A.I. Burnasyan  FMBC clinical bulletin. 2023 № 3

A.T. Betuganova, Z.A. Barkhanoeva, T.A. Martynova

The Burden of Orthostatic Hypotension in the Elderly

International Office, State Research Center – Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russiа

Contact person: Barkhanoeva Zaira Aslanovna: zaira007006@gmail.com

Abstract
The purpose of this review was to summarize current domestic and foreign literature data on orthostatic hypotension (OH) and to assess the prevalence of the disease. The article presents the definition of OH and the features of the course in the elderly. Particular attention is paid to the review of the results of scientific studies on the effect of OH on the risk of coronary, cerebrovascular events and death from all causes. The found literature is analyzed and summarized by the authors of this literature review.

Conclusion: OH is a common condition that doctors of various specialties often encounter in practice. This disease sharply worsens the quality of life, often leads to hospitalization and often to disability of the patient. The combination of OH and supine hypertension requires more careful selection of therapy, assessment of short-term and medium-term risks. The use of simple, effective, practical measures to diagnose, monitor and alleviate this problem can have a significant impact on maintaining independence in older people.

Keywords: orthostatic hypotension, prevalence, blood pressure, old age, cardiovascular disease, chronic kidney disease, diabetes mellitus, cognitive function

For citation: Betuganova AT, Barkhanoeva ZA, Martynova TA. The Burden of Orthostatic Hypotension in the Elderly. A.I. Burnasyan Federal Medical Biophysical Center Clinical Bulletin. 2023.3:18-20. (In Russian) DOI: 10.33266/2782-6430-2023-3-18-20

 

REFERENCES

1. Kim M.J., Farrell J. Orthostatic Hypotension: A Practical Approach. Am. Fam. Physician. 2022;105;1:39-49.

2. Low P.A. Prevalence of Orthostatic Hypotension. Clin. Auton. Res. 2008;18;1:8–13. https://doi.org/10.1007/s10286-007-1001-3.

3. Dani M., Dirksen A., Taraborrelli P., Panagopolous D., Torocastro M., Sutton R., Lim P.B. Orthostatic Hypotension in Older People: Considerations, Diagnosis and Management. Clin. Med. (Lond). 2021;21;3:e275-e282. doi: 10.7861/clinmed.2020-1044.

4. Duggan E., Romero-Ortuno R., Anne Kenny R. Affiliations Expand Admissions for Orthostatic Hypotension: an Analysis of NHS England Hospital Episode Statistics data. BMJ Open. 2019;9:e034087.

5. Barbic F., Heusser K., Minonzio M., et al. Effects of Prolonged Head–Down Bed Rest on Cardiac and Vascular Baroreceptor Modulation and Orthostatic Tolerance in Healthy Individuals. Front. Physiol. 2019;10:1061.

6. Fleg J.L., Evans G.W., Margolis K.L., et al. Orthostatic Hypotension in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) Blood Pressure Trial: Prevalence, Incidence, and Prognostic Significance. Hypertension. 2016;68:888–895.

7. Min M., Shi T., Sun C., et al. Orthostatic Hypotension and the Risk of Atrial Fibrillation and Other Cardiovascular Diseases: An Updated Meta-Analysis of Prospective Cohort Studies. J. Clin. Hypertens. (Greenwich). 2019;21:1221–1227.

8. Juraschek S.P., Daya N., Appel L.J., et al. Orthostatic Hypotension in Middle-Age and Risk of Falls. Am. J. Hypertens. 2017;30:188–195.

9. Bannister R., Low P.A. Multiple System Atrophy and Pure Autonomic Failure. Clinical Autonomic Disorders: Evaluation and Management. Ed. Low P.A.

10. van Twist D.J.L., Mostard G.J.M., Sipers W. Delayed Recovery from Initial Orthostatic Hypotension: an Expression of Frailty in the Elderly. Clin. Auton. Res. 2020;30;2:105-106.  doi: 10.1007/s10286-019-00664-2.

11. Thompson A.D., Shea M.J. Медицинский обзор. Ортостатическая гипотензия. 2022.

12. Атюнина И.В. Реактивность и ауторегуляция церебрального кровообращения при разных вариантах ортостатических гипотензивных реакций у больных артериальной гипертензией старших возрастных групп с цереброваскулярной патологией. М., 2021. URL: https://cardioweb.ru/files/autoref/302/dis.pdf. [Atyunina I.V. Reaktivnost i Autoregulyatsiya Tserebralnogo Krovoobrashcheniya Pri Raznykh Variantakh Ortostaticheskikh Gipotenzivnykh Reaktsiy u Bolnykh Arterialnoy Gipertenziyey Starshikh Vozrastnykh Grupp s Tserebrovaskulyarnoy Patologiyey = Reactivity and Autoregulation of Cerebral Circulation in Different Types of Orthostatic Hypotensive Reactions in Patients with Arterial Hypertension of Older Age Groups with Cerebrovascular Pathology. Moscow Publ., 2021. URL: https://cardioweb.ru/files/autoref/302/dis.pdf (In Russ.)].

13. Shibao C., Biaggioni I. Orthostatic Hypotension and Cardiovascular Risk. Hypertension. 2010;56:1042–1044.

14. Rose K.M., Eigenbrodt M.L., Biga R.L., Couper D.J., Light K.C., Sharrett A.R., Heiss G.. Orthostatic Hypotension Predicts Mortality in Middle-Aged Adults: The Atherosclerosis Risk in Communities (ARIC) Study. Circulation. 2006;114:630–636.

15. Ricci F., Fedorowski A., Radico F., Romanello M., Tatasciore A., Di Nicola M. et al. Cardiovascular Morbidity and Mortality Related to Orthostatic Hypotension: a Meta-Analysis of Prospective Observational Studies. Eur. Heart. J. 2015;36:1609–1617.

16. Verwoert G.C., Mattace-Raso F.U., Hofman A., et al. Orthostatic Hypotension and Risk of Cardiovascular Disease in Elderly People: the Rotterdam Study. J. Am. Geriatr. Soc. 2008;56;10:1816-1820.

17. O’Connell M.D.L, Savva G.M., Fan C.W., Kenny R.A. Orthostatic Hypotension, Orthostatic Intolerance and Frailty: The Irish Longitudinal Study on Aging TILDA. Arch. Gerontol. Geriatr. 2015;60:507–513.

18. Farrell M.C., Shibao C.A. Morbidity and Mortality in Orthostatic Hypotension. Auton. Neurosci. 2020;229:102717.

19. Xin W., Mi S., Lin Z., Wang H., Wei W. Orthostatic Hypotension and the Risk of Incidental Cardiovascular Diseases: a Meta-Analysis of Prospective Cohort Studies. Prev. Med. 2016;85:90–97.

20. Eigenbrodt M.L., Rose K.M., Couper D.J., et al. Orthostatic Hypotension as a Risk Factor for Stroke: the Atherosclerosis Risk in Communities (ARIC) Study, 1987-1996. Stroke. 2000;31:2307-2313.

21. Rose K.M., Holme I., Light K.C. et al. Association between the Blood Pressure Response to a Change in Posture and the 6-Year Incidence of Hypertension: Prospective Findings from the ARIC Study. J. Hum. Hypertens. 2002;16:771-777.

22. Rutan G.H., Hermanson B., Bild D.E., et al. Orthostatic Hypotension in Older Adults. The Cardiovascular Health Study. CHS Collaborative Research Group. Hypertension. 1992;19:508–519.

23. Fedorowski A., Burri P., Struck J., Juul-Moller S., Melander O. Novel Cardiovascular Biomarkers in Unexplained Syncopal Attacks: the SYSTEMA Cohort. J. Intern. Med. 2013;273:359–367.

24. Fedorowski A., Ostling G., Persson M., et al. Orthostatic Blood Pressure Response, Carotid Intima-Media Thickness, and Plasma Fibrinogen in Older Nondiabetic Adults. J. Hypertens. 2012;30:522-529.

25. Fedorowski A., Ricci F., Sutton R. Orthostatic Hypotension and Cardiovascular Risk. Kardiol. Pol. 2019;77:1020-1027.

26. Fedorowski A., Stavenow L., Hedblad B., et al. Orthostatic Hypotension Predicts All-Cause Mortality and Coronary Events in Middle-Aged Individuals (The Malmo Preventive Project). Eur. Heart. J. 2010;31:85–91.

27. Fedorowski A., Wahlstrand B., Hedner T., Melander O. Systolic and Diastolic Component of Orthostatic Hypotension and Cardiovascular Events in Hypertensive Patients: the Captopril Prevention Project. J. Hypertens. 2014;32:75-81.

28. Fedorowski A., Hedblad B., Melander O. Early Postural Blood Pressure Response and Cause-Specific Mortality among Middle-Aged Adults. Eur. J. Epidemiol. 2011;26;7:537-546.

29. Berger R., Pacher R. The Role of the Endothelin System in Myocardial Infarction—New Therapeutic Targets? Eur. Heart. J. 2003;24:294–296.

30. Grossman E., Oren S., Messerli F.H. Left Ventricular Filling and Stress Response Pattern in Essential Hypertension. Am. J. Med. 1991;91:502–506.

31. Боронова В.Б., Протасов К.В., Антоненко Н.Б., Петухова Е.А., Баканач С.В. Ортостатическая гипотензия при гипертонической болезни в молодом и среднем возрасте: есть ли связь с поражением органов-мишеней? // Артериальная гипертензия. 2014. № 4. С. 255 -261. [Boronova V.B., Protasov K.V., Antonenko N.B., Petukhova E.A., Bakanach S.V. Orthostatic Hypotension in Young and Middle-Aged Hypertensives: Does it Relate to Target Organ Damage? Arterialnaya Gipertenziya = Arterial Hypertension. 2014;4:255 -261 (In Russ.)].

32. Colloby S.J., Vasudev A., O’Brien J.T., Firbank M.J., Parry S.W., Thomas A.J. Relationship of Orthostatic Blood Pressure to White Matter Hyperintensities and Subcortical Volumes in Late-Life Depression. Br. J. Psychiatry. 2011;199;5:404–410.

33. Остроумова О.Д., Черняева М.С., Петрова М.М., Головина О.В. Ортостатическая гипотензия: определение, патофизиология, классификация, прогностические аспекты, диагностика и лечение // Рациональная Фармакотерапия в Кардиологии. 2018. Т.14, № 5. С. 747-756. DOI: 10.20996/1819-6446-2018-14-5-747-756. [Ostroumova O.D., Chernyayeva M.S., Petrova M.M., Golovina O.V. Orthostatic Hypotension: Definition, Pathophysiology, Classification, Prognostic Aspects, Diagnostics and Treatment. Ratsionalnaya Farmakoterapiya v Kardiologii = Rational Pharmacotherapy in Cardiology. 2018;14;5:747-756. DOI: 10.20996/1819-6446-2018-14-5-747-756 (In Russ.)].

34. Franceschini N., Rose K.M., Astor B.C., et al. Orthostatic Hypotension is Associated with Incident Chronic Kidney Disease: The Atherosclerosis Risk in Communities Study. Hypertension. 2010;56;6:1054-1059. doi:10.1161/HYPERTENSIONAHA.110.156380.

 

Conflict of interest. The authors declare no conflict of interest.
Financing. The study had no sponsorship. 
Contribution. Article was prepared with equal participation of the authors.
Article received: 15.07.2023. Accepted for publication: 18.08.2023