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Xiong Q, Li F, Chi H, Yang Y, Li M, Liu Y, Zhang Y, Leng B, Qi X, Sun H, Li Z, Zhang J. Orthostatic Hypotension Promotes the Progression From Mild Cognitive Impairment to Dementia in Type 2 Diabetes Mellitus. J Clin Endocrinol Metab 2024; 109:1454-1463. [PMID: 38165720 PMCID: PMC11099487 DOI: 10.1210/clinem/dgad764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/14/2023] [Accepted: 01/02/2024] [Indexed: 01/04/2024]
Abstract
CONTEXT In type 2 diabetes mellitus (T2DM), orthostatic hypotension (OH) is associated with cognition, but the mechanisms governing the link between OH and cognition are still unclear. OBJECTIVE We sought to analyze Alzheimer's disease (AD) biomarkers and the part of complement proteins in modulating the association of OH with cognitive impairment and examine whether OH could accelerate the clinical progression of mild cognitive impairment (MCI) to dementia in T2DM. METHODS We recruited patients with T2DM with MCI and collected general healthy information and blood samples. Complement proteins of astrocyte-derived exosomes were isolated and AD biomarkers of neuronal cell-derived exosomes isolated were quantified by enzyme-linked immunosorbent assay. Cognitive assessments were performed at patient enrollment and follow-up. RESULTS Mediation analysis showed that the influence of OH on cognition in T2DM was partly mediated by baseline AD biomarkers and complement proteins. Cox proportional-hazards regression proved the OH group had a higher risk of developing dementia compared to the T2DM without OH group. CONCLUSION In T2DM with MCI patients, AD biomarkers and complement proteins mediate the effects of OH on cognitive impairment and OH may be a risk factor of progression from MCI to dementia in T2DM.
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Affiliation(s)
- Qiao Xiong
- Department of Clinical Medicine, Weifang Medical University, Weifang, Shandong 261053, China
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong 264200, China
| | - Fang Li
- Department of Neurology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121017, China
| | - Haiyan Chi
- Department of Endocrinology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong 264200, China
| | - Yachao Yang
- Department of Endocrinology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong 264200, China
| | - Mengfan Li
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong 264200, China
| | - Yingxiao Liu
- Department of Endocrinology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong 264200, China
| | - Yupan Zhang
- Department of Endocrinology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong 264200, China
| | - Bing Leng
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong 264200, China
| | - Xiaoxiao Qi
- Department of Clinical Medicine, Weifang Medical University, Weifang, Shandong 261053, China
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong 264200, China
| | - Hairong Sun
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong 264200, China
| | - Zhenguang Li
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong 264200, China
| | - Jinbiao Zhang
- Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong 264200, China
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Iwański MA, Sokołowska A, Sokołowski A, Wojdyła R, Styczkiewicz K. The Prevalence of Orthostatic Hypotension in Cancer Patients. Cancers (Basel) 2024; 16:1541. [PMID: 38672623 PMCID: PMC11049507 DOI: 10.3390/cancers16081541] [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: 03/17/2024] [Revised: 04/13/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Orthostatic hypotension (OH) is associated with a higher risk of mortality in the general population; however, it has not been studied in the cancer population. This study aimed to assess the prevalence of OH in cancer patients compared to that in the noncancer population. METHODS A total of 411 patients (mean age 63.5 ± 10.6 years) were recruited: patients with active cancer (n = 223) and patients hospitalised for other reasons, but without a cancer diagnosis (n = 188). Medical histories were collected and an orthostatic challenge test was performed. OH was defined as a blood pressure (BP) decrease upon standing of ≥20 mmHg for the systolic or ≥10 mmHg for the diastolic BP after 1 or 3 min; or a systolic BP decrease <90 mmHg. RESULTS The prevalence of OH in the subjects with cancer was significantly higher than in the subjects without cancer (28.7% vs. 16.5%, respectively, p = 0.003). OH was the most common in the lung cancer patients (57.5%). In a single-variable analysis, the predictors of OH were cancer presence, age ≥ 65 years, and body mass index (BMI) ≥ 30 kg/m2. In the multivariable model, the strongest independent predictor of OH was cancer status, which doubled the risk of OH, and BMI ≥ 30 kg/m2 and diabetes. CONCLUSIONS Cancer patients are characterised by a high prevalence of OH. In this population, the recommendation of routine orthostatic challenge tests should be considered.
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Affiliation(s)
- Mateusz A. Iwański
- Institute of Medical Sciences, College of Medical Sciences, University of Rzeszow, 1a Warzywna St., 35-310 Rzeszow, Poland; (M.A.I.); (A.S.)
| | - Aldona Sokołowska
- Institute of Medical Sciences, College of Medical Sciences, University of Rzeszow, 1a Warzywna St., 35-310 Rzeszow, Poland; (M.A.I.); (A.S.)
| | - Andrzej Sokołowski
- Collegium Humanum, Warsaw Management University, 133A Aleje Jerozolimskie St., 02-304 Warsaw, Poland;
| | - Roman Wojdyła
- New Medical Techniques Specialist Hospital of the Holy Family, Rudna Mała 600, 36-060 Rzeszow, Poland;
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland
| | - Katarzyna Styczkiewicz
- Institute of Medical Sciences, College of Medical Sciences, University of Rzeszow, 1a Warzywna St., 35-310 Rzeszow, Poland; (M.A.I.); (A.S.)
- Subcarpathian Oncological Centre, Frederic Chopin University Clinical Hospital, 2 Fryderyka Szopena St., 35-055 Rzeszow, Poland
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Cheng HJ, Sun ZJ, Lu FH, Yang YC, Chang CJ, Wu JS. Functional status associated with postural dizziness, but not postural hypotension, in older adults: a community-based study. BMC Geriatr 2023; 23:383. [PMID: 37344784 DOI: 10.1186/s12877-023-04100-z] [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: 11/14/2022] [Accepted: 06/09/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Functional status, postural dizziness (PD), and postural hypotension (PH) were important issues in older adults. Only one study on the relationship for the three of them in female was without adjusting some important associated factors. This study was intended to investigate the association of PD and PH with functional status in older people of both genders. METHODS Based on a stratified randomized cluster sampling, 1361 subjects ≥ 65 years in the community were recruited from Tainan City, Taiwan, from 2000 to 2001. PH was defined as a decrease in systolic/diastolic blood pressure of ≥ 20/10 mm Hg after 1 or 2 min of standing. PD was defined by a positive response to dizziness-like symptoms after standing up from a supine position. Functional status included the activities of daily living (ADLs) and instrumental activities of daily living (IADLs). RESULTS After adjusting other variables, ADL disability (OR: 1.84, 95% CI: 1.35-2.51) and IADL disability (OR: 1.62, 95% CI: 1.21-2.17) were associated with PD, but not PH. In male and female subgroups, ADL disability (male OR: 1.70, 95% CI: 1.08-2.67; female OR 1.96, 95% CI: 1.26-3.07) was associated with PD. In male, IADL disability was associated with PD (OR: 2.32, 95% CI: 1.36-3.95). CONCLUSIONS Impaired functional status, shown using ADLs or IADLs, was positively associated with PD, but not PH in older adults ≥ 65 years. Clinically, it may be important to evaluate PD in older adults with ADL or IADL disability.
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Affiliation(s)
- Hsiang-Ju Cheng
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Zih-Jie Sun
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Family Medicine, National Cheng Kung University Hospital Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Feng-Hwa Lu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ching Yang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Jen Chang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Jin-Shang Wu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Department of Family Medicine, National Cheng Kung University Hospital Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin, Taiwan.
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Beretta MV, Milan VB, Hoffmeister MC, Rodrigues TC. Orthostatic hypotension, falls and in-hospital mortality among elderly patients with and without type 2 diabetes. J Hypertens 2023; 41:388-392. [PMID: 36728920 DOI: 10.1097/hjh.0000000000003338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To evaluate the association of falls and in-hospital mortality with the presence of orthostatic hypotension and type 2 diabetes mellitus (T2D). The study also aims to identify whether the orthostatic hypotension assessed at 1 min or at 3 min can predict falls and mortality, as a secondary objective to identify the predictors of fall during hospitalization. METHODS We performed a prospective study with patients admitted to a university hospital. The risk of falls was assessed using the Morse questionnaire and the presence of falls was verified by the patient's medical records during hospitalization. The orthostatic hypotension was determined by measuring blood pressure at three times, considering as orthostatic hypotension the reduction of at least 20 mmHg in SBP or 10 mmHg in DBP. In-hospital mortality was consulted in the medical records. RESULTS Patients with orthostatic hypotension were slower on Timed Up and Go test (TUG) (12.26 ± 3.16 vs. 16.08 ± 5.96 s, P = 20 s) and presence of orthostatic hypotension. After adjustments, patients with T2D and orthostatic hypotension had a 2.7 times greater risk of in-hospital falls and 1.54 times greater odds of in-hospital mortality when compared with patients without T2D and orthostatic hypotension. CONCLUSION In this sample, sedentary patients and those with lower TUG had a higher risk of falls. The prevalence of falls was higher in patients with T2D. The association of T2D with orthostatic hypotension significantly increased both the risk of falls and the risk of in-hospital mortality.
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Affiliation(s)
- Mileni V Beretta
- Internal Medicine Department, Postgraduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul
- Endocrine Division, Hospital de Clínicas de Porto Alegre
| | - Victoria B Milan
- Endocrine Division, Hospital de Clínicas de Porto Alegre
- Federal University of Medical Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Mariana C Hoffmeister
- Internal Medicine Department, Postgraduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul
| | - Ticiana C Rodrigues
- Internal Medicine Department, Postgraduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul
- Endocrine Division, Hospital de Clínicas de Porto Alegre
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Rasmussen TK, Finnerup NB, Singer W, Jensen TS, Hansen J, Terkelsen AJ. Preferential impairment of parasympathetic autonomic function in type 2 diabetes. Auton Neurosci 2022; 243:103026. [PMID: 36137485 DOI: 10.1016/j.autneu.2022.103026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 07/07/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Cardiovascular autonomic neuropathy is a known complication in type 2 diabetes (T2D). However, the extent of sympathetic dysfunction and its relation to blood pressure (BP) dysregulation is insufficiently studied. We therefore assessed the cardiovascular sympathetic function using a standardized autonomic test-battery. RESEARCH DESIGN AND METHODS Forty T2D patients (mean age and duration of diabetes ±SD, 65.5 ± 7.3 and 9.5 ± 4.2 years) and 40 age- and gender-matched controls were examined through autonomic testing, assessing cardiovascular responses to deep breathing, Valsalva maneuver and tilt-table testing. Additionally, 24-hour oscillometric BP and self-reported autonomic symptoms on COMPASS-31 questionnaire was recorded. RESULTS Patients with T2D had reduced parasympathetic activity with reduced deep breathing inspiratory:expiratory-ratio (median [IQR] T2D 1.11 [1.08-1.18] vs. controls 1.18 [1.11-1.25] (p = 0.01)), and reduced heart rate variability (p < 0.05). We found no differences in cardiovascular sympathetic function measured through BP responses during the Valsalva maneuver (p > 0.05). 24-hour-BP detected reduced night-time systolic BP drop in T2D (9.8 % ± 8.8 vs. controls 15.8 % ± 7.7 (p < 0.01)) with more patients having reverse dipping. Patients with T2D reported more symptoms of orthostatic intolerance on the COMPASS-31 (p = 0.04). CONCLUSIONS Patients with T2D showed reduced parasympathetic activity but preserved short-term cardiovascular sympathetic function, compared to controls, indicating autonomic dysfunction with predominantly parasympathetic impairment. Despite this, T2D patients reported more symptoms of orthostatic intolerance in COMPASS-31 and had reduced nocturnal BP dipping, indicating that these are not a consequence of cardiovascular sympathetic dysfunction.
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Affiliation(s)
- Thorsten K Rasmussen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark; International Diabetic Neuropathy Consortium (IDNC), Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Nanna B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark; International Diabetic Neuropathy Consortium (IDNC), Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Denmark
| | | | - Troels S Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark; International Diabetic Neuropathy Consortium (IDNC), Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - John Hansen
- Department of Health Science and Technology, Aalborg University, Denmark
| | - Astrid J Terkelsen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark; International Diabetic Neuropathy Consortium (IDNC), Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Denmark
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Rasmussen NH, Vestergaard P. Diabetes and osteoporosis - Treating two entities: A challenge or cause for concern? Best Pract Res Clin Rheumatol 2022; 36:101779. [PMID: 36154803 DOI: 10.1016/j.berh.2022.101779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
People with T1D and T2D have an increased risk of fractures than the general population, posing several significant pathophysiologic, diagnostic, and therapeutic challenges. The pathophysiology is still not fully elucidated, but it is considered a combination of increased skeletal fragility and falls. Diagnostics issues exist, as regular and even newer scan methods underestimate the true incidence of osteoporosis and thus the fracture risk. Therefore, co-managing diabetes and osteoporosis by using top-line strategies is essential to preserve bone health and minimize the risk of falls. The therapeutic focus should start with lifestyle implementation and physical exercise interventions to reduce diabetic complications, strengthen bones, and improve postural control strategies. In addition, osteoporosis should be treated according to current guidelines by including bisphosphonates and antidiabetic drugs that support bone health. Finally, potentially modifiable risk factors for falls should be managed.
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Affiliation(s)
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Denmark
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Idiaquez Rios JF, Lovblom LE, Perkins BA, Bril V. Orthostatic blood pressure changes and diabetes duration. J Diabetes Complications 2022; 36:108169. [PMID: 35307262 DOI: 10.1016/j.jdiacomp.2022.108169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
UNLABELLED To determine the prevalence and the associated clinical characteristics of orthostatic hypotension and orthostatic hypertension in patients with diabetic sensorimotor polyneuropathy (DSP). METHODS A single-center retrospective cross-sectional study was conducted on 200 DSP patients who had 3-minute orthostatic measures as part of the standard clinic evaluation. We measured the heart rate (HR) and blood pressure (BP) supine and again after 3 min of standing. RESULTS The prevalence of orthostatic hypotension was 19.5% and that of orthostatic hypertension was 23%. Subjects with orthostatic hypotension had significantly longer diabetes duration than subjects who were normotensive and those with orthostatic hypertension. Quantitatively, BP changes from supine to standing correlated with diabetes duration (R = 0.306; P = 0.0582) and age (R = 0.434; P = 0.006) in subjects with orthostatic hypotension. CONCLUSIONS Orthostatic hypertension and orthostatic hypotension are frequent in patients with DSP. Orthostatic hypertension is associated with shorter diabetes duration than orthostatic hypotension.
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Affiliation(s)
- Juan F Idiaquez Rios
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases University Health Network, University of Toronto, Canada
| | - Leif Erik Lovblom
- Division of Endocrinology, Department of Medicine, Leadership Sinai Centre for Diabetes, Sinai Health System, University of Toronto, Toronto, Canada; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Bruce A Perkins
- Division of Endocrinology, Department of Medicine, Leadership Sinai Centre for Diabetes, Sinai Health System, University of Toronto, Toronto, Canada
| | - Vera Bril
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases University Health Network, University of Toronto, Canada.
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Abstract
Falls are a common presenting complaint, particularly in older patients, and are associated with significant morbidity. Inpatient falls also have financial implications for healthcare systems, including litigation costs. This article provides an approach to assessing a patient presenting with a fall, encompassing the cause and consequence of the event. It also highlights the need to consider both the acute and chronic factors that predispose a particular patient to fall. Chronic factors such as frailty, sarcopenia, cognitive impairment, and continence issues are often under-recognised and, as a result, not managed optimally. A comprehensive geriatric assessment is an ideal structure to identify modifiable risks. Practical interventions that can be of benefit to minimise a patient's risk of falling include a medication review, assessment of their mobility and their environment. In addition, continence review and visual assessment may be appropriate.
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Affiliation(s)
- Anna N Barnard
- Department of Ageing and Health, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Daniel S Furmedge
- Department of Ageing and Health, Guy's and St Thomas NHS Foundation Trust, London, UK
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McDonagh STJ, Mejzner N, Clark CE. Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis. BMC FAMILY PRACTICE 2021; 22:1. [PMID: 33388038 PMCID: PMC7777418 DOI: 10.1186/s12875-020-01313-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 11/12/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Postural hypotension (PH), the reduction in blood pressure when rising from sitting or lying 0to standing, is a risk factor for falls, cognitive decline and mortality. However, it is not often tested for in primary care. PH prevalence varies according to definition, population, care setting and measurement method. The aim of this study was to determine the prevalence of PH across different care settings and disease subgroups. METHODS Systematic review, meta-analyses and meta-regression. We searched Medline and Embase to October 2019 for studies based in primary, community or institutional care settings reporting PH prevalence. Data and study level demographics were extracted independently by two reviewers. Pooled estimates for mean PH prevalence were compared between care settings and disease subgroups using random effects meta-analyses. Predictors of PH were explored using meta-regression. Quality assessment was undertaken using an adapted Newcastle-Ottawa Scale. RESULTS One thousand eight hundred sixteen studies were identified; 61 contributed to analyses. Pooled prevalences for PH using the consensus definition were 17% (95% CI, 14-20%; I2 = 99%) for 34 community cohorts, 19% (15-25%; I2 = 98%) for 23 primary care cohorts and 31% (15-50%; I2 = 0%) for 3 residential care or nursing homes cohorts (P = 0.16 between groups). By condition, prevalences were 20% (16-23%; I2 = 98%) with hypertension (20 cohorts), 21% (16-26%; I2 = 92%) with diabetes (4 cohorts), 25% (18-33%; I2 = 88%) with Parkinson's disease (7 cohorts) and 29% (25-33%, I2 = 0%) with dementia (3 cohorts), compared to 14% (12-17%, I2 = 99%) without these conditions (P < 0.01 between groups). Multivariable meta-regression modelling identified increasing age and diabetes as predictors of PH (P < 0.01, P = 0.13, respectively; R2 = 36%). PH prevalence was not affected by blood pressure measurement device (P = 0.65) or sitting or supine resting position (P = 0.24), however, when the definition of PH did not fulfil the consensus description, but fell within its parameters, prevalence was underestimated (P = 0.01) irrespective of study quality (P = 0.04). CONCLUSIONS PH prevalence in populations relevant to primary care is substantial and the definition of PH used is important. Our findings emphasise the importance of considering checking for PH, particularly in vulnerable populations, to enable interventions to manage it. These data should contribute to future guidelines relevant to the detection and treatment of PH. PROSPERO CRD42017075423.
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Affiliation(s)
- Sinead T J McDonagh
- Primary Care Research Group, University of Exeter Medical School, College of Medicine and Health, St Luke's Campus, Magdalen Road, Exeter, Devon, EX1 2LU, England.
| | - Natasha Mejzner
- Primary Care Research Group, University of Exeter Medical School, College of Medicine and Health, St Luke's Campus, Magdalen Road, Exeter, Devon, EX1 2LU, England
| | - Christopher E Clark
- Primary Care Research Group, University of Exeter Medical School, College of Medicine and Health, St Luke's Campus, Magdalen Road, Exeter, Devon, EX1 2LU, England
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Farrell MC, Shibao CA. Morbidity and mortality in orthostatic hypotension. Auton Neurosci 2020; 229:102717. [PMID: 32896712 DOI: 10.1016/j.autneu.2020.102717] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/27/2020] [Accepted: 08/07/2020] [Indexed: 02/07/2023]
Abstract
This review summarizes the current literature on the epidemiology of orthostatic hypotension (OH) in the elderly and in patients with autonomic impairment also known as neurogenic OH (nOH); these two conditions have distinct pathophysiologies and affect different patient populations. The prevalence of OH in the elderly varies depending on the study population. In community dwellers, OH prevalence is estimated at 16%, whereas in institutionalized patients, it may be as high as 60%. The prevalence of OH increases exponentially with age, particularly in those 75 years and older. Multiple epidemiological studies have identified OH as a risk factor for all-cause mortality and cardiovascular disease including heart failure and stroke. Real-world data from administrative databases found polypharmacy, multiple co-morbid conditions, and high health-care utilization as common characteristics in OH patients. A comprehensive evaluation of medications associated with OH is discussed with particular emphasis on the use of anti-hypertensive therapy from two large clinical trials on high-intensive versus standard blood pressure management. Finally, we also review the epidemiology of nOH based on the underlying neurodegenerative disorder (either Parkinson's disease or multiple system atrophy), and the presence of co-morbid conditions such as hypertension and cognitive impairment.
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Affiliation(s)
- Maureen C Farrell
- Drexel University College of Medicine, Philadelphia, PA, United States of America
| | - Cyndya A Shibao
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt Autonomic Dysfunction Center, Vanderbilt University Medical Center, Nashville, TN, United States of America.
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Saedon NI, Pin Tan M, Frith J. The Prevalence of Orthostatic Hypotension: A Systematic Review and Meta-Analysis. J Gerontol A Biol Sci Med Sci 2020; 75:117-122. [PMID: 30169579 PMCID: PMC6909901 DOI: 10.1093/gerona/gly188] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Orthostatic hypotension (OH) is associated with increased risk of falls, cognitive impairment and death, as well as a reduced quality of life. Although it is presumed to be common in older people, estimates of its prevalence vary widely. This study aims to address this by pooling the results of epidemiological studies. METHODS MEDLINE, EMBASE, PubMed, Web of Science, and ProQuest were searched. Studies were included if participants were more than 60 years, were set within the community or within long-term care and diagnosis was based on a postural drop in systolic blood pressure (BP) ≥20 mmHg or diastolic BP ≥10 mmHg. Data were extracted independently by two reviewers. Random and quality effects models were used for pooled analysis. RESULTS Of 23,090 identified records, 20 studies were included for community-dwelling older people (n = 24,967) and six were included for older people in long-term settings (n = 2,694). There was substantial variation in methods used to identify OH with differing supine rest duration, frequency and timing of standing BP, measurement device, use of standing and tilt-tables and interpretation of the diagnostic drop in BP. The pooled prevalence of OH in community-dwelling older people was 22.2% (95% CI = 17, 28) and 23.9% (95% CI = 18.2, 30.1) in long-term settings. There was significant heterogeneity in both pooled results (I2 > 90%). CONCLUSIONS OH is very common, affecting one in five community-dwelling older people and almost one in four older people in long-term care. There is great variability in methods used to identify OH.
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Affiliation(s)
- Nor I'zzati Saedon
- Ageing and Age-Associated Disorders Research Group, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - James Frith
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Falls and Syncope Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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West RK, Ravona-Springer R, Livny A, Heymann A, Shahar D, Leroith D, Preiss R, Zukran R, Silverman JM, Schnaider-Beeri M. Age Modulates the Association of Caffeine Intake With Cognition and With Gray Matter in Elderly Diabetics. J Gerontol A Biol Sci Med Sci 2020; 74:683-688. [PMID: 29982422 DOI: 10.1093/gerona/gly090] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The association between caffeine and cognitive performance has not been tested in older individuals with type 2 diabetes (T2D). Its association with brain volume in T2D has been tested only in animals. METHODS We examined the association of caffeine with cognitive function and brain volume in a sample of elderly diabetics participating in the Israel Diabetes and Cognitive Decline Study (n = 638) and the moderating effect of age on this association. In a subsample (n = 185) with magnetic resonance imaging, we also examined these associations with gray and white matter volumes (GM/WM). RESULTS Using linear regression adjusting for cognition-related covariates, we found that higher caffeine intake was associated with better function in overall cognition (p = .018), attention/working memory (p = .002), executive functioning (p = .047), and semantic categorization (p = .026). Interaction analyses of caffeine intake with age were significant for semantic categorization (p = .025), and approached significance for overall cognition (p = .066). This association was driven by the older group (above-median) for whom the association of caffeine intake with semantic categorization (p = .001), attention/working memory (p = .007), executive functioning (p = .005), and overall cognition (p = .002) were significant. In the magnetic resonance imaging subsample, there was an interaction (p = .034) of caffeine intake with age for GM volume; in the older group, higher caffeine intake was associated with greater GM volume (β = .198, p = .033). CONCLUSIONS Caffeine intake may have a beneficial role in cognitive functioning of elderly adults with T2D, which may be moderated by age. Greater GM volume may be a mechanism underlying the association of higher caffeine intake with better cognitive function.
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Affiliation(s)
- Rebecca K West
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ramit Ravona-Springer
- Sheba Medical Center, The Joseph Sagol Neuroscience Center, Tel Aviv University, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abigail Livny
- Sheba Medical Center, The Joseph Sagol Neuroscience Center, Tel Aviv University, Tel Aviv, Israel.,Sheba Medical Center, Diagnostic Imaging Department, affiliated to Sackler Facility of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Danit Shahar
- The S. Daniel Abraham International Center for Health and Nutrition, Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Derek Leroith
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rachel Preiss
- Sheba Medical Center, The Joseph Sagol Neuroscience Center, Tel Aviv University, Tel Aviv, Israel
| | - Ruth Zukran
- Sheba Medical Center, The Joseph Sagol Neuroscience Center, Tel Aviv University, Tel Aviv, Israel
| | - Jeremy M Silverman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,James J. Peters Veterans Affairs Medical Center, Bronx, NY
| | - Michal Schnaider-Beeri
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Sheba Medical Center, The Joseph Sagol Neuroscience Center, Tel Aviv University, Tel Aviv, Israel
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13
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Toledo RCD, Formiga CKMR, Ayres FM. Association between diabetes and vestibular dysfunction: an integrative review. REVISTA CEFAC 2020. [DOI: 10.1590/1982-0216/20202214719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Purpose: to identify, in the literature, the factors associated with the development of vestibular dysfunctions in individuals with type 2 diabetes mellitus (DM2). Methods: an integrative review of the literature, whose survey was conducted in the databases ISI, SciELO, LILACS and PubMed, using the following descriptors: “type 2 diabetes mellitus”, “vertigo”, “dizziness”, and “vestibular diseases". Articles published in the last 10 years that answered the research question (“What factors are associated with the development of vestibular disorders in individuals with DM2?”) were included in the study. Results: the search returned 426 articles, 10 of which met the eligibility criteria. Most of the participants of the selected studies who had vestibular dysfunctions were women over 40 years old and had more than one comorbidity related to DM2, the main one being the systemic arterial hypertension (SAH). According to the literature, the physiology of the inner ear allows small glucose alterations to influence its normal functioning, which makes diabetic individuals more susceptible to developing vestibular dysfunctions. Conclusion: according to this study, DM2 can trigger or contribute to the manifestation of vestibular dysfunction, whose main associated factors are advanced age, female gender, and various comorbidities, as dyslipidemia, SAH and metabolic syndrome.
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14
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Orthostatic hypotension is associated with new-onset atrial fibrillation: Systemic review and meta-analysis. Indian Heart J 2019; 71:320-327. [PMID: 31779860 PMCID: PMC6890958 DOI: 10.1016/j.ihj.2019.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/02/2019] [Accepted: 07/24/2019] [Indexed: 01/11/2023] Open
Abstract
Introduction Orthostatic hypotension (OH) is common among elderly patients. Its presence may herald severe underlying comorbidities and be associated with a higher risk of mortality. Interestingly, recent studies suggest that OH is associated with new-onset atrial fibrillation (AF). However, a systematic review and meta-analysis of the literature has not been performed. We assessed the association between AF and OH through a systematic review of the literature and a meta-analysis. Methods We comprehensively searched the databases of MEDLINE and EMBASE from inception to November 2018. Published prospective or retrospective cohort studies that compared new-onset AF between male patients with and without OH were included. Data from each study were combined using the random-effects, generic inverse-variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. Results Four studies from October 2010 to March 2018 were included in the meta-analysis involving 76,963 subjects (of which 3318 were diagnosed with OH). The presence of OH was associated with new-onset AF (pooled risk ratio 1.48; 95% confidence interval [1.21, 1.81], p?< 0.001; I2 = 69.4%). In hypertensive patients, analysis revealed an association between OH and the occurrence of new-onset AF (OR 1.46; 95% CI [1.27, 1.68], p < 0.001 with I2 = 0). Conclusions OH was associated with new-onset AF up to 1.5-fold compared with those subjects without OH. The interplay between OH and AF is likely bidirectional.
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15
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Safarpour M, Fotouhi A, Hosseini SR, Mohamadzade M, Bijani A. Predictors of Orthostatic Hypotension in the Elderly: Results from the Amirkola Health and Ageing Project (AHAP) Study. J Tehran Heart Cent 2019; 14:165-170. [PMID: 32461756 PMCID: PMC7231680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Orthostatic hypotension (OH) in the elderly is an important health challenge that poses a significant burden. We sought to determine the prevalence and correlates of OH in an elderly population-based study. Methods: This study was conducted within the framework of the Amirkola Health and Ageing Project (AHAP) on 1,588 elderly individuals aged ≥60 years. The baseline measurement was performed from April 2011 to July 2012. The relationships between OH (dependent variable) and age, sex, diabetes, hypertension, and cognitive status (independent variables) were investigated by logistic regression. Results: The mean age of the participants was 69.37±7.42 years (men: 69.96±7.68 y, women: 68.66±7.02 y). The prevalence of OH was 10.7%: 8.4% in the male and 13.7% in the female patients. In the final model, hypertension (OR=2.4, 95% CI: 1.6-3.7), diabetes (OR=1.3, 95% CI: 1.0-1.9), age (OR=2.9, 95% CI: 1.7-4.8), and female sex (female [OR=1.6, 95% CI: 1.1-2.3]) were significantly correlated with OH. Conclusion: The prevalence of OH in our elderly subjects increased with age. Additionally, the older participants with diabetes and hypertension had a higher likelihood of having this OH.
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Affiliation(s)
- Mehdi Safarpour
- Department of Disease Prevention and Control, Health Deputy, Babol University of Medical Sciences, Babol, Iran.
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Seyed Reza Hosseini
- Department of Community Medicine, School of Medicine, Babol University of Medical Sciences, Babol, Iran.,Corresponding Author: Seyed Reza Hosseini, Professor of Community Medicine, Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.47745-47176. Tel: +98 11-32190560. Fax: + 98 11-32199936. E-mail: .
| | - Masume Mohamadzade
- Department of Disease Prevention and Control, Health Deputy, Babol University of Medical Sciences, Babol, Iran.
| | - Ali Bijani
- Children’s Non-Communicable Diseases Research Center, Babol University of Medical Sciences, Babol, Iran.
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16
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Zhang J, Chi H, Wang T, Shen T, Wang H, Yuan X, Li Z. Effects of orthostatic hypotension on cognition in type 2 diabetes mellitus. Ann Neurol 2019; 86:754-761. [DOI: 10.1002/ana.25578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Jinbiao Zhang
- Department of NeurologyWeihai Municipal Hospital and Weihai Clinical School of Shandong University Weihai
| | - Haiyan Chi
- Department of EndocrinologyWeihai Municipal Hospital and Weihai Clinical School of Shandong University Weihai
| | - Tong Wang
- Department of NeurologyWeihai Municipal Hospital and Weihai Clinical School of Shandong University Weihai
| | - Tengqun Shen
- Department of NeurologyWeihai Municipal Hospital and Weihai Clinical School of Shandong University Weihai
| | - Haijing Wang
- Department of EndocrinologyWeihai Municipal Hospital and Weihai Clinical School of Shandong University Weihai
| | - Xiaoling Yuan
- Department of NeurologyLiaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University Liaocheng China
| | - Zhenguang Li
- Department of NeurologyWeihai Municipal Hospital and Weihai Clinical School of Shandong University Weihai
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17
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Abstract
PURPOSE OF REVIEW Based on a systematic literature search, we performed a comprehensive review of risk factors for falls and fractures in patients with diabetes. RECENT FINDINGS Patients with diabetes have an increased risk of fractures partly explained by increased bone fragility. Several risk factors as altered body composition including sarcopenia and obesity, impaired postural control, gait deficits, neuropathy, cardiovascular disease, and other co-morbidities are considered to increase the risk of falling. Diabetes and bone fragility is well studied, but new thresholds for fracture assessment should be considered. In general, the risk factors for falls in patients with diabetes are well documented in several studies. However, the fall mechanisms among diabetic patients have only been assessed in few studies. Thus, a gab of knowledge exits and may influence the current understanding and treatment, in order to reduce the risk of falling and thereby prevent fractures.
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Affiliation(s)
| | - Jakob Dal
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
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18
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Mol A, Bui Hoang PTS, Sharmin S, Reijnierse EM, van Wezel RJA, Meskers CGM, Maier AB. Orthostatic Hypotension and Falls in Older Adults: A Systematic Review and Meta-analysis. J Am Med Dir Assoc 2019; 20:589-597.e5. [PMID: 30583909 DOI: 10.1016/j.jamda.2018.11.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 11/02/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Orthostatic hypotension is a potential risk factor for falls in older adults, but existing evidence on this relationship is inconclusive. This study addresses the association between orthostatic hypotension and falls. DESIGN Systematic review and meta-analysis of the cross-sectional and longitudinal studies assessing the association between orthostatic hypotension and falls, as preregistered in the PROSPERO database (CRD42017060134). SETTING AND PARTICIPANTS A literature search was performed on February 20, 2017, in MEDLINE (from 1946), PubMed (from 1966), and EMBASE (from 1947) using the terms orthostatic hypotension, postural hypotension, and falls. References of included studies were screened for other eligible studies. Study selection was performed independently by 2 reviewers using the following inclusion criteria: published in English; mean/median age of the population ≥65 years; blood pressure measurement before and after postural change; and assessment of the association of orthostatic hypotension with falls. The following studies were excluded: conference abstracts, case reports, reviews, and editorials. Data extraction was performed independently by 2 reviewers. MEASURES Unadjusted odds ratios of the association between orthostatic hypotension and falls were used for pooling using a random effects model. Studies were rated as high, moderate, or low quality using the Newcastle-Ottawa Scale. RESULTS Out of 5646 studies, 63 studies (51,800 individuals) were included in the systematic review and 50 studies (49,164 individuals) in the meta-analysis. Out of 63 studies, 39 were cross-sectional and 24 were longitudinal. Orthostatic hypotension was positively associated with falls (odds ratio 1.73, 95% confidence interval 1.50-1.99). The result was independent of study population, study design, study quality, orthostatic hypotension definition, and blood pressure measurement method. CONCLUSIONS AND IMPLICATIONS Orthostatic hypotension is significantly positively associated with falls in older adults, underpinning the clinical relevance to test for an orthostatic blood pressure drop and highlighting the need to investigate orthostatic hypotension treatment to potentially reduce falls.
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Affiliation(s)
- Arjen Mol
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands; Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Faculty of Science, Nijmegen, the Netherlands
| | - Phuong Thanh Silvie Bui Hoang
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, City Campus, Parkville, Melbourne, Victoria, Australia
| | - Sifat Sharmin
- Melbourne Academic Centre for Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Melbourne, Victoria, Australia
| | - Esmee M Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, City Campus, Parkville, Melbourne, Victoria, Australia
| | - Richard J A van Wezel
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Faculty of Science, Nijmegen, the Netherlands; Department of Biomedical Signals and Systems, Technical Medical Centre, University of Twente, Zuidhorst Building, Enschede, the Netherlands
| | - Carel G M Meskers
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands; Department of Rehabilitation Medicine, Amsterdam UMC, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands; Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, City Campus, Parkville, Melbourne, Victoria, Australia.
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19
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Ostroumova OD, Cherniaeva MS, Petrova MM, Golovina OV. Orthostatic Hypotension: Definition, Pathophysiology, Classification, Prognostic Aspects, Diagnostics and Treatment. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2018. [DOI: 10.20996/1819-6446-2018-14-5-747-756] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- O. D. Ostroumova
- A.I. Evdokimov Moscow State University of Medicine and Dentistry; I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - M. S. Cherniaeva
- Central State Medical Academy of Administrative Department of the President of the Russian Federation
| | - M. M. Petrova
- Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky
| | - O. V. Golovina
- Russian Medical Academy of Continuous Professional Education
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20
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Safarpour M, Hosseini SR, Mohamadzade M, Bijani A, Fotouhi A. Predictors of Incidence of Fall in Elderly Women; A Six-Month Cohort Study. Bull Emerg Trauma 2018; 6:226-232. [PMID: 30090818 PMCID: PMC6078482 DOI: 10.29252/beat-060307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: To determine the incidence and predictive factors of the falls in elderly women in Northern Iran. Methods: A total of 717 elderly women aged 60 years and above in Amirkola, Northern of Iran participated in this study. Age, history of falls during the 12 months leading to the study, accompanying diseases, status of balance, cognitive status, orthostatic hypotension, state of depressive symptoms, strength of quadriceps muscles and serum vitamin D level were assessed as independent variables during baseline measurement. Incidence of fall (dependent variable) was recorded during a six-month follow-up period. Results: Of the participants, 7.8% had experience of fall, out of which 50.0% experienced it once, 25.0% twice, and the rest three times or more. With aging, the incidence of orthostatic hypotension also increased and symptomatic depression became aggravated. In the final model, the variables of the number of accompanying diseases (RR=1.78, 95% CI: 1.00-3.18), severe cognitive impairment (RR=12.70, 95% CI: 3.05-52.86), and depressive symptoms (RR=3.19, 95% CI: 1.48-6.86) remained as strong associated variables for incidence of fall. Conclusion: With increasing severity of depressive symptoms and cognitive impairment along with the comorbidities, incidence of fall also increases in the elderly. Thus, psychological aspects of the elderly and comorbidities in this group should be taken care of seriously.
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Affiliation(s)
- Mehdi Safarpour
- Health Deputy, Babol University of Medical Sciences, Babol, Iran
| | - Seyed Reza Hosseini
- Department of Community Medicine, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | | | - Ali Bijani
- Children's Non-Communicable Diseases Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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21
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22
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Juraschek SP, Daya N, Appel LJ, Miller ER, McEvoy JW, Matsushita K, Ballantyne CM, Selvin E. Orthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle-Aged Adults. J Am Heart Assoc 2018; 7:JAHA.118.008884. [PMID: 29735525 PMCID: PMC6015335 DOI: 10.1161/jaha.118.008884] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Although orthostatic hypotension (OH) is a well‐recognized manifestation of neuropathy and hypovolemia, its contribution to cardiovascular disease (CVD) risk is controversial. Methods and Results Participants with OH, defined as a decrease in blood pressure (systolic ≥20 mm Hg or diastolic ≥10 mm Hg) from the supine to standing position, were identified during the first visit of the ARIC (Atherosclerosis Risk in Communities) Study (1987–1989) within 2 minutes of standing. All participants were followed up for the development of myocardial infarction, heart failure, stroke, fatal coronary heart disease (CHD), any CHD (combination of silent, nonfatal, and fatal CHD or cardiac procedures), and all‐cause mortality. Participants were assessed for carotid intimal thickness and plaque during the first visit. Detectable high‐sensitivity troponin T (≥5 ng/L) and elevated NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide; ≥100 pg/mL) were determined in blood collected during the second visit (1990–1992). All associations were adjusted for known CVD risk factors. In 9139 participants (57% women; 23% black; mean age, 54±5.7 years), 3% had OH. During follow‐up (median, 26 years), OH was associated with myocardial infarction (hazard ratio [HR], 1.88; 95% confidence interval [CI], 1.44–2.46), congestive heart failure (HR, 1.65; 95% CI, 1.34–2.04), stroke (HR, 1.83; 95% CI, 1.35–2.48), fatal CHD (HR, 2.77; 95% CI, 1.93–3.98), any CHD (HR, 2.00; 95% CI, 1.64–2.44), and all‐cause mortality (HR, 1.68; 95% CI, 1.45–1.95). OH was also associated with carotid intimal thickness (β, 0.05 mm; 95% CI, 0.04–0.07 mm), carotid plaque (odds ratio, 1.51; 95% CI, 1.18–1.93), detectable high‐sensitivity troponin T (odds ratio, 1.49; 95% CI, 1.16–1.93), and elevated NT‐proBNP (odds ratio, 1.92; 95% CI, 1.48–2.49). Conclusions OH identified in community‐dwelling middle‐aged adults was associated with future CVD events and subclinical CVD. Further research is necessary to establish a causal role for OH in the pathogenesis of CVD.
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Affiliation(s)
- Stephen P Juraschek
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA .,Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,The Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD.,Johns Hopkins Medical Institutions, Baltimore, MD
| | - Natalie Daya
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Johns Hopkins Medical Institutions, Baltimore, MD
| | - Lawrence J Appel
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Johns Hopkins Medical Institutions, Baltimore, MD
| | - Edgar R Miller
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Johns Hopkins Medical Institutions, Baltimore, MD
| | - John William McEvoy
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Johns Hopkins Medical Institutions, Baltimore, MD
| | - Kunihiro Matsushita
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Johns Hopkins Medical Institutions, Baltimore, MD
| | - Christie M Ballantyne
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX.,Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
| | - Elizabeth Selvin
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Johns Hopkins Medical Institutions, Baltimore, MD
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23
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Chisholm P, Anpalahan M. Orthostatic hypotension: pathophysiology, assessment, treatment and the paradox of supine hypertension. Intern Med J 2017; 47:370-379. [PMID: 27389479 DOI: 10.1111/imj.13171] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/12/2016] [Accepted: 06/27/2016] [Indexed: 12/11/2022]
Abstract
Both hypertension and orthostatic hypotension (OH) are strongly age-associated and are common management problems in older people. However, unlike hypertension, management of OH has unique challenges with few well-established treatments. Not infrequently, they both coexist, further compounding the management. This review provides comprehensive information on OH, including pathophysiology, diagnostic workup and treatment, with a view to provide a practical guide to its management. Special references are made to patients with supine hypertension and postprandial hypotension and older hypertensive patients.
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Affiliation(s)
- Peter Chisholm
- Eastern Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mahesan Anpalahan
- Eastern Health, The University of Melbourne, Melbourne, Victoria, Australia.,North West Academic Centre, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
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25
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Zhou Y, Ke SJ, Qiu XP, Liu LB. Prevalence, risk factors, and prognosis of orthostatic hypotension in diabetic patients: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e8004. [PMID: 28885363 PMCID: PMC6392609 DOI: 10.1097/md.0000000000008004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Orthostatic hypotension (OH) is a major clinical sign of cardiovascular autonomic dysfunction in diabetic patients. Our aim was to quantitatively evaluate the prevalence and risk factors of OH in patients with diabetes mellitus (DM) and assess its prognosis. METHODS A comprehensive search of the PubMed, Embase, China National Knowledge Infrastructure, VIP Chinese Journal, Wanfang, and SINOMED databases was conducted for related published work up to September 25, 2016, and manually searched eligible studies from the references in accordance with the inclusion criteria. RESULTS We included 21 studies in the analysis, with a total sample size of 13,772. The pooled prevalence of OH in DM was 24% (95% confidence interval [CI]: 19-28%). Potential risk factors, that is, glycosylated hemoglobin A (HbA1c) (odds ratio [OR], 1.13, 95% CI, 1.07-1.20), hypertension (OR, 1.02, 95% CI, 1.01-1.02), and diabetic nephropathy (OR, 2.37, 95% CI, 1.76-3.19), were significantly associated with OH in DM. In addition, the prognosis of OH in DM was associated with higher risk of total mortality and cardiovascular events. CONCLUSION The pooled prevalence of OH in DM appears high. HbA1c, hypertension, and diabetic nephropathy are risk factors for OH in DM. OH indicates poor prognosis in diabetic patients. Attention should be focused on diabetic patients with the stated risk factors to prevent OH.
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26
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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: 76] [Impact Index Per Article: 10.9] [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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Hartog L, Cimzar-Sweelssen M, Knipscheer A, Groenier K, Kleefstra N, Bilo H, van Hateren K. Orthostatic hypotension does not predict recurrent falling in a nursing home population. Arch Gerontol Geriatr 2017; 68:39-43. [DOI: 10.1016/j.archger.2016.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/26/2016] [Accepted: 08/31/2016] [Indexed: 11/30/2022]
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Implications of Orthostatic Hypotension in Older Persons With and Without Diabetes. J Am Med Dir Assoc 2016; 18:84-85. [PMID: 27876479 DOI: 10.1016/j.jamda.2016.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 10/11/2016] [Accepted: 10/11/2016] [Indexed: 11/20/2022]
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29
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de Baat C, de Baat P, Gerritsen AE, Flohil KA, van der Putten GJ, van der Maarel-Wierink CD. Risks, consequences, and prevention of falls of older people in oral healthcare centers. SPECIAL CARE IN DENTISTRY 2016; 37:71-77. [DOI: 10.1111/scd.12212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Cees de Baat
- Flemish-Netherlands Geriatric Oral Research Group BENECOMO; Ghent Belgium/Nijmegen The Netherlands
- Department of Oral Function and Prosthetic Dentistry; Radboud university medical center; Nijmegen The Netherlands
| | - Paul de Baat
- Department of Orthopaedic Surgery; Catharina Hospital; Eindhoven The Netherlands
| | - Anneloes E. Gerritsen
- Department of Oral Function and Prosthetic Dentistry; Radboud university medical center; Nijmegen The Netherlands
| | | | - Gert-Jan van der Putten
- Flemish-Netherlands Geriatric Oral Research Group BENECOMO; Ghent Belgium/Nijmegen The Netherlands
- Department of Oral Function and Prosthetic Dentistry; Radboud university medical center; Nijmegen The Netherlands
- Amaris Gooizicht; Hilversum The Netherlands
| | - Claar D. van der Maarel-Wierink
- Flemish-Netherlands Geriatric Oral Research Group BENECOMO; Ghent Belgium/Nijmegen The Netherlands
- Centre for Special Care in Dentistry; Amsterdam The Netherlands
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30
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Orthostatic hypotension and drug therapy in patients at an outpatient comprehensive geriatric assessment unit. J Hypertens 2016; 34:351-8. [PMID: 26599221 DOI: 10.1097/hjh.0000000000000781] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the rate of orthostatic hypotension and factors associated with it among elderly patients who underwent a comprehensive, ambulatory geriatric assessment. METHODS The study included patients 65 years and older who were assessed in the outpatient comprehensive geriatric assessment unit. Data were collected from the computerized medical record including sociodemographic data, lifestyle, falls, blood pressure, BMI, functional and cognitive status, medications, and comorbidity. RESULTS The study population consisted of 571 patients who underwent assessment over a nine-year period. The mean age was 83.7 ± 6.1, 35.9% were men, and 183 (32.1%) were diagnosed with orthostatic hypotension. Multiple drugs, in general, and multiple drugs with the potential to cause orthostatic hypotension in particular increased the risk for orthostatic hypotension after adjustment for age, sex, chronic comorbidity, and supine systolic blood pressure ≥150 mmHg [odds ratio (OR) = 1.09, 95% confidence interval (CI): 1.03-1.14 and OR = 1.22, 95% CI: 1.08-1.37, respectively]. In addition, α-blockers and calcium channel blockers increased the risk for orthostatic hypotension after similar adjustments (OR = 1.82, 95% CI: 1.01-3.16 and OR = 1.66, 95% CI: 1.11-2.48, respectively). Similarly, two additional drug types increased the risk for orthostatic hypotension: selective serotonin reuptake inhibitors (OR = 2.09, 95% CI: 1.33-3.19) and tricyclic antidepressants (OR = 4.36, 95% CI: 1.85-10.06). There were no specific associations between age, cognitive and functional state, morbidity (as measured by the Charlson Comorbidity Index), and specific diseases, and orthostatic hypotension. CONCLUSION The results of the present study reinforce evidence of an association between drug therapy and orthostatic hypotension.
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Costa A, Bosone D, Ramusino MC, Ghiotto N, Guaschino E, Zoppi A, D'Angelo A, Fogari R. Twenty-four-hour blood pressure profile, orthostatic hypotension, and cardiac dysautonomia in elderly type 2 diabetic hypertensive patients. Clin Auton Res 2016; 26:433-439. [PMID: 27624333 DOI: 10.1007/s10286-016-0381-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/24/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to evaluate the relationship between orthostatic hypotension (OH), defined as a decrease in systolic blood pressure (SBP) ≥20 mmHg and/or a decrease in diastolic blood pressure (DBP) ≥10 mmHg, and 24-h ambulatory BP profile in elderly hypertensive type 2 diabetic patients. METHODS After a 2-week antihypertensive wash-out period, 200 hypertensive well-controlled diabetic outpatients, aged 65-75 years, underwent a clinical examination, including BP measurements, ECG, 24-h ABP monitoring (ABPM), an orthostatic test, and three tests for cardiovascular autonomic function assessment [deep breathing, heart rate (HR) variability, resting HR]. RESULTS According to their nighttime BP profile, patients were divided into three groups: dippers (n = 86) (BP fall during nighttime ≥10 %), non-dippers (n = 80) (BP fall during nighttime 0-10 %), and reverse dippers (n = 34) (nighttime BP > daytime BP). Orthostatic test produced a significantly greater orthostatic SBP fall in dippers and even more in reverse dippers. In these latter, a significant fall was observed also in DBP. Prevalence of OH was 9.3 % in dippers, 30 % in non-dippers, and 79.4 % in reverse dippers. CONCLUSIONS In elderly hypertensive type 2 diabetics, a blunted nocturnal BP fall is associated with OH and autonomic dysfunction. These data suggest that ABPM should be performed in the assessment of hypertensive diabetic patients in whom the cardiovascular dysautonomia is suspected or the signs of it are present (such as OH).
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Affiliation(s)
- Alfredo Costa
- Department of Neurosciences and Behavior, National Institute of Neurology IRCCS C. Mondino Foundation, University of Pavia, Via Mondino, 2, 27100, Pavia, Italy
| | - Daniele Bosone
- Department of Neurosciences and Behavior, National Institute of Neurology IRCCS C. Mondino Foundation, University of Pavia, Via Mondino, 2, 27100, Pavia, Italy
| | - Matteo Cotta Ramusino
- Department of Neurosciences and Behavior, National Institute of Neurology IRCCS C. Mondino Foundation, University of Pavia, Via Mondino, 2, 27100, Pavia, Italy
| | - Natascia Ghiotto
- Department of Neurosciences and Behavior, National Institute of Neurology IRCCS C. Mondino Foundation, University of Pavia, Via Mondino, 2, 27100, Pavia, Italy
| | - Elena Guaschino
- Department of Neurosciences and Behavior, National Institute of Neurology IRCCS C. Mondino Foundation, University of Pavia, Via Mondino, 2, 27100, Pavia, Italy
| | - Annalisa Zoppi
- Department of Neurosciences and Behavior, National Institute of Neurology IRCCS C. Mondino Foundation, University of Pavia, Via Mondino, 2, 27100, Pavia, Italy
| | - Angela D'Angelo
- Department of Neurosciences and Behavior, National Institute of Neurology IRCCS C. Mondino Foundation, University of Pavia, Via Mondino, 2, 27100, Pavia, Italy
| | - Roberto Fogari
- Department of Neurosciences and Behavior, National Institute of Neurology IRCCS C. Mondino Foundation, University of Pavia, Via Mondino, 2, 27100, Pavia, Italy.
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Steffel J, Giugliano RP, Braunwald E, Murphy SA, Mercuri M, Choi Y, Aylward P, White H, Zamorano JL, Antman EM, Ruff CT. Edoxaban Versus Warfarin in Atrial Fibrillation Patients at Risk of Falling. J Am Coll Cardiol 2016; 68:1169-1178. [DOI: 10.1016/j.jacc.2016.06.034] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/02/2016] [Accepted: 06/08/2016] [Indexed: 10/21/2022]
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33
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Falls and Balance Impairments in Older Adults with Type 2 Diabetes: Thinking Beyond Diabetic Peripheral Neuropathy. Can J Diabetes 2016; 40:6-9. [DOI: 10.1016/j.jcjd.2015.08.005] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/05/2015] [Accepted: 08/06/2015] [Indexed: 02/07/2023]
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35
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Hile ES. Imbalance and Falls in Older Cancer Survivors. TOPICS IN GERIATRIC REHABILITATION 2015. [DOI: 10.1097/tgr.0000000000000079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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36
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The association between orthostatic hypotension, falling and successful rehabilitation in a nursing home population. Arch Gerontol Geriatr 2015; 61:190-6. [PMID: 26026216 DOI: 10.1016/j.archger.2015.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/07/2015] [Accepted: 05/08/2015] [Indexed: 11/23/2022]
Abstract
PURPOSE OF THE STUDY Our objectives were to identify the prevalence of orthostatic hypotension (OH) in frail, elderly nursing home residents, and assess its possible association with falling and chances of successful rehabilitation. MATERIALS AND METHODS A prospective observational cohort study. A total of 290 patients participated in this study, of which 128 were admitted to the rehabilitation department. OH was defined as a drop in systolic blood pressure of >20mmHg and diastolic blood pressure of >10mmHg after postural change within 3min. The analyses regarding falling and successful rehabilitation were only performed in the rehabilitation group. Multivariate binary logistic regression analyses were used to describe risk factors related with falling. Cox proportional hazard modeling was used to investigate the relation between OH and the time to successful rehabilitation. RESULTS The prevalence of OH in the studied nursing home population was 36.6% (95% CI (confidence interval): 31.1-42.1%). The prevalence varied from 28.6% (95% CI: 16.8-40.4%) in somatic patients, 36.7% (95% CI: 28.4-45.1%) in rehabilitation patients, to 40.6% (95% CI: 31.3-50.0%) in psychogeriatric patients. The association between orthostatic hypotension and previous falling was not significant; Odds ratio 0.66 (95% CI: 0.30-1.48). The Hazard ratio of the relationship between OH and successful rehabilitation was 2.88 (95% CI:1.77-4.69). CONCLUSIONS OH is highly prevalent in nursing home residents. Surprisingly, patients with OH were found to have a higher chance of successful rehabilitation compared to patients without OH. If confirmed in other studies, these results may change our view of the implications of OH.
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37
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Alagiakrishnan K. Current Pharmacological Management of Hypotensive Syndromes in the Elderly. Drugs Aging 2015; 32:337-48. [DOI: 10.1007/s40266-015-0263-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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38
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Stotz A, Rapp K, Oksa J, Skelton DA, Beyer N, Klenk J, Becker C, Lindemann U. Effect of a brief heat exposure on blood pressure and physical performance of older women living in the community-a pilot-study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:12623-31. [PMID: 25489997 PMCID: PMC4276636 DOI: 10.3390/ijerph111212623] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 11/17/2014] [Accepted: 11/28/2014] [Indexed: 11/16/2022]
Abstract
Global climate change is affecting health and mortality, particularly in vulnerable populations. High ambient temperatures decrease blood pressure (BP) in young and middle aged adults and may lead to orthostatic hypotension, increasing the risk of falls in older adults. The aim of this study was to evaluate the feasibility of a test protocol to investigate BP response and aerobic capacity of older adults in a hot indoor environment. BP response and aerobic capacity were assessed in 26 community-dwelling older women (median age 75.5 years) at a room temperature of either 20 °C or 30 °C. The protocol was well tolerated by all participants. In the 30 °C condition systolic and diastolic BP (median difference 10 and 8 mmHg, respectively) and distance walked in 6 min (median difference 29.3 m) were lower than in the 20 °C condition (all p < 0.01). Systolic BP decreased after standing up from a lying position in the 30 °C (17.4 mmHg) and 20 °C (14.2 mmHg) condition (both p < 0.001). In conclusion, the protocol is feasible in this cohort and should be repeated in older adults with poor physical performance and impaired cardio-vascular response mechanisms. Furthermore, aerobic capacity was reduced after exposure to hot environmental temperatures, which should be considered when recommending exercise to older people during the summer months.
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Affiliation(s)
- Anja Stotz
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, 70376 Stuttgart, Germany.
| | - Kilian Rapp
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, 70376 Stuttgart, Germany.
| | - Juha Oksa
- Physical Work Capacity Team, Finnish Institute of Occupational Health, 90220 Oulu, Finland.
| | - Dawn A Skelton
- Institute of Applied Health Research, Glasgow Caledonian University, Scotland, G4 0BA, UK.
| | - Nina Beyer
- Musculoskeletal Rehabilitation Research Unit, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, 2400 NV Copenhagen, Denmark.
| | - Jochen Klenk
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, 70376 Stuttgart, Germany.
| | - Clemens Becker
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, 70376 Stuttgart, Germany.
| | - Ulrich Lindemann
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, 70376 Stuttgart, Germany.
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Pasma JH, Bijlsma AY, Klip JM, Stijntjes M, Blauw GJ, Muller M, Meskers CGM, Maier AB. Blood pressure associates with standing balance in elderly outpatients. PLoS One 2014; 9:e106808. [PMID: 25222275 PMCID: PMC4164445 DOI: 10.1371/journal.pone.0106808] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 08/05/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Assessment of the association of blood pressure measurements in supine and standing position after a postural change, as a proxy for blood pressure regulation, with standing balance in a clinically relevant cohort of elderly, is of special interest as blood pressure may be important to identify patients at risk of having impaired standing balance in routine geriatric assessment. MATERIALS AND METHODS In a cross-sectional cohort study, 197 community-dwelling elderly referred to a geriatric outpatient clinic of a middle-sized teaching hospital were included. Blood pressure was measured intermittently (n = 197) and continuously (subsample, n = 58) before and after a controlled postural change from supine to standing position. The ability to maintain standing balance was assessed during ten seconds of side-by-side, semi-tandem and tandem stance, with both eyes open and eyes closed. Self-reported impaired standing balance and history of falls were recorded by questionnaires. Logistic regression analyses were used to examine the association between blood pressure and 1) the ability to maintain standing balance; 2) self-reported impaired standing balance; and 3) history of falls, adjusted for age and sex. RESULTS Blood pressure decrease after postural change, measured continuously, was associated with reduced ability to maintain standing balance in semi-tandem stance with eyes closed and with increased self-reported impaired standing balance and falls. Presence of orthostatic hypotension was associated with reduced ability to maintain standing balance in semi-tandem stance with eyes closed for both intermittent and continuous measurements and with increased self-reported impaired standing balance for continuous measurements. CONCLUSION Continuous blood pressure measurements are of additional value to identify patients at risk of having impaired standing balance and may therefore be useful in routine geriatric care.
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Affiliation(s)
- Jantsje H. Pasma
- Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Astrid Y. Bijlsma
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Section of Gerontology and Geriatrics, VU University Medical Center, Amsterdam, The Netherlands
| | - Janneke M. Klip
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Marjon Stijntjes
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Section of Gerontology and Geriatrics, VU University Medical Center, Amsterdam, The Netherlands
| | - Gerard Jan Blauw
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Geriatrics, Bronovo Hospital, The Hague, The Netherlands
| | - Majon Muller
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Carel G. M. Meskers
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Andrea B. Maier
- Department of Internal Medicine, Section of Gerontology and Geriatrics, VU University Medical Center, Amsterdam, The Netherlands
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de Waard EAC, van Geel TACM, Savelberg HHCM, Koster A, Geusens PPMM, van den Bergh JPW. Increased fracture risk in patients with type 2 diabetes mellitus: an overview of the underlying mechanisms and the usefulness of imaging modalities and fracture risk assessment tools. Maturitas 2014; 79:265-74. [PMID: 25192916 DOI: 10.1016/j.maturitas.2014.08.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 08/06/2014] [Indexed: 12/11/2022]
Abstract
Type 2 diabetes mellitus has recently been linked to an increased fracture risk. Since bone mass seems to be normal to elevated in patient with type 2 diabetes, the increased fracture risk is thought to be due to both an increased falling frequency and decreased bone quality. The increased falling frequency is mainly a result of complications of the disease such as a retinopathy and polyneuropathy. Bone quality is affected through changes in bone shape, bone micro-architecture, and in material properties such as bone mineralization and the quality of collagen. Commonly used methods for predicting fracture risk such as dual energy X-ray absorptiometry and fracture risk assessment tools are helpful in patients with type 2 diabetes mellitus, but underestimate the absolute fracture risk for a given score. New imaging modalities such as high resolution peripheral quantitative computed tomography are promising for giving insight in the complex etiology underlying the fragility of the diabetic bone, as they can give more insight into the microarchitecture and geometry of the bone. We present an overview of the contributing mechanisms to the increased fracture risk and the usefulness of imaging modalities and risk assessment tools in predicting fracture risk in patients with type 2 diabetes.
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Affiliation(s)
- Ellis A C de Waard
- Maastricht University Medical Centre/NUTRIM, Department of Internal Medicine, Subdivision of Rheumatology, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - Tineke A C M van Geel
- Maastricht University/CAPHRI and NUTRIM, Department of Family Medicine, P.O. Box 616, 6200MD Maastricht, The Netherlands
| | - Hans H C M Savelberg
- Maastricht University Medical Centre/NUTRIM, Department of Human Movement Science, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Annemarie Koster
- Maastricht University/CAPHRI, Department of Social Medicine, School for Public Health and Primary Care, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Piet P M M Geusens
- Maastricht University Medical Centre/CAPHRI, Department of Internal Medicine, Subdivision of Rheumatology, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; University of Hasselt, Biomedical Research Institute, P.O. Box 6, 3590 Diepenbeek, Belgium
| | - Joop P W van den Bergh
- Maastricht University Medical Centre/NUTRIM, Department of Internal Medicine, Subdivision of Rheumatology, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; University of Hasselt, Biomedical Research Institute, P.O. Box 6, 3590 Diepenbeek, Belgium; VieCuri Medical Centre, Department of Internal Medicine, Subdivision of Endocrinology, P.O. Box 1926, 5900 BX Venlo, The Netherlands
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