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Acute haemodynamic response to sleeping head-up at 6 inches in older inpatients.

Clin Auton Res. 2009 Feb;19(1):51-7

Authors: Fan CW, Gasparro D, Crowley V, Cunningham CJ

OBJECTIVE: Our aim was to investigate the effect of monotherapy of sleeping head-up (SHU) at 6 in. in a group of older inpatients with OH from all causes. METHODS: We recruited nine consecutive inpatients (mean age (SD) 76(5) years) with persistent, symptomatic OH with a mean systolic blood pressure (SBP) drop on standing and nadir SBP of 68 (27.8) and 94 (19.2) mmHg respectively. All patients underwent SHU for 1 week. Beat-to-beat haemodynamics during lying and standing, 24-hour ambulatory blood pressure, supine haematocrit, urea/electrolytes, plasma renin activity and aldosterone were measured before and after intervention. RESULTS: One week after SHU, SBP, stroke volume and cardiac output increased significantly (all P < 0.05) by 12 mmHg, 15 ml and 1.3 l/minutes respectively while heart rate and total peripheral resistance were significantly reduced by 3.6 bpm and 0.355 dynes/s/cm(5) respectively during 2 minute of standing. Serum creatinine was also significantly lower. Five patients improved in their mobility following SHU. INTERPRETATIONS: SHU for 1 week at 6 in. was well tolerated by older in-patients with OH, associated with improved orthostatic tolerance, and with haemodynamic changes in keeping with increased extracellular volume. SHU at 6 in. has a role in the acute treatment of OH for patients in hospital, but its longer-term effects and in the out-patient setting require further study.

PMID: 19198925 [PubMed - indexed for MEDLINE]

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Current pharmacologic treatment for orthostatic hypotension.

Clin Auton Res. 2008 Mar;18 Suppl 1:14-8

Authors: Freeman R

Orthostatic hypotension is treated effectively with the combined use of non-pharmacological and pharmacological interventions. Patients should be counseled as to the nature of the underlying disorder and reversible causes of orthostatic hypotension should be removed. Should symptoms persist, pharmacological treatment is implemented. First line pharmacotherapeutic interventions include volume repletion in combination with alpha-adrenoreceptor agonists. If unsuccessful there are several supplementary agents with different mechanisms of action that may provide an additive effect.

PMID: 18368302 [PubMed - indexed for MEDLINE]

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The pathophysiology and diagnosis of orthostatic hypotension.

Clin Auton Res. 2008 Mar;18 Suppl 1:2-7

Authors: Robertson D

Orthostatic Hypotension (OH) is a common manifestation of blood pressure dysregulation. OH takes a heavy toll on quality of life. It has many potential etiologies, and many effects of aging can increase susceptibility to OH. Neurological disorders are especially likely to cause severe OH. In this brief review, the pathogenesis of OH is considered, particularly in terms of autonomic neuropathy, multiple system atrophy (MSA), pure autonomic failure, baroreflex failure, and dopamine beta hydroxylase deficiency. While OH is difficult to treat, its control greatly enhances the quality of life.

PMID: 18368300 [PubMed - indexed for MEDLINE]

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Related Articles

Prevalence of orthostatic hypotension.

Clin Auton Res. 2008 Mar;18 Suppl 1:8-13

Authors: Low PA

Orthostatic hypotension (OH) is defined as a fall in blood pressure of at least 20 mmHg systolic or 10 mmHg diastolic when standing or during head-up tilt testing. The prevalence of OH increases with age, with disorders that affect autonomic nerve transmission, and with increasingly severe orthostatic stress. In normal elderly subjects, the prevalence of OH is reported to be between 5 and 30%. The actual prevalence depends on the conditions during diagnostic testing, such as the frequency of blood pressure recordings, the time of day and the degree of orthostatic stress. Elderly subjects are often taking medications, such as antihypertensives and diuretics that can cause or aggravate OH. Neurological diseases such as diabetic neuropathy, Parkinson’s disease, multiple system atrophy and the autonomic neuropathies further increase the likelihood of OH. The development of OH in normal subjects is associated with an increased mortality rate. OH in diabetes is also associated with a significant increase in mortality rate.

PMID: 18368301 [PubMed - indexed for MEDLINE]

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