Orthostatic hypotension in patients of 60 years and older with arterial hypertension: an association between arterial stiffness and frailty

Cover Page

Cite item

Abstract

Aim: To assess an association between orthostatic hypotension and arterial stiffness, measured by the cardio-ankle vascular index (CAVI), in a group of patients≥60 years of age with arterial hypertension and frailty.

Materials and methods: The study included 160 patients aged 60 to 101 years with confirmed arterial hypertension without severe concomitant physical disorders. Compliance to the previously prescribed medications was assessed. A  short questionnaire, "Age is not a  hindrance," was used to identify patients with frailty. According to the current diagnostic algorithm for frailty, the patients were categorized into three groups: group 1, frail, group 2, pre-frail, group 3, healthy. Arterial stiffness was assessed by volumetric sphygmometry (VaSera-VS-1500, Fukuda Denshi, Japan) with the measurement of CAVI. The orthostatic test was considered positive if blood pressure falls by≥20/10 mm Hg after changing from supine to standing position.

Results: The mean age of the study patients was 77.2±8.1 years (n=160), being 72.4±6.9 years in the healthy patients (n=50), 76.6±8.1 years in the pre-frail (n=50) and 81.7±6.6 years in the frail patients (n=60). Orthostatic hypotension was identified in total of 53 (33%) patients, with marginally significant difference between the pre-frail and healthy groups (44 and 20% of the patients, respectively, p=0.053). The CAVI values were higher in frail patients, compared to healthy ones (p=0.0005). Orthostatic hypotension was associated with a  higher CAVI, irrespective of the patients’ age and frailty (р=0.0067). The association between orthostatic hypotension and CAVI in frail patients was found only with unifactor analysis, but became non-significant with the additional analysis.

Conclusion: Orthostatic hypotension can be found in 33% of the elderly patients with arterial hypertension. Arterial stiffness increases with increasing frailty, as well as with concomitant orthostatic hypotension in the group of the patients≥60 years of age. The progression of arterial stiffness in the elderly group is heterogeneous and depends on the presence of frailty.

About the authors

A. V. Luzina

Russian Clinical and Research Center of Gerontology

Author for correspondence.
Email: alexalav@mail.ru
ORCID iD: 0000-0002-1695-9107

Alexandra V. Luzina – MD, Junior Research Fellow, Laboratory of Cardiovascular Ageing; Cardiologist

161-ya Leonova ul., Moscow, 129226, Russian Federation 

Russian Federation

N. K. Runikhina

Russian Clinical and Research Center of Gerontology

Email: nkrunihina@rgnkc.ru
ORCID iD: 0000-0001-5272-0454

Nadezhda K. Runikhina – MD, PhD, Professor, Chair of Ageing Diseases, Deputy Director on Geriatric Medicine

161-ya Leonova ul., Moscow, 129226, Russian Federation 

Russian Federation

O. N. Tkacheva

Russian Clinical and Research Center of Gerontology

Email: tkacheva@rgnkc.ru
ORCID iD: 0000-0002-4193-688X

Olga N. Tkacheva – MD, PhD, Professor, Chair of Ageing Diseases, Director

161-ya Leonova ul., Moscow, 129226, Russian Federation 

Russian Federation

S. N. Lysenkov

Russian Clinical and Research Center of Gerontology; Lomonosov Moscow State University

Email: s_lysenkov@mail.ru
ORCID iD: 0000-0002-5791-7712

Sergey N. Lysenkov – Junior Research Fellow, Laboratory of Musculoskeletal Disorders; Senior Research Fellow, Biological Faculty 

161-ya Leonova ul., Moscow, 129226, Russian Federation;

1 Leninskie gory, Moscow, 119991, Russian Federation 

Russian Federation

Yu. V. Kotovskaya

Russian Clinical and Research Center of Gerontology

Email: kotovskaya_yv@rgnkc.ru
ORCID iD: 0000-0002-1628-5093

Yulia V. Kotovskaya – MD, PhD, Professor, Deputy Director on Science

161-ya Leonova ul., Moscow, 129226, Russian Federation;

Russian Federation

K. A. Eruslanova

Russian Clinical and Research Center of Gerontology

Email: eruslanova_ka@rgnkc.ru
ORCID iD: 0000-0003-0048-268X

Kseniia A. Eruslanova – MD, Junior Research Fellow, Laboratory of Cardiovascular Ageing

161-ya Leonova ul., Moscow, 129226, Russian Federation;

Russian Federation

References

  1. Kovacic JC, Moreno P, Hachinski V, Nabel EG, Fuster V. Cellular senescence, vascular disease, and aging: Part 1 of a 2-part review. Circulation. 2011;123(15):1650–1660. doi: 10.1161/CIRCULATIONAHA.110.007021.
  2. Vermeiren S, Vella-Azzopardi R, Beckwée D, Habbig AK, Scafoglieri A, Jansen B, Bautmans I; Gerontopole Brussels Study group. Frailty and the Prediction of Negative Health Outcomes: A Meta-Analysis. J Am Med Dir Assoc. 2016;17(12):1163.e1–1163.e17. doi: 10.1016/j.jamda.2016.09.010.
  3. Ткачева ОН, Котовская ЮВ, Рунихина НК, Фролова ЕВ, Наумов АВ, Воробьева НМ, Остапенко ВС, Мхитарян ЭА, Шарашкина НВ, Тюхменев ЕА, Переверзев АП, Дудинская ЕН. Клинические рекомендации «Старческая астения». Российский журнал гериатрической медицины. 2020;(1):11–46. doi: 10.37586/2686-8636-1-2020-11-46.
  4. Cohen-Mansfield J, Skornick-Bouchbinder M, Brill S. Trajectories of End of Life: A Systematic Review. J Gerontol B Psychol Sci Soc Sci. 2018;73(4):564–572. doi: 10.1093/geronb/gbx093.
  5. Xue QL. The frailty syndrome: definition and natural history. Clin Geriatr Med. 2011;27(1): 1–15. doi: 10.1016/j.cger.2010.08.009.
  6. Magkas N, Tsioufis C, Thomopoulos C, Dilaveris P, Georgiopoulos G, Sanidas E, Papademetriou V, Tousoulis D. Orthostatic hypotension: From pathophysiology to clinical applications and therapeutic considerations. J Clin Hypertens (Greenwich). 2019;21(5):546–554. doi: 10.1111/jch.13521.
  7. Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I, Cheshire WP, Chelimsky T, Cortelli P, Gibbons CH, Goldstein DS, Hainsworth R, Hilz MJ, Jacob G, Kaufmann H, Jordan J, Lipsitz LA, Levine BD, Low PA, Mathias C, Raj SR, Robertson D, Sandroni P, Schatz I, Schondorff R, Stewart JM, van Dijk JG. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21(2):69–72. doi: 10.1007/s10286-011-0119-5.
  8. Kobayashi Y, Fujikawa T, Kobayashi H, Sumida K, Suzuki S, Kagimoto M, Okuyama Y, Ehara Y, Katsumata M, Fujita M, Fujiwara A, Saka S, Yatsu K, Hashimoto T, Kuji T, Hirawa N, Toya Y, Yasuda G, Umemura S. Relationship between Arterial Stiffness and Blood Pressure Drop During the Sit-to-stand Test in Patients with Diabetes Mellitus. J Atheroscler Thromb. 2017;24(2):147–156. doi: 10.5551/jat.34645.
  9. Shibao C, Lipsitz LA, Biaggioni I. ASH position paper: evaluation and treatment of orthostatic hypotension. J Clin Hypertens (Greenwich). 2013;15(3):147–153. doi: 10.1111/jch.12062.
  10. Bromfield SG, Ngameni CA, Colantonio LD, Bowling CB, Shimbo D, Reynolds K, Safford MM, Banach M, Toth PP, Muntner P. Blood Pressure, Antihypertensive Polypharmacy, Frailty, and Risk for Serious Fall Injuries Among Older Treated Adults With Hypertension. Hypertension. 2017;70(2):259–266. doi: 10.1161/HYPERTENSIONAHA.116.09390.
  11. Ткачева ОН, Котовская ЮВ, Рунихина НК, Фролова ЕВ, Наумов АВ, Воробьева НМ, Остапенко ВС, Мхитарян ЭА, Шарашкина НВ, Тюхменев ЕА, Переверзев АП, Дудинская ЕН. Клинические рекомендации «Старческая астения». Часть 2. Российский журнал гериатрической медицины. 2020;(2):115–130. doi: 10.37586/2686-8636-2-2020-115-130.
  12. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Neurology. 1996;46(5):1470. doi: 10.1212/wnl.46.5.1470.
  13. Fedorowski A, Stavenow L, Hedblad B, Berglund G, Nilsson PM, Melander O. Orthostatic hypotension predicts all-cause mortality and coronary events in middle-aged individuals (The Malmo Preventive Project). Eur Heart J. 2010;31(1):85–91. doi: 10.1093/eurheartj/ehp329.
  14. Hiitola P, Enlund H, Kettunen R, Sulkava R, Hartikainen S. Postural changes in blood pressure and the prevalence of orthostatic hypotension among home-dwelling elderly aged 75 years or older. J Hum Hypertens. 2009;23(1):33–39. doi: 10.1038/jhh.2008.81.
  15. Mol A, Slangen LRN, Trappenburg MC, Reijnierse EM, van Wezel RJA, Meskers CGM, Maier AB. Blood Pressure Drop Rate After Standing Up Is Associated With Frailty and Number of Falls in Geriatric Outpatients. J Am Heart Assoc. 2020;9(7):e014688. doi: 10.1161/JAHA.119.014688.
  16. Canney M, O'Connell MD, Murphy CM, O'Leary N, Little MA, O'Seaghdha CM, Kenny RA. Single Agent Antihypertensive Therapy and Orthostatic Blood Pressure Behaviour in Older Adults Using Beat-to-Beat Measurements: The Irish Longitudinal Study on Ageing. PLoS One. 2016;11(1):e0146156. doi: 10.1371/journal.pone.0146156.
  17. McCarthy K, Ward M, Romero Ortuño R, Kenny RA. Syncope, Fear of Falling and Quality of Life Among Older Adults: Findings From the Irish Longitudinal Study on Aging (TILDA). Front Cardiovasc Med. 2020;7:7. doi: 10.3389/fcvm.2020.00007.
  18. Kaess BM, Rong J, Larson MG, Hamburg NM, Vita JA, Levy D, Benjamin EJ, Vasan RS, Mitchell GF. Aortic stiffness, blood pressure progression, and incident hypertension. JAMA. 2012;308(9):875–881. doi: 10.1001/2012.jama.10503.
  19. Niiranen TJ, Lyass A, Larson MG, Hamburg NM, Benjamin EJ, Mitchell GF, Vasan RS. Prevalence, Correlates, and Prognosis of Healthy Vascular Aging in a Western Community-Dwelling Cohort: The Framingham Heart Study. Hypertension. 2017;70(2):267–274. doi: 10.1161/HYPERTENSIONAHA.117.09026.
  20. Ricci F, Fedorowski A, Radico F, Romanello M, Tatasciore A, Di Nicola M, Zimarino M, De Caterina R. Cardiovascular morbidity and mortality related to orthostatic hypotension: a meta-analysis of prospective observational studies. Eur Heart J. 2015;36(25):1609–1617. doi: 10.1093/eurheartj/ehv093.
  21. Centi J, Freeman R, Gibbons CH, Neargarder S, Canova AO, Cronin-Golomb A. Effects of orthostatic hypotension on cognition in Parkinson disease. Neurology. 2017;88(1):17–24. doi: 10.1212/WNL.0000000000003452.
  22. Mol A, Bui Hoang PTS, Sharmin S, Reijnierse EM, van Wezel RJA, Meskers CGM, Maier AB. Orthostatic Hypotension and Falls in Older Adults: A Systematic Review and Meta-analysis. J Am Med Dir Assoc. 2019;20(5):589–597.e5. doi: 10.1016/j.jamda.2018.11.003.

Supplementary files

There are no supplementary files to display.


Copyright (c) 2021 Luzina A.V., Runikhina N.K., Tkacheva O.N., Lysenkov S.N., Kotovskaya Y.V., Eruslanova K.A.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies