Article

The consensus statement on the definition of orthostatic hypotension: a revisit after 13 years

Journal of Hypertension (Impact Factor: 4.22). 06/2009; 27(5):935-8. DOI: 10.1097/HJH.0b013e32832b1145
Source: PubMed
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    ABSTRACT: Les diabétiques âgés sont surexposés à l’hypotension orthostatique (HO), elle-même néfaste sur le pronostic cardiovasculaire. L’objectif était d’évaluer la fréquence de l’HO et ses facteurs associés dans la cohorte Gerodiab à l’inclusion. Méthodes L’étude Gerodiab a recruté 987 diabétiques de type 2 autonomes, de 70 ans ou plus. La pression artérielle était mesurée, après 5 min de repos, et à 1, 3 et 5 minutes après passage en orthostatisme. L’HO était définie par une baisse de PAS d’au moins 20 mmHg et/ou de PAD d’au moins 10 mmHg à 1, 3 ou 5 minutes. Les données (m ± SD; %) ont été comparées par test t ou du chi2 ; l’analyse multivariée a été réalisée par modèle logistique. Résultats Trois cent un (30,5 %) patients avaient une HO ; la PAS et la PAD étaient plus élevées au repos chez les patients présentant une HO (146 ± 21 et 78 ± 11 vs. 138 ± 17 et 72 ± 10 mmHg ; p < 0,001). Ils avaient également une HTA plus sévère (p < 0,01). Les patients avec HO présentaient une pression pulsée plus élevée (68 ± 18 vs 65 ± 15 mmHg ; p < 0,05). Leur ratio taille-hanche était augmenté (p < 0,01). Aucune différence significative n’était constatée pour les traitements antihypertenseurs, notamment bêta-bloquants et diurétiques, l’âge, l’ancienneté du diabète ou les scores gériatriques. Les patients avec HO avaient plus souvent une artériopathie oblitérante des membres inférieurs (31 % vs 24 % ; p < 0,05) et des amputations (3,3 % vs 1,5 % ; p = 0,056). Ils n’avaient pas plus fréquemment de neuropathie périphérique, d’AVC, d’insuffisance cardiaque, de cardiopathie ischémique. En analyse multivariée, l’HO était associée successivement à l’HTA sévère (p < 0,01), au ratio taille-hanche (p < 0,05) et aux amputations (p < 0,05). Conclusion Un tiers environ des patients diabétiques âgés autonomes présente une HO. Ils ont une HTA plus sévère sans majoration du traitement antihypertenseur. L’HO pourrait constituer une limitation à l’intensification du traitement anti-HTA dans cette population.
    Annales de cardiologie et d'angeiologie 06/2014; DOI:10.1016/j.ancard.2014.05.013 · 0.30 Impact Factor
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    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.
    PLoS ONE 09/2014; 9(9):e106808. DOI:10.1371/journal.pone.0106808 · 3.53 Impact Factor
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    ABSTRACT: Objective: Several studies have suggested that orthostatic hypotension may be an independent predictor of cardiovascular or cerebrovascular risk and all-cause mortality, particularly in a geriatric population. In 1996, a consensus defined orthostatic hypotension as a SBP fall at least 20mmHg and/or a DBP fall at least 10mmHg within 3 min of standing. Methods: Pubmed and Cochrane database were searched up to October 2013 in order to identify prospective studies evaluating, in adult populations, the association between orthostatic hypotension as defined by the 1996 consensus and clinical outcome. Meta-regression was performed when sufficient data were available. Results: A total of 28 prospective studies were found eligible for inclusion in this systematic review. Nine prospective studies found an association between orthostatic hypotension and various cardiovascular events such as coronary disease, heart failure, and arrhythmias. No association was found between orthostatic hypotension and the risk for strokes and falls in the majority of the prospective included studies. Insufficient data were available to perform a meta-analysis for strokes and falls. The meta-analysis of seven prospective studies found that orthostatic hypotension is associated with a significant increased risk for overall mortality [pooled hazard ratio in random-effects model = 1.36 (1.13-1.63), P<0.001)]. Conclusion: This meta-analysis provides evidence that orthostatic hypotension is associated with a 36% increase in the risk of overall mortality. A systematic review of the literature suggests that orthostatic hypotension is also associated with a higher risk for cardiovascular events. Insufficient data are available to enable a precise assessment of the association of orthostatic hypotension with strokes and falls.
    Journal of Hypertension 05/2014; DOI:10.1097/HJH.0000000000000235 · 4.22 Impact Factor