The relative contribution of hemodynamic parameters to blood pressure decrease in classical orthostatic hypotension

Journal of Hypertension, vol. 43, pp. 436–444

Abstract

PURPOSE: We studied the relative contributions of total peripheral resistance (TPR), stroke volume (SV) and heart rate (HR) to low blood pressure in classical orthostatic hypotension (cOH) on group and individual levels. METHODS: We retrospectively analyzed tilt test records from cOH patients and age/sex-matched controls. We quantified relative effects of HR, SV and TPR on mean arterial pressure (MAP) with the log-ratio method. We studied relations of changes of HR, SV or TPR with the change of MAP across patients and variability of contributions of HR, SV and TPR to MAP. We also explored neurogenic vs. nonneurogenic causes. RESULTS: MAP responded to tilt with a decrease in patients ( n = 80) and an increase in controls ( n = 80). A too small TPR-increase contributed most to cOH, followed by a too large SV-decrease; both effects were partially corrected by a larger increase of HR. Only TPR changes consistently affected MAP change in patients and controls. TPR decreased almost exclusively in patients, most in those with severe cOH. Contributions of HR, SV and TPR to MAP did not differ between probable neurogenic and nonneurogenic causes. CONCLUSION: HR, SV and TPR all contributed to cOH, with a key role for TPR; a decrease of TPR was almost unique to patients and may be due to hyperventilation. The lack of differences between neurogenic and nonneurogenic causes needs further study.

Authors 10

1. Boriana S. Gagaouzova corresponding Aachen Department of Neurology and Clinical Neurophysiology

   Leiden University · Leiden University Medical Center · Stichting Epilepsie Instellingen Nederland

   Affiliation as printed

   Department of Neurology and Clinical Neurophysiology, Leiden University Medical Centre, Leiden

   Stichting Epilepsie Instellingen Nederland-SEIN, Heemstede

2. Amber van der Stam Aachen Department of Neurology and Clinical Neurophysiology

   Leiden University · Radboud University Nijmegen · Leiden University Medical Center · Radboud University Medical Center

   Affiliation as printed

   Department of Neurology and Clinical Neurophysiology, Leiden University Medical Centre, Leiden

   Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands

3. Madeleine Johansson

   Lund University · Skåne University Hospital

   Affiliation as printed

   Department of Cardiology, Skåne University Hospital

   Department of Clinical Sciences, Lund University, Malmö, Sweden

4. Ineke A. van Rossum Aachen Department of Neurology and Clinical Neurophysiology

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Neurology and Clinical Neurophysiology, Leiden University Medical Centre, Leiden

5. Fabian I. Kerkhof Aachen Department of Neurology and Clinical Neurophysiology

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Neurology and Clinical Neurophysiology, Leiden University Medical Centre, Leiden

6. Robert H. A. M. Reijntjes Aachen Department of Neurology and Clinical Neurophysiology

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Neurology and Clinical Neurophysiology, Leiden University Medical Centre, Leiden

7. Marc van Houwelingen

   Erasmus MC

   Affiliation as printed

   Department of Experimental Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands

8. Roland D. Thijs Aachen Department of Neurology and Clinical Neurophysiology

   Leiden University · Leiden University Medical Center · Stichting Epilepsie Instellingen Nederland · UCL Queen Square Institute of Neurology · University College London

   Affiliation as printed

   Department of Neurology and Clinical Neurophysiology, Leiden University Medical Centre, Leiden

   Stichting Epilepsie Instellingen Nederland-SEIN, Heemstede

   UCL Queen Square Institute of Neurology, University College London, London, UK

9. Artur Fedorowski

   Karolinska University Hospital · Lund University · Karolinska Institutet

   Affiliation as printed

   Department of Cardiology, Karolinska University Hospital

   Department of Clinical Sciences, Lund University, Malmö, Sweden

   Department of Medicine, Karolinska Institute, Stockholm, Sweden

10. J. Gert van Dijk Aachen Department of Neurology and Clinical Neurophysiology

    Leiden University · Leiden University Medical Center

    Affiliation as printed

    Department of Neurology and Clinical Neurophysiology, Leiden University Medical Centre, Leiden