Publication year
2013Source
Journals of Gerontology Series A-Biological Sciences and Medical Sciences, 68, 5, (2013), pp. 581-589ISSN
Publication type
Article / Letter to editor

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Organization
Geriatrics
IQ Healthcare
Journal title
Journals of Gerontology Series A-Biological Sciences and Medical Sciences
Volume
vol. 68
Issue
iss. 5
Page start
p. 581
Page end
p. 589
Subject
DCN PAC - Perception action and control NCEBP 11: Alzheimer Centre; NCEBP 14: Cardiovascular diseasesAbstract
BACKGROUND: Though highly prevalent, the pathophysiology of orthostatic hypotension (OH), postprandial hypotension (PPH), and carotid sinus hypersensitivity (CSH) are rarely studied together. Therefore, we conducted such a comprehensive study focusing on the common role of the cardiovascular autonomic system. We hypothesized that in geriatric patients, OH, PPH, and CSH are manifestations of cardiovascular autonomic dysfunction and investigated state-of-the-art cardiovascular autonomic function indices in a group of geriatric falls or syncope patients. METHODS: In a cross-sectional study of 203 consecutive eligible falls clinic patients, we compared heart rate variability (HRV), blood pressure variability (BPV), and baroreflex sensitivity (BRS) as potential autonomic function determinants of the three different hypotensive syndromes. RESULTS: OH, PPH, and CSH were diagnosed in 53%, 57%, and 50% of the patients, respectively. In a population relevant for geriatric practice, we found no differences in HRV, BPV, and BRS between patients with and without OH, with and without PPH, and with and without CSH, respectively, nor between patients with and without falls, dizziness, or syncope as presenting symptom, respectively. CONCLUSIONS: In geriatric patients with hypotensive syndromes, cardiovascular autonomic function as measured by HRV, BPV, and BRS is comparable to patients without such syndromes. These findings argue against a single or dominant etiological factor, that is, cardiac autonomic dysfunction and underline the structured, broad, and multifactorial approach to elderly patients with falls and/or syncope as proposed in the current evidence-based syncope guidelines.
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