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Orthostatic Hypotension in Older Adults

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This book provides a comprehensive and practical guide to orthostatic hypotension (OH) for doctors and nurses involved in the care of older adults, together with a state-of-the-art update on OH, covering its epidemiology, pathophysiology, assessment, diagnosis, causes, prevention, management, and relevance for geriatric practice. In addition, it addresses mechanisms of orthostatic tolerance and other orthostasis related conditions, as well as drugs, comorbidities and geriatric syndromes related to OH.

The homeostatic ability to maintain blood pressure while standing requires an adequate blood volume and the integrity of the nervous system, heart, blood vessels and muscle pump. However, in older adults, some age-related factors can contribute to the development of OH. For example, decreased baroreflex sensitivity, α-1-adrenergic vasoconstrictor response to sympathetic stimuli, parasympathetic activity, renal salt and water conservation, increased vascular stiffness and decreased ventricular diastolic filling, as well as concentrated capacities of the kidney may be associated with changes in postural blood pressure. It has also been shown that OH is associated with falls, cardiac events, heart failure, stroke, reduced quality of life, and increased risk of overall mortality in these patients.

“Orthostatic Hypotension in Older Adults” will be of considerable interest to all professionals working in the fields of geriatrics, geriatric psychiatry, neurology, internal medicine, cardiology, and emergency medicine, or working with older people in hospitals or in their community. 

Author(s): Ahmet Turan Isik, Pinar Soysal
Publisher: Springer
Year: 2021

Language: English
Pages: 148
City: Cham

Preface
Contents
1: Mechanisms of Orthostatic Tolerance and Age-Related Changes in Orthostatic Challenge
1.1 Introduction
1.2 Mechanisms of Orthostatic Tolerance
1.2.1 Cardiac Mechanism
1.2.2 Parasympathetic and Sympathetic Nervous Systems (Baroreflex)
1.2.3 Muscle Pump Reflex
1.2.4 Renal and Endocrine Systems
1.3 Age-Related Changes in Orthostatic Challenge
1.4 Conclusion
References
2: Orthostatic Hypotension: A New Geriatric Syndrome
2.1 Is OH a Geriatric Syndrome?
References
3: Epidemiology and Risk Factors Associated with Orthostatic Hypotension in Older Adults
3.1 Epidemiology
3.2 Pathophysiology
3.3 Risk Factors
3.3.1 Age as a Risk Factor for Orthostatic Hypotension
3.3.2 General and Lifestyle-Related Risk Factors
3.3.3 Medical Conditions as Risk Factors
3.3.4 Orthostatic Hypotension as Predictor for Other Health Outcomes
References
4: Orthostatic Hypotension: Clinical Features
4.1 Orthostatic Hypotension: Clinical Features
4.1.1 Orthostatic Intolerance and Orthostatic Hypotension
4.1.2 Associated Clinical Features of Orthostatic Hypotension
4.1.2.1 Falls and Syncope
4.1.2.2 Cognition
4.1.2.3 Cardiovascular Disease and Mortality
4.2 Conclusion
References
5: Diagnosis and Differential Diagnosis
5.1 Introduction
5.2 Diagnosis of OH
5.3 Variants of OH
5.4 Screening for OH
5.5 Recommendations for Accurate Diagnosis of OH
5.6 Gray Areas in Timing and Method for Diagnosis of OH
5.7 Reproducibility
5.8 Differential Diagnosis in OH
5.9 Conclusions
References
6: Orthostatic Hypotension and Drugs: Drug-Induced Orthostatic Hypotension
6.1 Introduction
6.2 Epidemiology
6.3 Drug-Induced Orthostatic Hypotension
6.4 The Relationship of Orthostatic Hypotension with Age
6.5 Pathophysiology
6.6 The Control Mechanisms in Maintaining Blood Pressure
6.7 Drug-Mediated Dysfunctions of Blood Pressure Maintenance in Older Age
6.8 α-Adrenergic Receptor Antagonists
6.9 Diuretics
6.10 Angiotensin Converting Enzyme (ACE) Inhibitors
6.11 Calcium Channel Blockers
6.12 Beta-Adrenergic Receptor Antagonists
6.13 Antipsychotic Drugs
6.14 Tricyclic Antidepressant Drugs
6.15 Anti-parkinsonian Drugs
6.16 Conclusion
References
7: Comorbidities and Geriatric Syndromes Related to Orthostatic Hypotension
7.1 Frailty and Orthostatic Hypotension
7.2 Dementia and Orthostatic Hypotension
7.3 Depression and Orthostatic Hypotension
7.4 Sarcopenia and Orthostatic Hypotension
7.5 Malnutrition and Orthostatic Hypotension
7.6 Falls/Fear of Falling and Orthostatic Hypotension
7.7 Orthostatic Hypotension and Comorbidities
7.8 Orthostatic Hypotension and Mortality
References
8: Orthostatic Hypotension in Neurodegenerative Diseases
8.1 Primer Autonomic Degenerative Disorders
8.1.1 Synucleopathies
8.1.1.1 Parkinson Disease (PD)
8.1.1.2 Dementia of Lewy Body (DLB)
8.1.1.3 Pure Autonomic Failure (PAF)
8.1.1.4 Multi System Atrophy (MSA)
8.1.2 Drugs
8.2 Peripheral Autonomic Disorders
8.3 Others
8.4 Treatment of Neurogenic Orthostatic Hypotension
References
9: Orthostatic Hypotension and Complications
9.1 Introduction
9.2 Association Between Orthostatic Hypotension and Syncope and Falls
9.3 Association Between Orthostatic Hypotension and Cardiovascular Disease
9.4 Association Between Orthostatic Hypotension and Neurological Conditions
9.5 Association Between Orthostatic Hypotension and Mortality
9.6 Conclusions
References
10: Nursing Perspective for Older Patient with Orthostatic Hypotension
10.1 Evaluate Blood Pressure
10.2 Education
10.3 Activity/Exercise
10.4 Elastic Bandage
10.5 Abdominal Binder
10.6 Diet
10.7 Bath Therapy
References
11: Prevention and Treatment
References
12: Orthostatic Hypertension
12.1 Definition
12.2 Pathophysiology
12.3 Epidemiology and Clinical Significance
12.4 Management and Treatment
12.5 Conclusion
References
13: Other Syndromes of Orthostatic Intolerance: Delayed Orthostatic Hypotension, Postprandial Hypotension, Postural Orthostatic Tachycardia Syndrome, and Reflex Syncope
13.1 Delayed and Postprandial Orthostatic Hypotension
13.1.1 Delayed Orthostatic Hypotension
13.1.1.1 Prevalence and Clinical Significance of Delayed OH
13.1.1.2 Diagnosis
13.1.1.3 Treatment
13.1.2 Postprandial Orthostatic Hypotension
13.2 Postural Orthostatic Tachycardia Syndrome
13.2.1 Diagnosis
13.2.2 Treatment
13.3 Reflex Syncope
13.3.1 Orthostatic Vasovagal Syncope
13.3.2 Carotid Sinus Syndrome
References
Index