Orthostatic hypotension without co-existent supine hypertension was associated with impaired cerebral oxygenation recovery, maintaining a 1.17% deficit in tissue saturation index at 180 seconds.
Cohort (n=2,761)
Does the presence of supine hypertension and/or orthostatic hypotension impair cerebral oxygenation during an active stand challenge in older adults?
Older adults with isolated orthostatic hypotension are at higher risk of cerebral hypoperfusion during standing than those with co-existent supine hypertension, suggesting that higher baseline blood pressure may protect cerebral blood flow during orthostatic drops.
Abstract Hypertension and orthostatic hypotension (OH) are common in older age, with both conditions recognized as risk factors for cardiovascular disease and end organ damage. Cerebral hypoperfusion is postulated to play a role in these adverse effects. For those with both hypertension and OH the effects on the cerebrovasculature are unclear, but there may be a risk of a higher hypotensive burden. We measured cerebral oxygenation utilizing near infrared spectroscopy, during an active stand challenge, and continuous blood pressure (BP), in The Irish Longitudinal Study on Ageing (TILDA) population. There was no difference in baseline oxygenation with supine hypertension (SH) or OH, but those with SH-OH had a higher supine BP, increased arterial stiffness and more cardiovascular conditions. Participants with SH-OH exhibited the largest BP drop and most impaired BP recovery on standing, yet the oxygenation response was not different to those with no SH and no OH. Those with OH only had the lowest BP values, lowest oxygenation values and most impaired oxygenation recovery, suggesting this group are at risk of cerebral hypotension when BP drops to low absolute values, whereas if BP is maintained at higher values as in those with SH-OH sufficient cerebral flow may be maintained.
Newman et al. (Sat,) conducted a cohort in Orthostatic hypotension and supine hypertension (n=2,761). Orthostatic hypotension without supine hypertension vs. Supine hypertension with or without orthostatic hypotension, and no supine hypertension/no orthostatic hypotension was evaluated on Change in Tissue Saturation Index (TSI) from baseline at 180 seconds (95% CI -1.46 to -0.87). Orthostatic hypotension without co-existent supine hypertension was associated with impaired cerebral oxygenation recovery, maintaining a 1.17% deficit in tissue saturation index at 180 seconds.