"A change in posture versus common setting, such as straining, dehydration, emotional or physical distress, etc. may be the most inciting factor     . In contrast, orthostatic hypotension (defined as reduction of systolic or diastolic blood pressure within 3 minutes of assuming the erect posture) occurs with greater frequency in the population aged 65 years and older  . "
[Show abstract][Hide abstract] ABSTRACT: Objective:
The aim of this study was to determine the false positive ratio of Tilt Table Test (TTT) result by using TNG spray (Sub-lingual; SL) as compared to TNG pearl in patients referred to military service.
Material and methods:
This was a prospective study. It was conducted on 110 cases referred for military service, expressed vasovagal symptoms. We divided the subjects into three groups; first Group (60 cases) used TNG pearl for provoking syncope in TTT, Group 2 (50 cases) and Group 3 (control cases) used TNG spray in the same dose (0.4 mg).
In the first step of tilt study, 10%, and 8% of subjects had fainted on not using provoking drug in cases and controls, respectively. After using the drugs, 36.6%, 96% and 18% showed positive results in pearl, spray and the control groups, respectively (p<0.05).
Rather than pearl group, a 40 minute tilt using TNG spray showed significant higher positive results, which may be incorrectly positive. Using this form of TNG seems not useful for distinguishing and diagnosing vasovagal shocks, especially in subjects referred for military service capacity. For constant evidence, a cross-over clinical trial study is required, involving suspected cases divided into two groups, who both will be examined with spray and pearl.
"When transitioning from the hospital to the primary setting, careful evaluation of OH and whether or not to continue medications is needed (Feldstein & Weder, 2012). Lastly, many studies have stressed the necessity of revising and updating the consensus of the American Autonomic Society and the American Academy of Neurology in 1996, including the diagnostic criteria for OH and blood pressure measurement methods, with consideration of cumulative evidence-based studies since then (Fedorowski, Burri, & Melander, 2009; Wieling & Schatz, 2009). "
[Show abstract][Hide abstract] ABSTRACT: To enhance awareness of orthostatic hypotension (OH) in older populations, and guide primary care nurse practitioners (NPs) in the assessment and management of patients with OH.
Electronic data collection was conducted on studies and reviews that were published between 2005 and 2012 in English, and contained information related to the purpose of this article from following databases: PubMed, Scopus, and MEDLINE.
OH is a syndrome that is accompanied by unfavorable symptoms such as dizziness, and headaches and can impede the individual's daily activities and quality of life. The prevalence of OH is higher in older people because of comorbidities, polypharmacy, and physiological changes that occur with aging. OH is diagnosed with serial blood pressure measurements and the primary goal of management is to relieve unfavorable symptoms and enhance patient safety. Pharmacological management is considered when nonpharmacological interventions fail.
OH is not a problem to be taken lightly as it is highly related to the risk of falling and cardiovascular problems, as well as increasing morbidity and mortality rates. NPs can contribute to improving the quality of life for older adults and reducing adverse consequences by understanding OH and adequately managing it.
Journal of the American Association of Nurse Practitioners 09/2013; 25(9):451-8. DOI:10.1002/2327-6924.12026
"As applied to the latter methods, OH is defined by consensus as a sustained reduction of systolic blood pressure (SBP) of at least 20 mmHg or diastolic blood pressure (DBP) of 10 mmHg within 3 minutes of standing . Many clinicians also measure orthostatic hemodynamic changes with non-invasive beat-to-beat finger arterial blood pressure monitors; however, in the latter case the consensus definition of OH may lack clinical relevance [3,4] and there are no internationally agreed cut-offs for the definition of OH. "
[Show abstract][Hide abstract] ABSTRACT: Our previously proposed morphological classification of orthostatic hypotension (MOH) is an approach to the definition of three typical orthostatic hemodynamic patterns using non-invasive beat-to-beat monitoring. In particular, the MOH pattern of large drop/non-recovery (MOH-3) resembles the syndrome of supine hypertension--orthostatic hypotension (SH-OH), which is a treatment challenge for clinicians. The aim of this study was to characterise MOH-3 in the first wave of The Irish Longitudinal Study of Ageing (TILDA), with particular attention to concurrent symptoms of orthostatic intolerance (OI), prescribed medications and association with history of faints and blackouts.
The study included all TILDA wave 1 participants who had a Finometer(R) active stand. Automatic data signal checks were carried out to ensure that active stand data were of sufficient quality. Characterisation variables included demographics, cardiovascular and neurological medications (WHO-ATC), and self-reported information on comorbidities and disability. Multivariable statistics consisted of logistic regression models.
Of the 4,467 cases, 1,456 (33%) were assigned to MOH-1 (small drop, overshoot), 2,230 (50%) to MOH-2 (medium drop, slower but full recovery), and 781 (18%) to MOH-3 (large drop, non-recovery). In the logistic regression model to predict MOH-3, statistically significant factors included being on antidepressants (OR = 1.99, 95% CI: 1.50 -- 2.64, P < 0.001) and beta blockers (OR = 1.60, 95% CI: 1.26 -- 2.04, P < 0.001). MOH-3 was an independent predictor of OI after full adjustment (OR = 1.47, 95% CI: 1.25 -- 1.73, P < 0.001), together with being on hypnotics or sedatives (OR = 1.83, 95% CI: 1.31 -- 2.54, P < 0.001). In addition, OI was an independent predictor of history of falls/blackouts after full adjustment (OR = 1.27, 95% CI: 1.09 -- 1.48, P = 0.003).
Antidepressants and beta blockers were independently associated with MOH-3, and should be used judiciously in older patients with SH-OH. Hypnotics and sedatives may add to the OI effect of MOH-3. Several trials have demonstrated the benefits of treating older hypertensive patients with cardiovascular medications that were not associated with adverse outcomes in our study. Therefore, the evidence of benefit does not necessarily have to conflict with the evidence of potential harm.
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