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Wieling W, Kaufmann H, Claydon VE, van Wijnen VK, Harms MPM, Juraschek SP, Thijs RD. Diagnosis and treatment of orthostatic hypotension. Lancet Neurol 2022; 21:735-746. [PMID: 35841911 PMCID: PMC10024337 DOI: 10.1016/s1474-4422(22)00169-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 01/24/2023]
Abstract
Orthostatic hypotension is an unusually large decrease in blood pressure on standing that increases the risk of adverse outcomes even when asymptomatic. Improvements in haemodynamic profiling with continuous blood pressure measurements have uncovered four major subtypes: initial orthostatic hypotension, delayed blood pressure recovery, classic orthostatic hypotension, and delayed orthostatic hypotension. Clinical presentations are varied and range from cognitive slowing with hypotensive unawareness or unexplained falls to classic presyncope and syncope. Establishing whether symptoms are due to orthostatic hypotension requires careful history taking, a thorough physical examination, and supine and upright blood pressure measurements. Management and prognosis vary according to the underlying cause, with the main distinction being whether orthostatic hypotension is neurogenic or non-neurogenic. Neurogenic orthostatic hypotension might be the earliest clinical manifestation of Parkinson's disease or related synucleinopathies, and often coincides with supine hypertension. The emerging variety of clinical presentations advocates a stepwise, individualised, and primarily non-pharmacological approach to the management of orthostatic hypotension. Such an approach could include the cessation of blood pressure lowering drugs, adoption of lifestyle measures (eg, counterpressure manoeuvres), and treatment with pharmacological agents in selected cases.
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Affiliation(s)
- Wouter Wieling
- Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Horacio Kaufmann
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Victoria E Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Veera K van Wijnen
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Mark P M Harms
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Stephen P Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Roland D Thijs
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands; UCL Queen Square Institute of Neurology, University College London, London, UK; Stichting Epilepsie Instellingen Nederland, Heemstede, Netherlands.
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Belaroussi Y, Roblot P, Peiffer-Smadja N, Delaye T, Mathoulin-Pelissier S, Lemeux J, Le Moal G, Caumes E, Roblot F, Bleibtreu A. Why Methodology Is Important: Coffee as a Candidate Treatment for COVID-19? J Clin Med 2020; 9:E3691. [PMID: 33213035 PMCID: PMC7698499 DOI: 10.3390/jcm9113691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/05/2020] [Accepted: 11/11/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND During this pandemic situation, some studies have led to hasty conclusions about Corona Virus Disease-19 (COVID-19) treatment, due to a lack of methodology. This pedagogic study aimed to highlight potential biases in research on COVID-19 treatment. METHODS We evaluate the effect of coffee's active part, 1,3,7-trimethylxanthine (TMX) on patients with COVID-19. A cohort of 93 patients, with a diagnosis of COVID-19 is analyzed. RESULTS TMX group and control group included, respectively, 26 and 67 patients. In the TMX group, patients had a median length of stay in hospital of 5.5 days shorter than in the control group (9.5 vs. 15 days, p < 0.05). Patients in the control group were more severe than patients in the TMX group with a significantly higher National Early Warning Score 2 (NEWS-2 score) (8 vs. 6, p = 0.002). CONCLUSIONS Multiple biases prevents us from concluding to an effect of coffee on COVID-19. Despite an important social pressure during this crisis, methodology and conscientiousness are the best way to avoid hasty conclusions that can be deleterious for patients. Identifier: NCT04395742.
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Affiliation(s)
- Yaniss Belaroussi
- INSERM, Bordeaux Population Health Research Center, ISPED, University of Bordeaux, 33000 Bordeaux, France; (Y.B.); (P.R.); (S.M.-P.); (J.L.)
- Department of Neurosurgery, Centre Hospitalier Universitaire de Bordeaux, 33000 Bordeaux, France
| | - Paul Roblot
- INSERM, Bordeaux Population Health Research Center, ISPED, University of Bordeaux, 33000 Bordeaux, France; (Y.B.); (P.R.); (S.M.-P.); (J.L.)
- Department of Neurosurgery, Centre Hospitalier Universitaire de Bordeaux, 33000 Bordeaux, France
| | - Nathan Peiffer-Smadja
- IAME, INSERM, Université de Paris, F-75006 Paris, France;
- Service de Maladies Infectieuses et Tropicales, AP-HP Hôpital Bichat, F-75018 Paris, France
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London SW7 2AZ, UK
| | - Thomas Delaye
- Service de Maladies Infectieuses et Tropicales, CHU Poitiers, 86000 Poitiers, France; (T.D.); (G.L.M.); (F.R.)
| | - Simone Mathoulin-Pelissier
- INSERM, Bordeaux Population Health Research Center, ISPED, University of Bordeaux, 33000 Bordeaux, France; (Y.B.); (P.R.); (S.M.-P.); (J.L.)
- INSERM CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonié, 33000 Bordeaux, France
| | - Joffrey Lemeux
- INSERM, Bordeaux Population Health Research Center, ISPED, University of Bordeaux, 33000 Bordeaux, France; (Y.B.); (P.R.); (S.M.-P.); (J.L.)
- Department of Neurosurgery, Centre Hospitalier Universitaire de Bordeaux, 33000 Bordeaux, France
| | - Gwenaël Le Moal
- Service de Maladies Infectieuses et Tropicales, CHU Poitiers, 86000 Poitiers, France; (T.D.); (G.L.M.); (F.R.)
- INSERM U1070, University of Poitiers, 86000 Poitiers, France
| | - Eric Caumes
- Assistance Publique—Hôpitaux de Paris, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Infectious Diseases Department, Pitié-Salpêtrière Hospital, 47–83 Boulevard de l’hôpital, 75013 Paris, France;
- INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Sorbonne University, 75013 Paris, France
- COVID SMIT PSL STUDY GROUP Infectious Diseases Department, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l’hôpital, 75013 Paris, France
| | - France Roblot
- Service de Maladies Infectieuses et Tropicales, CHU Poitiers, 86000 Poitiers, France; (T.D.); (G.L.M.); (F.R.)
- INSERM U1070, University of Poitiers, 86000 Poitiers, France
| | - Alexandre Bleibtreu
- Assistance Publique—Hôpitaux de Paris, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Infectious Diseases Department, Pitié-Salpêtrière Hospital, 47–83 Boulevard de l’hôpital, 75013 Paris, France;
- INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Sorbonne University, 75013 Paris, France
- COVID SMIT PSL STUDY GROUP Infectious Diseases Department, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l’hôpital, 75013 Paris, France
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