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Increased arterial stiffness and wave reflections are independently associated with orthostatic hypotension (OH). This study investigated whether heart rate variability (HRV) is also involved in the modulation of orthostatic blood pressure (BP) change. A total of 429 subjects (65.1±16.4 years, 77.4% men) were enrolled in this study. OH was defined...
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Context 1
... supine SBP, DBP, MAP, cf-PWV, cAI, cAP and Pb and lower logLF, logHF, logTP, eGFR and hemoglobin levels significantly correlated with the occurrence of OH (Table 2). In a multivariate logistic regression model with cf-PWV, Pb, logHF, eGFR and hemoglobin as independent variables, Pb and logHF, but not cf-PWV, were significant independent predictors of OH (Table 2). ...
Context 2
... supine SBP, DBP, MAP, cf-PWV, cAI, cAP and Pb and lower logLF, logHF, logTP, eGFR and hemoglobin levels significantly correlated with the occurrence of OH (Table 2). In a multivariate logistic regression model with cf-PWV, Pb, logHF, eGFR and hemoglobin as independent variables, Pb and logHF, but not cf-PWV, were significant independent predictors of OH (Table 2). Even after adjusting for the use of a-blockers, diuretics and the presence of heart failure, Pb and logHF but not cf-PWV remained as independent predictors of OH. (Table 2) In addition, Pb was still a significant independent predictor when logHF was replaced with logLF in the model (Supplementary Table S1). ...
Context 3
... a multivariate logistic regression model with cf-PWV, Pb, logHF, eGFR and hemoglobin as independent variables, Pb and logHF, but not cf-PWV, were significant independent predictors of OH (Table 2). Even after adjusting for the use of a-blockers, diuretics and the presence of heart failure, Pb and logHF but not cf-PWV remained as independent predictors of OH. (Table 2) In addition, Pb was still a significant independent predictor when logHF was replaced with logLF in the model (Supplementary Table S1). ...
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Citations
... Stiffening of the large elastic arteries, or arteriosclerosis, is a physiological process that occurs as a natural and progressive result of aging; it begins around 30 to 40 years of age and increases steadily after middle age [18,20,21]. It is characterized by changes in the physical properties of the artery wall, such as decreased distensibility, compliance, and elasticity. ...
Purpose of Review
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Summary
The maintenance of normal blood pressure levels is essential for the homeostasis of the whole organism; the increase in blood pressure is directly related to the increased risk of cardiovascular diseases. Hypertension is characterized by structural and functional changes in blood vessels and is associated with a more accelerated progression of arterial stiffness. Randomized clinical trials have shown that some specific classes of antihypertensive drugs can improve arterial stiffness independently of their effect on lowering brachial blood pressure. These studies show that calcium channel blockers (CCBs), angiotensin II receptor blockers (ARBs), and angiotensin-converting enzyme (ACE) inhibitors have been shown to have a better effect on arterial stiffness compared to diuretics and beta-blockers in individuals with arterial hypertension and other cardiovascular risk factors. More real-world studies are needed to assess whether this effect on arterial stiffness can improve the prognosis of patients with hypertension.
... For example, the allergic reaction may have caused a disturbance in normal postural circulatory reflexes, akin to the blunting of postural reflexes which is often observed during anaesthesia. 19 Orthostatic hypotension is associated with a decrease in heart rate variability, 20,21 and previous studies in both children and adults have reported reduced heart rate variability following food-induced allergic reactions, independent of severity. 18,22 Thus, these episodes could potentially represent a more mild form of the postural decompensation Anaphylaxis as initial reaction 0 0 ...
Background
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To evaluate the rate of new‐onset symptoms occurring at least one hour after stopping OFC in peanut‐allergic children and adults undergoing peanut‐OFC.
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Conclusions & Clinical Relevance
Progressive or new‐onset symptoms ≥1 hour following initial allergic reaction at OFC are common and can include orthostatic hypotension. Recurrent symptoms may be temporally associated with food consumption.
... Arterial baroreceptors located in the aortic arch and carotid sinuses play a crucial role in this regulation by sensing acute changes in BP with each pulse. Given that baroreceptor sensitivity is dependent on the ability to stretch and respond to the mechanical force of blood flow against the arterial wall, increased the stiffening of these segments (i.e., greater PWV) is believed to contribute to baroreflex dysfunction (Lu et al., 2014;Mattace-Raso et al., 2007;Monahan, 2007). The current findings also align with previous PWV studies that have revealed an inverse relation between arterial stiffness and HF-HRV (Lu et al., 2014;Perkins et al., 2006), which likely stems from impaired BRS and the associated alteration in vagal motor neuron outflow (Berntson et al., 1993). ...
... Given that baroreceptor sensitivity is dependent on the ability to stretch and respond to the mechanical force of blood flow against the arterial wall, increased the stiffening of these segments (i.e., greater PWV) is believed to contribute to baroreflex dysfunction (Lu et al., 2014;Mattace-Raso et al., 2007;Monahan, 2007). The current findings also align with previous PWV studies that have revealed an inverse relation between arterial stiffness and HF-HRV (Lu et al., 2014;Perkins et al., 2006), which likely stems from impaired BRS and the associated alteration in vagal motor neuron outflow (Berntson et al., 1993). However, despite d-ICG PWV exhibiting moderately strong associations with indices of autonomic function, only a relationship of small effect size (r = −0.19) ...
Pulse wave velocity (PWV) is a common measure of arterial stiffness. Non‐invasive methods to measure PWV are widely used in biomedical studies of aging and cardiovascular disease, but they are rarely used in psychophysiology. Barriers to wider use include the prohibitive costs of specialized equipment and need for trained technicians (e.g., ultrasonographers). Here, we describe an impedance cardiography method to measure PWV. By this method, impedance signals are dually collected from the thorax and calf. Combined with ensemble averaging of vascular signals, this dual impedance cardiography (d‐ICG) method allows for the measurement of aortic flow onset and the arrival time of peripheral pulse waveforms to compute PWV. In a community sample of adults (aged 19–78 years), PWV measured with d‐ICG exhibited a strong positive correlation with age. Moreover, age‐specific mean PWV values were within the normative reference intervals established by large scale studies using other techniques. PWV derived from d‐ICG exhibited high test‐retest reliability across several days, as well as excellent inter‐rater reliability. Last, PWV exhibited expected associations with known cardiovascular disease risk factors and indicators of autonomic cardiovascular control. d‐ICG is an inexpensive and reliable method to assess arterial stiffness. We describe a relatively low‐cost and reliable methodology based on impedance cardiography to assess arterial pulse wave velocity. Pulse wave velocity is an important index of arterial stiffness that is strongly related to increased age and other risk factors for cardiovascular disease, as well as aspects of cerebrovascular health and cognitive function. This methodology lends itself to broader use in psychophysiology, behavioral medicine, and allied fields of study.
... Although orthostatic hypotension is more commonly investigated [3], only a few studies reported on its relationship to PWV [28][29][30]. Data on arterial stiffness in individuals responding with a significant increase of BP with standing are also scarce and derived from varying populations with inconsistent results [6,18,19]. Whether orthostatic surges in BP are independently associated with HMOD remains unclear. ...
Background:
Positional changes in blood pressure (BP) have been shown to have effects on long-term outcomes. Although a BP drop with upright posture is frequently observed, an orthostatic rise in BP can also occur. Here, we aimed to investigate whether the phenotype of orthostatic hypertension is associated with more pronounced vascular hypertension-mediated organ damage (HMOD) and whether this is associated with other cardiovascular risk factors.
Methods:
In a cohort of 200 patients referred to our tertiary hypertension clinic, we prospectively assessed unattended seated automated office BP and the response to 1 min of upright posture. The difference in BP after standing up was calculated and pulse wave velocity (PWV) was assessed as a marker of vascular HMOD. Routine clinical cardiovascular risk markers were also assessed. Regression models were used to assess the association between orthostatic BP changes and pulse wave velocity.
Results:
Baseline characteristics and clinic cardiovascular risk factors were similar between orthostatic BP response groups. A U-shaped association was evident between PWV and orthostatic BP changes with elevated PWV in patients with either a fall or a rise in BP in response to upright posture. The regression models remained significant after adjusting for other cardiovascular risk factors, including 24 h ambulatory BP.
Conclusion:
Both an orthostatic BP drop and rise were associated with elevated PWV. Although standing BP is commonly measured in elderly hypertensive patients to exclude significant orthostatic hypotension, this simple measurement may provide an additional independent risk factor for vascular HMOD at any age.
... Fourth, we did not assess arterial stiffness which has been shown to increase in persons with SCI, 47 to improve with exercise, 48 and is known to affect the HRV parameters. 49 Lastly, although we used HRV, we did not assess blood pressure variability that could provide more information about baroreflex sensitivity. ...
Objective/Background: To assess frequency domain heart rate variability (HRV) parameters at rest and in response to postural autonomic provocations in individuals with spinal cord injury (SCI) and investigate the autonomic influences on the heart of different physical activities.
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Methods: Ten subjects with complete cervical SCI and fourteen subjects with complete low thoracic SCI were prospectively recruited from the community and further divided in sedentary and physically active groups, the latter defined as regular weekly 4 hour physical activity for the preceding 3 months. Sixteen healthy individuals matched for sex and age were recruited to participate in the control group. The Low Frequency (LF), High Frequency (HF) powers and the LF/HF ratio of HRV were measured from continuous electrocardiogram (ECG) recordings at rest and after sitting using a fast Fourier transformation.
Outcome measures: The LF,HF, and the LF/HF ratio at rest and after sitting.
Results: A significant decrease in all HRV parameters in patients with SCI was found compared to controls. The change in HF, LF and LF/HF following sitting maneuver was significantly greater in controls as compared with the SCI group and greater in subjects with paraplegia as compared to subjects with tetraplegia. Better HRV values and enhanced vagal activity appears to be related to the type of physical activity in active subjects with paraplegia.
Conclusion: In this cohort of subjects spectral parameters of HRV were associated with the level of the injury. Passive standing was associated with higher HRV values in subjects with paraplegia.
... 2,3 Increased vascular stiffness may affect BP homeostasis by diminishing cardiovagal baroreflex sensitivity, 4-6 which may blunt orthostatic BP response via limited changes in heart rate or peripheral vasoconstriction. 7 Arterial stiffness may be assessed via characteristic impedance (Z c ) or forward pressure wave amplitude, which takes into account both aortic stiffness and peak aortic flow. Additionally, carotid-femoral pulse wave velocity (CFPWV) has emerged as the reference standard measure of aortic stiffness. ...
Impaired regulation of blood pressure on standing can lead to adverse outcomes, including falls, syncope, and disorientation. Mean arterial pressure (MAP) typically increases on standing; however, an insufficient increase or a decline in MAP on standing may result in decreased cerebral perfusion. Orthostatic hypotension has been reported in older people with increased arterial stiffness, whereas the association between orthostatic change in MAP and arterial stiffness in young- to middle-aged individuals has not been examined. We analyzed orthostatic blood pressure response and comprehensive hemodynamic data in 3205 participants (1693 [53%] women) in the Framingham Heart Study Third Generation cohort. Participants were predominantly middle aged (mean age: 46±9 years). Arterial stiffness was assessed using carotid-femoral pulse wave velocity, forward pressure wave amplitude, and characteristic impedance of the aorta. Adjusting for standard cardiovascular disease risk factors, orthostatic change in MAP (6.9±7.7 mm Hg) was inversely associated with carotid-femoral pulse wave velocity (partial correlation, rp=-0.084; P<0.0001), forward wave amplitude (rp=-0.129; P<0.0001), and characteristic impedance (rp=-0.094; P<0.0001). The negative relation between forward wave amplitude and change in MAP on standing was accentuated in women (P=0.002 for sex interaction). Thus, higher aortic stiffness was associated with a blunted orthostatic increase in MAP, even in middle age. The clinical implications of these findings warrant further study.
... Individuals with orthostatic hypotension frequently show isolated nocturnal hypertension 15 and high arterial stiffness. 16 Nocturnal hypertension is one of the phenotypes of masked hypertension. Therefore, both orthostatic hypertension and orthostatic hypotension can be markers of masked hypertension. ...
Hypertension Research, official publication of the Japanese Society of Hypertension, publishes papers reporting original clinical and experimental research in the field of hypertension and related cardiovascular diseases.
... It is possible that this increased cardiovascular variability contributed to improved endothelial vascular function and reduced aortic stiffening observed with VNS in our study. Increased heart rate variability has been associated with improved endothelial vascular function (43) and with reduced aortic stiffening assessed by carotid-femoral PWV (31). However, whether these beneficial vascular effects are directly caused by increased heart rate variability is not known. ...
Parasympathetic activity is often reduced in hypertension and can elicit anti-inflammatory mechanisms. Thus, we hypothesized that chronic vagal nerve stimulation (VNS) may alleviate cardiovascular end-organ damage in stroke-prone spontaneously hypertensive rats. Vagal nerve stimulators were implanted, a high-salt diet initiated, and the stimulators turned on (VNS, n=10) or left off (Sham, n=14) for 4 weeks. Arterial pressure increased equally in both groups. After 4 weeks, endothelial function, assessed by in vivo imaging of the long posterior ciliary artery (LPCA) after stimulation (pilocarpine) and inhibition (L-NAME) of endothelial nitric oxide synthase (eNOS), had significantly declined (-2.3±1.2 µm, P<0.05) in Sham but was maintained (-0.7±0.8 µm, NS) in VNS. Furthermore, aortic eNOS activation (phosphorylated to total eNOS protein content ratio) was greater in VNS (0.83±0.07) than in Sham (0.47±0.08, P<0.05). After only 3 weeks, ultrasound imaging of the aorta demonstrated decreased aortic strain (-9.7±2.2%, P<0.05) and distensibility (-2.39±0.49 1000/mmHg, P<0.05) and increased pulse wave velocity (+2.4±0.7 m/s, P<0.05) in Sham but not in VNS (-3.8±3.8%, -0.70±1.4 1000/mmHg, and +0.1±0.7 m/s, all NS). Interleukin 6 (IL-6) serum concentrations tended to be higher in VNS than in Sham (34.3±8.3 pg/mL vs. 16.1±4.6 pgm/mL, P=0.06) and positive correlations were found between NO-dependent relaxation of the LPCA and serum levels of IL-6 (r=+0.70, P<0.05) and IL-10 (r=+0.56, P<0.05) and between aortic eNOS activation and IL-10 (r=+0.48, P<0.05). In conclusion, chronic VNS prevents hypertension-induced endothelial dysfunction and aortic stiffening in an animal model of severe hypertension. We speculate that anti-inflammatory mechanisms may contribute to these effects.
... 1,2 Orthostatic hypotension can occur acutely secondary to, for example, medication use or fluid or blood loss, or it can be a chronic condition as a result of altered blood pressure regulation mechanisms, CVD or autonomic nervous system dysfunction. [1][2][3] Increase in systolic blood pressure with increasing age is one of the major determinants of orthostatic hypotension development. 1,2 The long-chain omega-3 polyunsaturated fatty acids (PUFAs) from fish, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been associated with lower risk of hypertension in population studies. ...
Long-chain omega-3 polyunsaturated fatty acids (PUFAs) from fish have been shown to lower blood pressure. However, there is little information about the association with orthostatic hypotension, for which hypertension is a risk factor. We investigated the associations between serum long-chain omega-3 PUFAs and orthostatic hypotension in 1666 middle-aged or older men and women free of cardiovascular disease (CVD), diabetes or hypertension in 1998-2001 in the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD) in eastern Finland. We also investigated the associations with mercury exposure, a major source of which is fish, and which has been associated with higher CVD risk in KIHD. Orthostatic hypotension was defined as decrease in systolic blood pressure of at least 20 mm Hg or diastolic blood pressure of at least 10 mm Hg within 1 min of standing. Orthostatic hypotension was found in 146 participants (8.8%). The mean serum concentrations were 1.67% (s.d. 0.92) for eicosapentaenoic acid, 0.79% (s.d. 0.16) for docosapentaenoic acid (DPA) and 2.78 (s.d. 0.92) for docosahexaenoic acid of all serum fatty acids. The mean pubic hair mercury concentration was 1.5 μg g(-1) (s.d. 1.6). We did not find statistically significant associations between the serum long-chain omega-3 PUFAs or pubic hair mercury and risk of orthostatic hypotension, except for DPA. Those in the highest vs. the lowest serum DPA tertile had multivariate-adjusted 41% lower odds for orthostatic hypotension (95% confidence interval 7-63%, P-trend=0.02). Serum long-chain omega-3 PUFAs or mercury exposure were not associated with the risk of orthostatic hypotension, except for the inverse association with DPA.Hypertension Research advance online publication, 25 February 2016; doi:10.1038/hr.2016.19.
Background: Orthostatic hypotension, defined as a decrease in blood pressure on standing, is associated with an increased risk of mortality and cardiovascular events in the general population. In addition, it has recently been suggested that arterial stiffness is independently associated with orthostatic hypotension, which may be due to a loss of the buffering effect of the ascending aorta and an early return of pressure waves. However, the specific mechanisms underlying this association remain unclear. Thus, we aimed to evaluate the association between orthostatic hypotension and arterial stiffness in the adult population.
Methods: PubMed, Scopus, Web of Science, and Cochrane Library databases were searched from inception to 31 January 2022. The DerSimonian and Laird method was used to calculate pooled odds ratio (OR) estimates and their respective 95% confidence intervals (95% CI) for the association between orthostatic hypotension and arterial stiffness.
Results: Overall, 11 studies were included, with a total of 10,611 subjects. Our results showed that increased arterial stiffness raises the risk of orthostatic hypotension (OR: 1.40, 95% CI: 1.28–1.54), with a stronger association at central arterial stiffness (OR: 1.50, 95% CI: 1.34–1.68) than at peripheral arterial stiffness (OR: 1.29, 95% CI: 1.17–1.43).
Conclusion: Our findings showed that increased arterial stiffness raises the risk of orthostatic hypotension by 40% among the adult population. Considering that orthostatic hypotension, which is usually a consequence of antihypertensive treatment, has been widely associated with the risk of cardiovascular events, appropriate control of arterial stiffness could be a clinical strategy to prevent cardiovascular morbidity and mortality.
