Orthostatic hypotension: focus on the possibilities of restorative medicine

Authors:

Barsukov Anton Vladimirovich — Grand PhD in Medical Sciences (Dr. Med. Sci.), Professor, Deputy Chief Physician of KardioKlinika, 25 Kuznetsovskaya Street, 196105 St. Petersburg, Russian Federation; Associate Professor of Hospital Therapy Department, S.M. Kirov Military Medical Academy, 6 Akademika Lebedeva Street, 194044 St. Petersburg, Russian Federation; e-mail: avbarsukov@yandex.ru; https://orcid.org/0000-0002-1943-9545.

Karimova Alfiya Minigaraevna — PhD in Medical Sciences (Cand. Med. Sci.), Senior Lecturer, Department of Military Field Therapy, S.M. Kirov Military Medical Academy, 6 Akademika Lebedeva Street, 194044 St. Petersburg, Russian Federation; e-mail: karimova-am@yandex.ru; https://orcid.org/0000-0003-3833-5941.

Glukhovskoy Dmitry Vladimirovich — PhD in Medical Sciences (Cand. Med. Sci.), Head of the Department of Hospital Therapy, S.M. Kirov Military Medical Academy, 6 Akademika Lebedeva Street, 194044 St. Petersburg, Russian Federation; e-mail: giuhovskoi@inbox.ru; https://orcid.org/0000-0002-5920-9074.

Vasilyeva Irina Alekseevna — PhD in Medical Sciences (Cand. Med. Sci.), lecturer, Hospital Therapy Department, S.M. Kirov Military Medical Academy, 6 Akademika Lebedeva Street, 194044 St. Petersburg, Russian Federation; e-mail: vasilyeva-ia@yandex.ru; https://orcid.org/0000-0002-5698-9432.

Borisova Ekaterina Viktorovna — Grand PhD in Medical Sciences (Dr. Med. Sci.), Chief Physician of “KardioKlinika”, 25 Kuznetsovskaya Street, 196105 St. Petersburg, Russian Federation; Professor, Department of Internal Diseases, Clinical Pharmacology and Nephrology, North-Western State Medical University named after I.I. Mechnikov,y, 47 Piskarevsky Ave, 195067 St. Petersburg, Russian Federation; e-mail: borisova-ev@kardioklinika.ru; https://orcid.org/0000-0002-0960-9627.

Annotation:

The paper presents the definition and criteria for orthostatic (postural) hypotension. The hemodynamic patterns underlying the mechanisms of transient hypotension and symptoms of orthostatic instability are reflected, and a classification of syndromes and “diseases that cause” autonomic failure and hypovolemia is given. Methods for recording hemodynamic parameters used to diagnose postural hypotension are presented. Approaches to the prevention of transient hypotension are described in accordance with current expert views. The possibilities of restorative medicine using physical and medicinal techniques aimed at counteracting hypotension are revealed.

List of cited literature:

1. Lang GF. Gipotoniya [Hypotension]. Moskva: BME [Moscow: BME]. 1929. T. VII:177-179. (In Russian).

2. Molchanov NS. Gipotonicheskiye sostoyaniya [Hypotonic states]. Leningrad [Leningrad], 1962. 204 р. (In Russian).

3. Staessen JA, Bieniaszewski L, O’Brien ET, Imai Y et al. An epidemiological approach to ambulatory blood pressure monitoring:the Belgian Population Study. Blood Press Monit. 1996;1(1):13-26.

4. Cheshire WP Jr. Clinical classification of orthostatic hypotensions. Clin Auton Res. 2017;27(3):133-5. DOI: 10.1007/s10286-017-0414-x.

5. Rutan GH, Hermanso B, Bild DE, KittnerSJ et al. Orthostatic hypotension in older adults. The Cardiovascular Health Study. CHS Collaborative Research Group. Hypertension. 1992;19(6pt1):508-19. DOI: 10.1161/01.hyp.19.6.508.

6. Juraschek SP, Daya N, Appel LJ, Miller ER 3rd et al. Orthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in MiddleAged Adults. J Am Heart Assoc. 2018;7(10):e008884. DOI: 10.1161/JAHA.118.008884.

7. Hemmo SI, Naser AY, Taybeh EO. Hospital Admission Due to Hypotension in Australia and in England and Wales. Healthcare (Basel). 2023; 11(9): 1210. DOI: 10.3390/healthcare11091210.

8. Ooi WL, Hossain M, Lipsitz LA. The association between orthostatic hypotension and recurrent falls in nursing home residents. Am J Med. 2000; 108(2): 106-11. DOI: 10.1016/s0002-9343(99)00425-8.

9. Masaki KH, Curb JD, Chiu D, Petrovitch H, Rodriguez BL. Association of body mass index with blood pressure in elderly Japanese American men. The Honolulu Heart Program. Hypertension. 1997;29(2):673-7. DOI: 10.1161/01.hyp.29.2.673.

10. Eigenbrodt ML, Rose KM, Couper DJ, Arnett DK et al. Orthostatic hypotension as a risk factor for stroke: the atherosclerosis risk in communities (ARIC) study, 1987-1996. Stroke. 2000;31(10):2307-13. DOI: 10.1161/01.str.31.10.2307.

11. Rose KM, Couper D, Eigenbrodt ML, Mosley TH et al. Orthostatic hypotension and cognitive function: the Atherosclerosis Risk in Communities Study. Neuroepidemiology. 2010;34(1):1-7. DOI: 10.1159/000255459.

12. Ejaz AA, Kazory A, Heinig ME. 24-hour blood pressure monitoring in the evaluation of supine hypertension and orthostatic hypotension. J Clin Hypertens (Greenwich). 2007;9(12):952-5. DOI: 10.1111/j.1524-6175.2007.07298.x.

13. Vloet LC, Smits R, Frederiks CM, Hoefnagels WH et al. Evaluation of skills and knowledge on orthostatic blood pressure measurements in elderly patients. Age Ageing. 2002;31(3):211-6. DOI: 10.1093/ageing/31.3.211.

14. Mattace-Raso FU, van der Cammen TJ, van Popele NM, van der Kuip DA et al. Blood pressure components and cardiovascular events in older adults: the Rotterdam study. J Am Geriatr Soc. 2004 Sep;52(9):1538-42. DOI: 10.1111/j.1532-5415.2004.52419.x.

15. Verwoert GC, Mattace-Raso FU, Hofman A, Heeringa J et al. Orthostatic hypotension and risk of cardiovascular disease in elderly people: the Rotterdam study. Geriatr Soc. 2008;56(10):1816-20. DOI: 10.1111/j.1532-5415.2008.01946.x.

16. Hiitola P, Enlund H, Kettunen R, Sulkava R et al. Postural changes in blood pressure and the prevalence of orthostatic hypotension among home-dwelling elderly aged 75 years or older. J Human Hypertens. 2009;23(1):33-9. DOI: 10.1038/jhh.2008.81.

17. Fedorowski A, Hamrefors V, Sutton R, van Dijk JG et al. Do we need to evaluate diastolic blood pressure in patients with suspected orthostatic hypotension? Clin Auton Res. 2017;27(3):167-73. DOI: 10.1007/s10286-017-0409-7.

18. Feldstein C, Weder AB. Orthostatic hypotension: a common, serious and underrecognized problem in hospitalized patients. J Am Soc Hypertens. 2012;6(1):27-39. DOI: 10.1016/j.jash.2011.08.008.

19. Fleg JL, Evans GW, Margolis KL, Barzilay J et al. Orthostatic Hypotension in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) Blood Pressure Trial: Prevalence, Incidence, and Prognostic Significance. Hypertension. 2016;68(4):888-95. DOI: 10.1161/HYPERTENSIONAHA.116.07474.

20. Barsukov AV, Vasil’yeva IA, Karimova AM. Arterial’naya gipotenziya. Aktual’nyye voprosy diagnostiki profilaktiki i lecheniya [Arterial hypotension. Topical issues in the diagnosis of prevention and treatment]. SPb: ELBI-SPb [St. Petersburg: ELBI-SPb]. 2012;140 р. (In Russian).

21. Freeman R. Samuels M, Feske S. Autonomic dysfunction. In: The Office Practice of Neurology. 2nd ed. Churchill-Livingstone, Philadelphia. 2003;14:145.

22. Barsukov AV. Arterial’naya gipotenziya. Geriatriya: rukovodstvo dlya vrachey. Pod red. LP Khoroshininoy [Arterial hypotension. Geriatrics: a guide for doctors. Ed. LP Khoroshinina]. M.: GEOTAR-Media [Moscow: GEOTAR-Media]. 2019;163 p. (In Russian).

23. Shibao C, Lipsitz LA, Biaggioni I. ASH position paper: evaluation and treatment of orthostatic hypotension. J Clin Hypertens (Greenwich). 2013;15(3):1471-553. DOI: 10.1111 / jch.12062.

24. Palma JA, Kaufmann H. Management of orthostatic hypotension. Continuum (Minneap Minn). 2020; 26(1):154-77. DOI: 10.1212 / CON.0000000000000816.

25. Barsukov AV, Glukhovskoy DV. Algoritmy vrachebnykh resheniy pri sinkopal’nykh sostoyaniyakh [Algorithms for medical decisions in syncopal conditions]. SPb.: IP “Korovin VA” [St. Petersburg: IP “Korovin VA”] 2021;186 p. (In Russian).

26. Brignole M, Moya A, de Lange FJ, Deharo JC et al. ESC Scientific Document Group. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart. 2018; 39(21):1883-948. DOI: 10.1093 /eurheartj/ehy037.

27. Barsukov AV. [Arterial hypotension. Physical and rehabilitation medicine: national guide, ed. GN Ponomarenko. 2nd ed., revised. and additional]. M.: GEOTAR-Media [Moscow: GEOTAR-Media], 2023. P. 395-397. (In Russian).

28. Jansen RW. Postprandial hypotension: simple treatment but difficulties with the diagnosis. J Gerontol A Biol Sci Med Sci. 2005;60(10):1268-70. DOI: 10.1093/gerona/60.10.1268.

29. Barsukov A, Shoustov S, Vasilieva I, Resvantzev M. Some pathogenetic factors of asymptomatic postprandial hypotension in essential hypertensive patients. J Hypertens. 2007;25 (suppl. 2):S98.

30. Rivasi G, Brignole M, Rafanelli M, Bilo G et al. Blood pressure management in hypertensive patients with syncope: how to balance hypotensive and cardiovascular risk. J Hypertens. 2020;38(12):2356-62. DOI: 10.1097/HJH.0000000000002555.

31. Barsukov AV, Glukhovskoy DV, Yemel’yanova KYe, Vasil’yeva IA. Podkhody k antigipertenzivnoy terapii u patsiyentov, predraspolozhennykh k razvitiyu simptomnoy gipotenzii i sinkopal’nykh sostoyaniy [Approaches to antihypertensive therapy in patients predisposed to the development of symptomatic hypotension and syncope]. Vestnik Rossiyskoy Voyenno-meditsinskoy akademii [Bulletin of the Russian Military Medical Acad.emy]. 2021;23(2): 207-18. DOI: https://DOI.org/10.17816/brmma.71314. (In Russian).

32. Krediet CT, van Lieshout JJ, Bogert LW, Immink RV et al. Leg crossing improves orthostatic tolerance in healthy subjects: a placebo-controlled crossover study. Physiol Heart Circ Physiol. 2006;291(14):1768-72. DOI: 10.1152/ajpheart.00287.2006.

33. Okamoto LE, Diedrich A, Baudenbacher FJ, Harder R et al. Efficacy of servo-controlled splanchnic venous compression in the treatment of orthostatic hypotension: a randomized comparison with midodrine. Hypertension. 2016;68(2):418-26. DOI: 10.1161/ HYPERTENSIONAHA.116.07199.

34. Cheshire WP. Chemical pharmacotherapy for the treatment of orthostatic hypotension. Expert Opin Pharmacother. 2019; 20:187-99. DOI: 10.1080/14656566.2018.1543404.