scholarly journals Management of initial orthostatic hypotension: lower body muscle tensing attenuates the transient arterial blood pressure decrease upon standing from squatting

2007 ◽  
Vol 113 (10) ◽  
pp. 401-407 ◽  
Author(s):  
C. T. Paul Krediet ◽  
Ingeborg K. Go-Schön ◽  
Yu-Sok Kim ◽  
Mark Linzer ◽  
Johannes J. Van Lieshout ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Orthostatic Hypotension ◽  
Healthy Subjects ◽  
Lower Body ◽  
Blood Pressure Decrease ◽  
Body Muscle ◽  
Arterial Blood ◽  
Pressure Decrease ◽  
Standing Up ◽  
Initial Orthostatic Hypotension

IOH (initial orthostatic hypotension) comprises symptoms of cerebral hypoperfusion caused by an abnormally large transient MAP (mean arterial pressure) decrease 5–15 s after arising from a supine, sitting or squatting position. Few treatment options are available. In the present study, we set out to test the hypothesis that LBMT (lower body muscle tensing) attenuates IOH after rising from squatting and its symptoms in daily life. A total of 13 IOH patients (nine men; median age, 27 years) rose from squatting twice, once with LBMT and once without. In addition, seven healthy volunteers (five men; median age, 27 years) were studied in a cross-over study design. They stood up from the squatting position three times, once combined with LBMT. Blood pressure (Finometer) was measured continuously, and CO (cardiac output) by Modelflow and TPR (total peripheral resistance) were computed. MAP, CO and TPR were compared without and with LBMT. Using a questionnaire, the perceived effectiveness of LBMT in the patients' daily lives was evaluated. With LBMT, the minimal MAP after standing up was higher in both groups (19 mmHg in patients and 13 mmHg in healthy subjects). In healthy subjects, the underlying mechanism was a blunted TPR decrease (to 47% compared with 60%; P<0.05), whereas in the patients no clear CO or TPR pattern was discernible. During follow-up, eight out of ten patients using LBMT reported fewer IOH symptoms. In conclusion, LBMT is a new intervention to attenuate the transient blood pressure decrease after standing up from squatting, and IOH patients should be advised about the use of this manoeuvre.

A sudden arterial blood pressure decrease is compensated by an increase in intracranial blood volume

2002 ◽  
Vol 249 (5) ◽  
pp. 538-541 ◽  
Author(s):  
Bernhard Rosengarten ◽  
Damian Rüskes ◽  
Irene Mendes ◽  
Erwin Stolz
Keyword(s):  
Blood Pressure ◽  
Arterial Blood Pressure ◽  
Blood Volume ◽  
Blood Pressure Decrease ◽  
Arterial Blood ◽  
Pressure Decrease

Case 35: Initial Orthostatic Hypotension

2019 ◽  
pp. 211-214
Author(s):  
Peter Novak
Keyword(s):  
Blood Pressure ◽  
Orthostatic Hypotension ◽  
Autonomic Failure ◽  
Rapid Decrease ◽  
Standing Up ◽  
Initial Orthostatic Hypotension

Initial orthostatic hypotension (IOH)is characterized by a rapid decrease in blood pressure in response to standing up quickly, with restoration of blood pressure in less than a minute. IOH is not associated with autonomic failure.

Initial orthostatic hypotension and cerebral blood flow regulation: effect of α1-adrenoreceptor activity

2013 ◽  
Vol 304 (2) ◽  
pp. R147-R154 ◽  
Author(s):  
Nia C. S. Lewis ◽  
Philip N. Ainslie ◽  
Greg Atkinson ◽  
Helen Jones ◽  
Emily J. M. Grant ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Orthostatic Hypotension ◽  
Relative Difference ◽  
Cerebral Hypoperfusion ◽  
Adrenergic Blockade ◽  
Absolute Level ◽  
Arterial Blood ◽  
Placebo Trial ◽  
Initial Orthostatic Hypotension ◽  
End Tidal

We examined the hypothesis that α1-adrenergic blockade would lead to an inability to correct initial orthostatic hypotension (IOH) and cerebral hypoperfusion, leading to symptoms of presyncope. Twelve normotensive humans (aged 25 ± 1 yr; means ± SE) attempted to complete a 3-min upright stand, 90 min after the administration of either α1-blockade (prazosin, 1 mg/20 kg body wt) or placebo. Continuous beat-to-beat measurements of middle cerebral artery velocity (MCAv; Doppler), blood pressure (finometer), heart rate, and end-tidal Pco2were obtained. Compared with placebo, the α1-blockade reduced resting mean arterial blood pressure (MAP) (−15%; P < 0.01); MCAv remained unaltered ( P ≥ 0.28). Upon standing, although the absolute level of MAP was lower following α1-blockade (39 ± 10 mmHg vs. 51 ± 14 mmHg), the relative difference in IOH was negligible in both trials (mean difference in MAP: 2 ± 2 mmHg; P = 0.50). Compared with the placebo trial, the declines in MCAv and PetCO2during IOH were greater in the α1-blockade trial by 12 ± 4 cm/s and 4.4 ± 1.3 mmHg, respectively ( P ≤ 0.01). Standing tolerance was markedly reduced in the α1-blockade trial (75 ± 17 s vs. 180 ± 0 s; P < 0.001). In summary, while IOH was little affected by α1-blockade, the associated decline in MCAv was greater in the blockade condition. Unlike in the placebo trial, the extent of IOH and cerebral hypoperfusion failed to recover toward baseline in the α1-blockade trial leading to presyncope. Although the development of IOH is not influenced by the α1-adrenergic receptor pathway, this pathway is critical in the recovery from IOH to prevent cerebral hypoperfusion and ultimately syncope.

Lower limb-localized vascular phenomena explain initial orthostatic hypotension upon standing from squat

2011 ◽  
Vol 301 (5) ◽  
pp. H2102-H2112 ◽  
Author(s):  
Michael E. Tschakovsky ◽  
Kristine Matusiak ◽  
Catherine Vipond ◽  
Lisa McVicar
Keyword(s):  
Blood Pressure ◽  
Cardiac Output ◽  
Orthostatic Hypotension ◽  
Arterial Blood Pressure ◽  
Lower Limb ◽  
Potential Contribution ◽  
Vascular Conductance ◽  
Leg Muscles ◽  
Arterial Blood ◽  
Initial Orthostatic Hypotension

The cause(s) of initial orthostatic hypotension (transient fall in blood pressure within 15 s upon active rising) have not been established. We tested the hypothesis that this hypotension is due to local vascular phenomena in contracting leg muscles from the brief effort of standing up. Seventeen young healthy subjects (2 male and 15 female, 22.5 ± 1.0 years) performed an active rise from resting squat after a 10-s squat, a 1-min squat, or a 5-min squat. Beat-by-beat arterial blood pressure, cardiac output, heart rate, and stroke volume (Finometer finger photoplethysmography) and right common femoral artery blood flow (Doppler and Echo ultrasound) were recorded. Data are means ± SE. Quiet standing before squat represented baseline. Peak increases in lower limb and total vascular conductance (ml·min−1·mmHg−1) upon standing were not different within squat conditions (10-s squat, 50.0 ± 12.4 vs. 44.3 ± 5.0; 1-min squat, 54.7 ± 9.2 vs. 50.5 ± 4.5; 5-min squat, 67.4 ± 13.7 vs. 58.8 ± 3.9; all P > 0.574). Mean arterial blood pressure (in mmHg) fell to a nadir well below standing baseline in all conditions despite increases in cardiac output. The hypotension predicted by the increase in leg vascular conductance accounted for this hypotension [observed vs. predicted (in mmHg): 10-s squat, −17.1 ± 2.1 vs. −18.3 ± 5.5; 1-min squat, −22.0 ± 3.8 vs. −25.3 ± 4.9; 5-min squat, −28.3 ± 4.0 vs. −29.2 ± 6.7]. We conclude that rapid contraction induced dilation in leg muscles with the effort of standing, along with a minor potential contribution of elevated lower limb arterio-venous pressure gradient, outstrips compensatory cardiac output responses and is the cause of initial orthostatic hypotension upon standing from squat.

Association of Early Blood Pressure Decrease and Renal Function With Prognosis in Acute Heart Failure

2021 ◽  
Author(s):  
Yuya Matsue ◽  
Iziah E. Sama ◽  
Douwe Postmus ◽  
Marco Metra ◽  
Barry H. Greenberg ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Renal Function ◽  
Acute Heart Failure ◽  
Blood Pressure Decrease ◽  
Pressure Decrease
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