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

Romero-Ortuno R, O'Connell MD, Finucane C, Soraghan C, Fan CW, Kenny RA - BMC Geriatr (2013)

Bottom Line: 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).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.

View Article: PubMed Central - HTML - PubMed

Affiliation: The Irish Longitudinal Study of Ageing (TILDA), Lincoln Gate, Trinity College Dublin, Dublin 2, Republic of Ireland. romeror@tcd.ie

ABSTRACT

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.

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MOH phenotypes (visual description of SBP, DBP and HR behaviour).
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Figure 2: MOH phenotypes (visual description of SBP, DBP and HR behaviour).

Mentions: In the K-means analysis on N = 4,467, all clustering variables significantly contributed to the solution (P < 0.001). Table 2 shows the characteristics of the three morphological groups and Figure 2 shows their hemodynamic profiles. Of the 4,467 cases assigned to clusters, 1,456 (33%) were assigned to MOH-1 (characterised by a small drop and overshoot), 2,230 (50%) to MOH-2 (characterised by a medium drop and slower but full recovery), and 781 (18%) to MOH-3 (characterised by a large drop and incomplete recovery).


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

Romero-Ortuno R, O'Connell MD, Finucane C, Soraghan C, Fan CW, Kenny RA - BMC Geriatr (2013)

MOH phenotypes (visual description of SBP, DBP and HR behaviour).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3716968&req=5

Figure 2: MOH phenotypes (visual description of SBP, DBP and HR behaviour).
Mentions: In the K-means analysis on N = 4,467, all clustering variables significantly contributed to the solution (P < 0.001). Table 2 shows the characteristics of the three morphological groups and Figure 2 shows their hemodynamic profiles. Of the 4,467 cases assigned to clusters, 1,456 (33%) were assigned to MOH-1 (characterised by a small drop and overshoot), 2,230 (50%) to MOH-2 (characterised by a medium drop and slower but full recovery), and 781 (18%) to MOH-3 (characterised by a large drop and incomplete recovery).

Bottom Line: 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).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.

View Article: PubMed Central - HTML - PubMed

Affiliation: The Irish Longitudinal Study of Ageing (TILDA), Lincoln Gate, Trinity College Dublin, Dublin 2, Republic of Ireland. romeror@tcd.ie

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus