The hemodynamic pattern of the syndrome of delayed orthostatic hypotension
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We investigated the hemodynamic mechanisms underlying the syndrome of delayed orthostatic hypotension (OH) and the hemodynamic effect of the treatment with leg compression bandages.
Non-invasive monitoring of systolic blood pressure (SBP), heart rate (HR), cardiac output (CO), stroke volume (SV), and total peripheral resistance (TPR) was performed during tilt testing in patients affected by delayed OH compared to age- and sex-matched controls. Thirteen patients (68 ± 14 years) and nine controls (68 ± 8 years) were studied.
Immediately after tilt-up, SBP progressively decreased in patients but not in controls. Symptoms developed at 100 ± 7 mmHg. At the end of the test, SBP was significantly lower in patients than in controls. TPR progressively decreased in patients but not in controls. SV and CO did not change significantly. HR increased progressively in the patients until the end of the test and remained unchanged in controls. Active treatment with compression bandages avoided the decrease in SBP and TPR, while CO showed minimal variation.
In patients affected by delayed OH, the progressive decrease of SBP is associated with progressive decrease of TPR, while CO and SV show little variation; the compensatory increase in HR is insufficient to compensate for the decline in blood pressure.
KeywordsDelayed orthostatic hypotension Progressive orthostatic hypotension Compression bandage Non-invasive monitoring Blood pressure Total peripheral resistance
Cristian Podoleanu, Emilian Carasca, and Carmen Ginghina were supported by the National University Research Council of Romania (grant CNCSIS 1125/2007).
- 2.Podoleanu, C., Maggi, R., Brignole, M., Croci, F., Incze, A., Solano, A., et al. (2006). Lower limb and abdominal compression bandages prevent progressive orthostatic hypotension in elderly persons: a randomized single-blind controlled study. Journal of the American College of Cardiology, 48(7), 1425–1432.CrossRefPubMedGoogle Scholar
- 3.The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. (1996). Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. Neurology, 46(5), 1470.Google Scholar
- 4.Gratze, G., Fortin, J., Holler, A., Grasenick, K., Pfurtscheller, G., Wach, P., et al. (1998). A software package for non-invasive, real-time beat-to-beat monitoring of stroke volume, blood pressure, total peripheral resistance and for assessment of autonomic function. Computers in Biology and Medicine, 28, 121–142.CrossRefPubMedGoogle Scholar
- 6.Fortin, J., Haitichi, G., Bojic, A., Habenbacher, W., Grüllenberger, R., Heller, A. et al. (2001). Validation and verification of the Task Force monitor. Results of clinical studies for FDA 510 k no. K014063 Google Scholar
- 19.Smit, A. A., Wieling, W., Fujimura, J., Denq, J. C., Opfer-Gehrking, T. L., Akarriou, M., et al. (2004). Use of lower abdominal compression to combat orthostatic hypotension in patients with autonomic dysfunction. Clinical Atomic Research, 14(3), 167–175.Google Scholar
- 20.Blomqvist, C. G., & Stone, H. L. (1983). Cardiovascular adjustments to gravitational stress. In J. T. Shepherd & F. M. Abboud (Eds.), Handbook of Physiology. The Cardiovascular System, Peripheral Circulation and Organ Blood Flow (pp. 1025–1063). Bethesda: American Physiological Society.Google Scholar
- 22.Verheyden, B., Liu, J., van Dijk, N., Westerhof, B. E., Reybrouck, T., Aubert, A. E., et al. (2008). A steep fall in cardiac output is the main determinant of hypotension during drug free and nitroglycerine induced orthostatic vasovagal syncope. Heart Rhythm, 5, 1695–1701.CrossRefPubMedGoogle Scholar