Insights into the clinical management of the syndrome of supine hypertension – orthostatic hypotension (SH-OH): The Irish Longitudinal Study on Ageing (TILDA)

BMC Geriatrics

Rose Anne Kenny¹  Chie Wei Fan¹  Christopher Soraghan¹  Ciaran Finucane¹  Matthew DL O’Connell¹  Roman Romero-Ortuno¹ 

[1] The Irish Longitudinal Study of Ageing (TILDA), Lincoln Gate, Trinity College Dublin, Dublin 2, Republic of Ireland

关键词: Cross-sectional survey;    Polypharmacy;    Hypnotics and sedatives;    Antidepressive agents;    Beta-adrenergic blockers;    Fainting;    Syncope;    Orthostatic intolerance;    Hypertension;    Orthostatic hypotension;   

Others  :  857540
DOI  :  10.1186/1471-2318-13-73

 received in 2013-03-13, accepted in 2013-07-12,  发布年份 2013

【 摘 要 】

Background

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.

Methods

The study included all TILDA wave 1 participants who had a Finometer® 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.

Results

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).

Conclusions

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.

【 授权许可】

   
2013 Romero-Ortuno et al.; licensee BioMed Central Ltd.

【 图 表 】

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