Advancing orthostatic hypotension diagnostics

Research output: PhD ThesisPhD Thesis - Research VU, graduation VU

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Abstract

This thesis investigated the diagnostics of orthostatic hypotension (OH). OH is defined as a sustained systolic/diastolic blood pressure (BP) drop larger than 20/10 mmHg within 3 minutes after standing up. OH is common among older adults aged above 65 years (6 – 31%) and geriatric outpatients (22-56%), sometimes accompanied by orthostatic intolerance (dizziness, light-headedness and blurry vision) and associated with poor clinical outcome (cardiovascular diseases, impaired cognitive performance and mortality). Current OH diagnostics is limited due to 1) contradictory evidence on the association between the OH definition and physical functioning and falls; 2) the uncertainty of the clinical value of continuous BP measurements, which may in contrast to intermittent sphygmomanometer measurements reflect the challenge posed to compensation systems and brain exposure to low perfusion pressures; and 3) the lack of assessment of systems compensating for orthostatic BP drops such as baroreflex sensitivity (i.e., heart rate increase in response to a BP drop to stabilize BP), peripheral vasoconstriction (i.e., narrowing of peripheral artery diameter in response to a BP drop to increase peripheral resistance and stabilize BP) and cerebral autoregulation (i.e., dilation of cerebral arterioles in response to a BP drop to keep cerebral blood flow constant). In conclusion, the currently used OH definition was found to be clinically valuable as patients diagnosed according to this definition are at increased risk of impaired physical functioning and falls. BP drop rate and BP recovery derived from continuous BP measurements were found to have added clinical value by their association with clinical outcome and may after confirmation of the results in further studies have to be incorporated in a new OH definition for continuous orthostatic BP measurements to better identify individuals with clinical consequences due to OH. Parameters expressing baroreflex sensitivity, cerebral oxygenation and cerebral autoregulation were by their sensitivity, test-retest reliability and validity in younger and older adults demonstrated to be potentially valuable, supporting further study on the clinical value of these parameters.
Original languageEnglish
QualificationMPhil
Awarding Institution
  • Vrije Universiteit Amsterdam
Supervisors/Advisors
  • Maier, Andrea, Supervisor
  • van Wezel, R.J.A., Supervisor, External person
  • Meskers, Carolus Gerardus Maria, Co-supervisor, External person
Award date7 Apr 2021
Place of PublicationEde
Publisher
Print ISBNs978-94-6332-722-0
Electronic ISBNs978-94-6332-722-0
Publication statusPublished - 7 Apr 2021

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