncope, and death at 18.9, 17.0, and 31.4 per 1000 person-years. Measurement 2 was associated with the highest rate of falls and motor vehicle crashes at 13.2 and 2.5 per 1000 person-years. Furthermore, after adjustment measurement 1 was significantly associated with risk of fall (hazard ratio [HR], 1.22; 95% CI, 1.03-1.44), fracture (HR, 1.16; 95% CI, 1.01-1.34), syncope (HR, 1.40; 95% CI, 1.20-1.63), and mortality (HR, 1.36; 95% CI, 1.23-1.51). Measurement 2 (mean [SD], 53 [7.5] seconds; range, 43-83 seconds) was associated with all long-term outcomes, including motor vehicle crashes (HR, 1.43; 95% CI, 1.04-1.96). Measurements obtained after 1 minute were not associated with dizziness and were inconsistently associated with individual long-term outcomes. CONCLUSIONS AND RELEVANCE In contrast with prevailing recommendations, OH measurements performed within 1 minute of standing were the most strongly related to dizziness and individual adverse outcomes, suggesting that OH be assessed within 1 minute of standing.
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Affiliation(s)
- Stephen P Juraschek
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,The Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Natalie Daya
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,The Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Andreea M Rawlings
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,The Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Lawrence J Appel
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,The Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Edgar R Miller
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,The Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - B Gwen Windham
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Michael E Griswold
- Department of Medicine, University of Mississippi Medical Center, Jackson.,Center of Biostatistics, University of Mississippi Medical Center, Jackson
| | - Gerardo Heiss
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | - Elizabeth Selvin
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,The Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Johns Hopkins Medical Institutions, Baltimore, Maryland
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46
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Moein H, Wu A, Menon C. A Shape Memory Alloy-Based Compression Therapy Prototype Tested With Individuals in Seated Position. J Med Device 2017. [DOI: 10.1115/1.4037441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Orthostatic intolerance in patients can occur secondary to concomitant venous pooling and enhanced capillary filtration when standing upright, and is one of the principle causes of syncope or fainting. Compression therapy is commonly recommended for the management of syncope based on the assumption that it increases venous return. Technologies currently used include compression stockings, whose efficacy has, however, been challenged, and intermittent pneumatic pressure devices, which highly restrict the patients' mobility. This paper therefore investigates a novel active compression brace (ACB), which could potentially provide intermittent pressure while not restricting movements. The ACB, actuated by shape memory alloy (SMA) wires, in this work was tested with twelve healthy individuals in a seated position. The experimental observation showed that the ACB can apply a constant initial pressure to the leg similar to commercial compression stockings and also produce intermittent pressure exceeding 30 mmHg. A comparison between analytical and experimental results showed a maximum of 2.08 mmHg absolute averaged difference among all the participants. A correlation analysis showed that the normalized root-mean-square deviation (NRMSD) between the experimental and analytical results had a significant negative correlation with the estimated total calf circumference minus the calf fat cross-sectional area (CSA). A calibration formula, accounting for fat and circumference of the leg, was introduced to account for these two parameters. The comfort of the ACB was also compared to two other available compression devices using questionnaires. No participants reported discomfort in terms of pressure, skin irritation, or heat generated by the ACB.
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Affiliation(s)
- Hadi Moein
- Mem. ASME MENRVA Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Metro Vancouver, Burnaby, BC V5A-1S6, Canada e-mail:
| | - Alex Wu
- MENRVA Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Metro Vancouver, Burnaby, BC V5A-1S6, Canada e-mail:
| | - Carlo Menon
- Mem. ASME MENRVA Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Metro Vancouver, Burnaby, BC V5A-1S6, Canada e-mail:
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Abstract
Dizziness/vertigo, falls and syncope are among the most common reasons for seeking medical care. As clinical entities they share common pathogenetic and clinical features and differences. The diagnostic work-up can often be initiated in a general practitioner's or internist's practice and, if necessary, completed in an interdisciplinary emergency unit. Simple diagnostic tools can be used in an outpatient setting to obtain valuable diagnostic information. First and foremost, it is important to differentiate between prognostically favorable clinical events and potentially serious disease. In younger patients diagnostic procedures should primarily focus on potential structural cardiac disease and/or primary arrhythmia. The same applies to elderly patients in whom, however, multicausal clinical symptoms and severe complications in the case of falls are characteristic. Elderly patients frequently require the involvement of various clinical specialties to investigate a broad spectrum of potential differential diagnoses in an interdisciplinary diagnostic approach, which is not always available in practice. In the emergency unit, decisions regarding inpatient care need to be made individually. In elderly patients, inpatient care is sometimes necessary not only due to acute disease, but also in order to ensure social care. Geriatric day hospitals may be a suitable option for some of these patients.
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48
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Ong HL, Abdin E, Seow E, Pang S, Sagayadevan V, Chang S, Vaingankar JA, Chong SA, Subramaniam M. Prevalence and associative factors of orthostatic hypotension in older adults: Results from the Well-being of the Singapore Elderly (WiSE) study. Arch Gerontol Geriatr 2017. [PMID: 28647615 DOI: 10.1016/j.archger.2017.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Orthostatic hypotension (OH) is commonly reported among older adults and is associated with an increased risk of mortality. This study aimed to describe the prevalence and investigate the possible associations between OH with sociodemographic variables, chronic medical conditions, health service utilisation, dementia and cognitive status among older adults residing in Singapore. METHODS Data was collected from 2266 participants aged 60 years and older who participated in the Well-being of the Singapore Elderly (WiSE) study in 2013. Face-to-face interviews were conducted and data collected includes sociodemographic information, blood pressure measurements, medical history, health services utilisation, and cognitive status. RESULTS The prevalence of OH among older adults in Singapore was 7.8%. OH was highest in participants aged 85 years and above (OR: 2.33; 1.26-4.30; p=0.007) compared to those aged 75-84 years (OR: 1.76; 1.08-2.85; p=0.023). Participants with hypertension were more likely to have OH (OR: 3.03; 1.56-5.88, p=0.001) than those without hypertension. Those with dementia were also more likely to have OH than those with normal cognitive status (p=0.007). CONCLUSIONS Older age, hypertension, and dementia were independently associated with OH in the older adult population in Singapore. Interventions such as home safety assessment and preventive measures should be implemented to improve older adult's functional capacity and quality of life to prevent injury.
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Affiliation(s)
- Hui Lin Ong
- Research Division, Institute of Mental Health, Singapore
| | | | - Esmond Seow
- Research Division, Institute of Mental Health, Singapore
| | - Shirlene Pang
- Research Division, Institute of Mental Health, Singapore
| | | | - Sherilyn Chang
- Research Division, Institute of Mental Health, Singapore
| | | | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
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Logan A, Marsden J, Freeman J, Kent B. Effectiveness of non-pharmacological interventions in treating orthostatic hypotension in the elderly and people with a neurological condition: a systematic review protocol. ACTA ACUST UNITED AC 2017; 15:948-960. [DOI: 10.11124/jbisrir-2016-003027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Matuszak JM, McVige J, McPherson J, Willer B, Leddy J. A Practical Concussion Physical Examination Toolbox. Sports Health 2017; 8:260-269. [PMID: 27022058 PMCID: PMC4981071 DOI: 10.1177/1941738116641394] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CONTEXT With heightened awareness of concussion, there is a need to assess and manage the concussed patient in a consistent manner. Unfortunately, concussion physical examination has not been standardized or supported by evidence. Important questions remain about the physical examination. EVIDENCE ACQUISITION Review of ClinicalKey, Cochrane, MEDLINE, and PubMed prior to July 2015 was performed using search terms, including concussion, mTBI, physical examination, mental status, cranial nerves, reflexes, cervical, vestibular, and oculomotor. The references of the pertinent articles were reviewed for other relevant sources. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 3. RESULTS The pertinent physical examination elements for concussion include evaluation of cranial nerves, manual muscle testing, and deep tendon reflexes; inspecting the head and neck for trauma or tenderness and cervical range of motion; Spurling maneuver; a static or dynamic balance assessment; screening ocular examination; and a mental status examination that includes orientation, immediate and delayed recall, concentration, mood, affect, insight, and judgment. Other examination elements to consider, based on signs, symptoms, or clinical suspicion, include testing of upper motor neurons, cervical strength and proprioception, coordination, pupillary reactivity, and visual acuity; examination of the jaw, temporomandibular joint, and thoracic spine; fundoscopic evaluation; orthostatic vital signs; assessment of dynamic visual acuity; and screening for depression, anxiety, substance abuse disorders, and preinjury psychiatric difficulties. CONCLUSION Various elements of the physical examination, such as screening ocular examination, cervical musculoskeletal examination, static and/or dynamic balance assessment, and mental status examination, appear to have utility for evaluating concussion; however, data on validity are lacking.
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Affiliation(s)
| | | | | | - Barry Willer
- UBMD Orthopaedics and Sports Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, New York
| | - John Leddy
- UBMD Orthopaedics and Sports Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, New York
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