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Cited by 54Cardiovascular Syncope and Autonomic DisordersHeart Rate Variability and Autonomic ControlBalance, Gait, and Falls Prevention

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

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Romero-Ortuno, Roman, O’Connell, Matthew DL, Finucane, Ciaran, Soraghan, Christopher, Fan, Chie Wei, Kenny, Rose Anne·2013·BMC Geriatrics
DOI 10.1186/1471-2318-13-73PMC PMC3716968
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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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  • ACE inhibitors, angiotensin receptor blockers, and calcium channel blockers are less likely to be associated with OH compared with beta-blockers and thiazide diuretics.

    “Angiotensin-converting enzyme inhibitors, angiotensin receptors blockers, and calcium channel blockers are less likely to be associated with OH compared with beta-blockers and thiazide diuretics. 315-318”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [316]

    The Discussion (page unavailable) associates beta-blockers with an impaired orthostatic blood-pressure response, while reporting no adverse-outcome association for ACE inhibitors or angiotensin receptor antagonists and a possible protective effect for peripheral calcium channel blockers. It does not support the thiazide comparison: the paper does not report a thiazide-specific finding and says diuretics as a group were not linked to its adverse outcomes. (LLM, conf=0.88)

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Authors
Romero-Ortuno, R., O’Connell, M. D., Finucane, C., Soraghan, C., Fan, C. W., & Kenny, R. A.
Affiliations
Trinity College Dublin (IE)
ORCID
Venue
BMC Geriatrics
Publisher
Springer Science and Business Media LLC
Published
2013-07-15
Volume
13
Issue
1
Pages
73-73
ISSN
1471-2318 (ISSN-L)
DOI
10.1186/1471-2318-13-73
PMC
PMC3716968
OpenAlex
W2151875632
Cited by
54
References
83
Citations by year
2025: 1 · 2024: 3 · 2023: 2 · 2022: 3 · 2021: 6 · 2020: 7 · 2019: 4 · 2018: 8 · 2017: 4 · 2016: 4 · 2015: 6 · 2014: 5 · 2013: 1
FWCI
5.25
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Geriatrics (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Arrow@dit (Dublin Institute of Technology) (submittedVersion, cc-by-nc-sa)
  • Lenus, The Irish Health Repository (Dr Steevens Hospital Library) (submittedVersion)
  • Apollo (University of Cambridge) (submittedVersion, cc-by)
  • Apollo (cc-by)
Funders
Atlantic Philanthropies
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
Keywords
orthostatic hypotension, orthostatic intolerance, Finometer, antidepressants, beta-blockers, sedative-hypnotic drugs, cardiovascular drugs, older adults, TILDA, beat-to-beat blood pressure monitoring
MeSH terms
Aged, Aging, Blood Pressure, Cross-Sectional Studies, Female, Humans, Hypertension, Hypotension, Orthostatic, Ireland, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Cohort Studies, Supine Position, Disease Management

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