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Journal of Geriatric Cardiology 2018年第10期15卷 644-646页

作者： Sarah Damanti Dario Consormi Annalisa Valentini Benedetta Cerasoli Martina Biotto Federica Conti Marta Clerici Pasqualina Iannuzzi Emanuela Manzo Paolo D Rossi Simona Ciccone Matteo Cesari Geriatric Unit Fondazione IRCCS Ca'Granda Ospedale Maggiore PoliclinicoMilanltaly Department of Clinical Sciences and Community Health University of MilanMilanItaly Unit of Epidemiology Fondazione IRCCS Ca'Granda Ospedale Maggiore PoliclinicoMilanltaly Fellowship in Geriatrics and Gerontology University of MilanMilanItaly

orthostatic hypotension (OH)is a common condition in older persons.According to the 2011criteria,OH is defined by a sustained reduction of systolic blood pressure of 20 mmHg or a 10mmHg-fall of diastolic blood pressure,[1] Its prevalence increases with age and according to a recent systematic review the pooled prevalence in community dwelling older people is 22.2%.[2]Although OH is largely explained by concurrent clinical conditions (in particular, hypertension,diabetes,malnutrition,vascular encephalopa- thy,anemia,Parkinson's disease)[3],aging per se determines a series of physiological dysfunctions potentially representing its biological substratum (e.g.,reduction in barore- flex-mediated cardiovascular function,altered salt and water balance at renal level,impaired cardiac diastolic filling).It is also noteworthy that age-related changes in pharmacokinetic and pharmacodynamic mechanisms of drugs (especially in the context of polypharmacy)also increase the risk of OH.

关键词： Elderly orthostatic hypotension Prevalence Real-life

orthostatic Intolerance and Coagulation Abnormalities:An Update

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Neuroscience Bulletin 2019年第1期35卷 171-177页

作者： Wei Quan Yuchen Wang Selena Chen Junbao Du Department of Pediatrics Peking University First Hospital Department of Clinical Medicine Peking University Health Science Center Department of Biochemistry and Cellular Biology University of California at San Diego Key Laboratory of Molecular Cardiovascular Science of the Ministry of Education

orthostatic intolerance(OI)is a series of clinical symptoms that develop during long-term standing in the upright position,with clinical manifestations of frequent,recurrent,or persistent dizziness,fatigue,and heart p... 详细信息

关键词： HUT Hg orthostatic Intolerance and Coagulation Abnormalities:An Update vWF

What is the relationship between frailty and orthostatic hypotension in older adults?

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Journal of Geriatric Cardiology 2019年第3期16卷 272-279页

作者： Suleyman Emre Kocyigit Pinar Soysal Esra Ates Bulut Ali Ekrem Aydin Ozge Dokuzlar Ahmet Turan Isik Unit for Aging Brain and Dementia Department of Geriatric MedicineFaculty of MedicineDokuz Eylul UniversityIzmirTurkey Department of Geriatric Medicine Bezmialem Vakif UniversityFaculty of MedicineIstanbulTurkey

Background Frailty and orthostatic hypotension (OH),which is common in older adults,is associated with morbidity and mortality.The relationship between them remains unclear.The aim of the study is to determine whether there is a relationship between frailty and OH.Methods A total of 496 patients who were admitted to the geriatric clinic and underwent comprehensive geriatric assessment were retrospectively reviewed.In a cross-sectional and observational study,OH was measured by the Head-up Tilt Table test at 1,3,and 5 min (respectively,OH1,OH3,and OH5) and the frailty was measured by the Fried’s frailty scale.Results The mean age of all patients was 75.4 ± 7.38.The prevalence of females was 69.8%.When the frail people were compared with the pre-frail and the robust ones,the frailty was associated with OH1.There was no relationship between the groups in terms of OH1 when the pre-frail group was compared with the robust group.OH3 were higher in the frail group than in the pre-frail group (P 0.05).Slowness and weakness were associated with OH1 (P < 0.05),whereas the other components of the Fried’s test were not.Conclusions Frailty may be a risk factor for OH1.The 1^st min measurements of OH should be routinely evaluated in frail older adults to prevent OH-related poor outcomes.

关键词： Frail orthostatic hypotension Pre-frail Robust

The association between orthostatic blood pressure changes and subclinical target organ damage in subjects over 60 years old

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Journal of Geriatric Cardiology 2019年第5期16卷 387-394页

作者： Hong-Jie CHI Hai-Jun FENG Xiao-Jiao CHEN Xiao-Tao ZHAO En-Xiang ZHANG Yi-Fan FAN Xian-Chen MENG Jiu-Chang ZHONG Shou-Ling WU Jun CAI Heart Center&Beijing Key Laboratory of Hypertension Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina Respiratory Department Beijing First Hospital of Integrated Chinese and Western MedicineBeijingChina Cardiology Department Beijing Liangxiang HospitalCapital Medical UniversityBeijingChina Department of Statistics Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina Department of Cardiology Kailuan General HospitalHebei United UniversityTangshanChina Hypertension Center Fuwai HospitalState Key Laboratory of Cardiovascular Disease of ChinaNational Center for Cardiovascular Diseases of ChinaChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

Background Although recent studies have indicated that both orthostatic hypotension and orthostatic hypertension independently predict cardiovascular events,the underlying mechanisms are still controversial.The aim of the study was to investigate the relationships between orthostatic changes and organ damage in subjects over 60 years old.Methods This is a prospective observational cohort study.One thousand nine hundred and ninety-seven subjects over 60 years old were enrolled.Participants were grouped according to whether they had a drop>20 mmHg in systolic or>10 mmHg in diastolic BP(orthostatic hypotension),an increase in mean orthostatic systolic blood pressure>20 mm Hg(orthostatic hypertension),or normal changes within 3 min of orthostatism.Multiple regression modeling was used to investigate the relationship between orthostatic hypotension,orthostatic hypertension and subclinical organ damage with adjustment for confounders.Results orthostatic hypotension and orthostatic hypertension were found in 461(23.1%)and 189(9.5%)participants,respectively.Measurement of carotid intima-media thickness(IMT),brachial-ankle pulse wave velocity(baPWV),clearance of creatinine,and microalbuminuria were associated with orthostatic hypotension;measurement of IMT and baPWV were associated with orthostatic hypertension in a cruse model.After adjustment,IMT[odds ratio(OR),95%confidence interval(CI)per one-SD increment:1.385,1.052-1.823;P=0.02],baPWV(OR=1.627,95%CI:1.041-2.544;P=0.033)and microalbuminuria(OR=1.401,95%CI:1.002-1.958;P=0.049)were still associated with orthostatic hypotension,while orthostatic hypertension was only associated with IMT(OR=1.730,95%CI:1.143-2.618;P=0.009).Conclusions orthostatic hypotension seems to be independently correlated with increased carotid atherosclerosis,arterial stiffness and renal damage in subjects over 60 years old.orthostatic hypertension correlates with carotid atherosclerosis only.

关键词： Atherosclerosis Blood pressure orthostatic Organ damage

Clinical progress of orthostatic hypertension in children

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Chinese Medical Journal 2014年第21期127卷 3825-3828页

作者： Duan Hongyu Zhou Kaiyu Hua Yimin Department of Pediatrics West China Second University Hospital Sichuan University Chengdu Sichuan 610041 China

In healthy subjects, changes in posture are accompanied by autoregulatory mechanisms that ensure the relatively small fluctuations of blood pressure （BP）. orthostatic hypotension （OH） is well-recognized as a risk factor for falls, syncope, and cardiovascular events. Although OH is commonly encountered, orthostatic hypertension （OHT）, with a marked increase in BP upon standing, has not been frequently reported. In the clinic, it is generally both unexpected and counterintuitive. However, sometimes, OHT can be dramatic and persistent. Studies in recent years have shown that OHT is a new cardiovascular risk factor. However, till date, most studies only focused on adults and aged patients; there were very few reports in children. Therefore, appreciation of the true incidence of OHT, elucidation of the underlying pathophysiology, and understanding of the potentially effective treatment approaches, associated risks, and benefits, might be significant in children.

关键词： orthostatic hypertension children

Reversible postural orthostatic tachycardia syndrome

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World Journal of Clinical Cases 2015年第7期3卷 655-660页

作者： Aza Abdulla Thirumagal Rajeevan Department of Care of the Elderly Princess Royal University HospitalKing’s College Hospital NHS Foundation Trust Department of Care of the Elderly St Peter’s Hospital

Postural orthostatic tachycardia syndrome(POTS) is a relatively rare syndrome recognised since 1940. It is a heterogenous condition with orthostatic intolerance due to dysautonomia and is characterised by rise in heart rate above 30 bpm from base line or to more than 120 bpm within 5-10 min of standing with or without change in blood pressure which returns to base line on resuming supine position. This condition present with various disabling symptoms such as light headedness, near syncope, fatigue, nausea, vomiting, tremor, palpitations and mental clouding, etc. However there are no identifiable signs on clinical examination and patients are often diagnosed to have anxiety disorder. The condition predominantly affects young female between the ages of 15-50 but is rarely described in older people. We describe an older patient who developed POTS which recovered over 12 mo. Recognising this condition is important as there are treatment options available to alleviate the disabling symptoms.

关键词： Postural orthostatic Tachycardia Dysautonomia Hypotension Postural tachycardia syndrome Older person

Quantification of the Beneficial Effects of Compression Stockings on Symptoms of Exercise and orthostatic Intolerance in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis Patients

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International Journal of Clinical Medicine 2018年第5期9卷 367-376页

作者： C. (Linda) M. C. van Campen Freek W. A. Verheugt Frans C. Visser Stichting Cardiozorg Hoofddorp Netherlands Radboud UMC Department of Cardiology Nijmegen Netherlands

Chronic fatigue syndrome and myalgic encephalomyelitis (CFS/ME) are, amongst others, characterized by exercise intolerance, pain, post exertional malaise and orthostatic intolerance. It has been shown in venous disease and sport participation that compression stockings may improve exercise performance and reduce post exercise muscle soreness. Moreover, its use is advocated in orthostatic hypotension. Therefore, it was hypothesized that compression stockings may reduce symptomatology in CFS/ME patients. Methods: 100 patients used compression stockings class II for minimally 3 weeks and thereafter filled in a questionnaire, based on the Rand 36 physical activity questions (n = 9), whether compression stockings changed perceived symptoms or not. Moreover, 7 questions referring to prolonged standing and sitting, to recovery post exercise, muscle pain during or immediately post exercise, and to dizziness/light-headedness during or immediately post exercise, while standing and during prolonged sitting were added. Questions were scored as 1: able to perform activity much less while wearing the stockings, 2: perform activity somewhat less, 3: no perceived change in activity, 4: perform activity slightly better, 5: able to perform activity much better while wearing the stockings. Results: In patients able to answer the question, all mean scores per activity were significantly higher than 3, being no perceived change in activity while wearing the stockings. Subgroup analysis showed that patients with orthostatic intolerance reported higher effects than patients without orthostatic intolerance. Conclusion: This pilot study suggests that compression stockings may be useful to reduce symptomatology of physical activities in CFS/ME patients, especially in patients with orthostatic intolerance. Larger prospective studies with hard endpoints are warranted.

关键词： Chronic Fatigue Syndrome Myalgic Encephalomyelitis Compression Stockings Exercise Tolerance orthostatic Intolerance

Value of orthostatic Hypotension as a Prognostic Bed-Side Test in Heart Failure

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World Journal of Cardiovascular Surgery 2012年第4期2卷 132-140页

作者： Tarek M. Abdel Rahman Cardiology Department El Minia University Hospital Minya Egypt

Background: Neurohumoral compensatory mechanisms play an important role in stabilizing the functional activity of patients with heart failure using the arms of autonomic nervous system. orthostatic Hypotension (OH) is one of the most incapacitating symptoms of Cardiac Autonomic Dysfunction (CAD). OH can include sympathetic withdrawal which in turn leads to marked disability and deterioration of heart failure symptoms. Progressive Autonomic Dysfunction (AD) associated with progressive deterioration and impact on mortality of many diseases as hypertension, diabetes and other chronic diseases. The idea of using (OH) as a bed-side simple test expecting the risk of deterioration of cardiac function and furthermore on mortality open a gateway for preventive medicine and care to these group of patients. For more confidential prove, studying subjective and objective factors in heart failure patients became necessary to support these idea. Methods and Results: Sixty-Four patients with known history of heart failure were collected. All patients taking the fixed regiment of 4 drugs (diuretic, ACE inhibitor, Digitalis and B-blocker) in appropriate tolerated doses for two weeks prior to the study. History taking and all routine investigations were done for all patients. Grouping is based upon wither they have (OH) or not. Group-A found to have normal Bp response to standing;they were 24 patients (18 male and 6 female) of mean Age (45 ± 8 years). Group-B discovered to have significant (OH) and was 22 patients (16 males and 6 females) of mean Age (43 ± 4 years). The first Clinical and Echocardiographic examination was done and considered as a base-line characteristic. Then, a Call-back after 6 months for follow-up and second visit examination is recorded. Furthermore, every patient was advised to report changes in his clinical symptoms in a note-book describing five main items to answer a questionnaire at the end of the study involves [times of admission to hospital, need for treatment modification, numbers of paroxysmal noctur

关键词： orthostatic Hypotension Heart Failure

Cardiac autonomic neuropathy: Risk factors, diagnosis and treatment

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World Journal of Diabetes 2018年第1期9卷 1-24页

作者： Victoria A Serhiyenko Alexandr A Serhiyenko Department of Endocrinology Lviv National Medical University Named by Danylo Halitsky

Cardiac autonomic neuropathy(CAN)is a serious complication of diabetes mellitus(DM)that is strongly associated with approximately five-fold increased risk of cardiovascular mortality.CAN manifests in a spectrum of things,ranging from resting tachycardia and fixed heart rate(HR)to development of"silent"myocardial infarction.Clinical correlates or risk markers for CAN are age,DM duration,glycemic control,hypertension,and dyslipidemia(DLP),development of other microvascular complications.Established risk factors for CAN are poor glycemic control in type 1 DM and a combination of hypertension,DLP,obesity,and unsatisfactory glycemic control in type 2DM.Symptomatic manifestations of CAN include sinus tachycardia,exercise intolerance,orthostatic hypotension(OH),abnormal blood pressure(BP)regulation,dizziness,presyncope and syncope,intraoperative cardiovascular instability,asymptomatic myocardial ischemia and infarction.Methods of CAN assessment in clinical practice include assessment of symptoms and signs,cardiovascular reflex tests based on HR and BP,short-term electrocardiography(ECG),QT interval prolongation,HR variability(24 h,classic24 h Holter ECG),ambulatory BP monitoring,HR turbulence,baroreflex sensitivity,muscle sympathetic nerve activity,catecholamine assessment and cardiovascular sympathetic tests,heart sympathetic imaging.Although it is common complication,the significance of CAN has not been fully appreciated and there are no unified treatment algorithms for today.Treatment is based on early diagnosis,life style changes,optimization of glycemic control and management of cardiovascular risk factors.Pathogenetic treatment of CAN includes:Balanced diet and physical activity;optimization of glycemic control;treatment of DLP;antioxidants,first of allα-lipoic acid(ALA),aldose reductase inhibitors,acetylL-carnitine;vitamins,first of all fat-soluble vitamin B1;correction of vascular endothelial dysfunction;prevention and treatment of thrombosis;in severe cases-treatment of OH.The promising methods include prescrip

关键词： Diabetes mellitus Risk factors Cardiac autonomic neuropathy Screening for cardiac autonomic neuropathy Cardiovascular reflex tests orthostatic hypotension Heart rate variability Prophylaxis Treatment

Vascular dysfunction of postural tachycardia syndrome in children

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World Journal of Pediatrics 2018年第1期14卷 13-17页

作者： Wei Bai Si-Yao Chen Hong-Fang Jin Jun-Bao Du Department of Pediatrics Peking University First HospitalBeijing100034China Department of Cardiac Surgery Guangdong CardiovascularInstituteGuangdong General Hospital and GuangdongAcademy of Medical SciencesGuangzhouChina

Background Postural orthostatic tachycardia syndrome (POTS) is a form of orthostatic intolerance, and its incidence in children is approximately 6.8% (1)The pathogenesis of POTS is complex with multiple, overlapping, interacting pathophysi-ological mechanisms. Although the specific pathogenic mechanism has remained perplexing, with the discovery of various gasotransmitters and biological peptides, the vascular dysfunction has aroused overwhelming attention. Data sources On the basis of searching in a wide range of recent original literatures, we reviewed the pathogenesis of vas-cular dysfunction in children with POTS. Results The flow-mediated vasodilation of POTS patients was greater than that of healthy controls, and the vasodilator factors were increased in patients with POTS under basal condition or under a standing position, while the vasoconstriction factors were reduced. Conclusions Vascular dysfunction, as one of pathogenesis in pediatric POTS patients, affects the occurrence and develop-ment of diseases through a variety of factors.

关键词： Children Postural orthostatic tachycardia syndrome Vasodilation