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The Respiratory System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Orthopnea is the term that describes dyspnea (difficulty m breathing) in the lying-down position (the prefix ortho- means "straight" or "flat," as in orthostatic hypertension). Orthopnea is often seen in cardiovascular disorders involving elevation of the pulmonary venous and capillary pressures.
Old and New Office Blood Pressure Measurement Approaches
Published in Giuseppe Mancia, Guido Grassi, Konstantinos P. Tsioufis, Anna F. Dominiczak, Enrico Agabiti Rosei, Manual of Hypertension of the European Society of Hypertension, 2019
Michael Bursztyn, Iddo Z. Ben-Dov
Older patients, those with diabetes mellitus, and those treated with medications, particularly α-blockers, should be examined for orthostatic hypotension (a reduction of ≥20 mmHg systolic or ≥10 mmHg diastolic) after 1 and 3 minutes of standing, because orthostatic hypotension is common, symptomatic at times, antedates falls and injuries, and has prognostic significance (29). Recently it was suggested that orthostatic hypertension, a BP rise of similar magnitude, is associated with adverse outcome (30), though this is not a consistent finding (31).
Hypertension
Published in Clive Handler, Gerry Coghlan, Marie-Anne Essam, Preventing Cardiovascular Disease in Primary Care, 2018
Clive Handler, Gerry Coghlan, Marie-Anne Essam
Blood pressure should be measured with the patient sitting at ease and as relaxed as possible, in a quiet room (or standing if elderly or diabetic, or if orthostatic hypertension is suspected). Two recordings separated by at least one minute should be taken, and more if the recordings are very different. Measure the blood pressure in both arms at the first visit, to investigate the possibility of coarctation. The patient should be relaxed.
When Blood Pressure Increases with Standing: Consensus Definition for Diagnosing Orthostatic Hypertension
Published in Blood Pressure, 2023
Jens Jordan, Italo Biaggioni, Guido Grassi, Artur Fedorowski, Kazuomi Kario
An international expert panel suggested pragmatic definitions for an exaggerated orthostatic pressor response and for orthostatic hypertension.3,4 An exaggerated orthostatic pressor response was defined as sustained increase in systolic blood pressure by at least 20 mmHg when changing from the supine to the standing position regardless of absolute blood pressure while standing. Orthostatic hypertension was defined as an exaggerated orthostatic pressor response associated with systolic blood pressure of at least 140 mmHg while standing. An increase in systolic blood pressure by 20 mmHg corresponds is approximately two standard deviations above the population mean in the Malmö Preventive Project5 and the Malmö Offspring Study.6 Diastolic blood pressure was not included in the definition because increases in diastolic blood pressure with standing can be normal and are difficult to interpret, particluarly in patients with elevated standing heart rate. The panel decided to differentiate between an exaggerated orthostatic pressor response and orthostatic hypertenson because individuals with blood pressure in the normal range could otherwise be labeled as hypertensive. The panel recognized that we lack empirical data to determine if these definitions predict increased cardiovascular risk.
Atherosclerosis of the carotid bulb is associated with the severity of orthostatic hypotension in non-diabetic adult patients: a cross-sectional study
Published in Clinical and Experimental Hypertension, 2019
Yusuke Kobayashi, Hiroaki Ishiguro, Tetsuya Fujikawa, Hideo Kobayashi, Koichiro Sumida, Minako Kagimoto, Yuki Okuyama, Yosuke Ehara, Mari Katsumata, Megumi Fujita, Akira Fujiwara, Sanae Saka, Keisuke Yatsu, Nobuhito Hirawa, Yoshiyuki Toya, Gen Yasuda, Satoshi Umemura, Kouichi Tamura
Middle-aged and older (age ≥ 40 years) patients undergoing treatment for lifestyle-related diseases such as hypertension (HT) and dyslipidaemia (DL) at the Kobayashi Medical Clinic, Yokohama, Japan, from February 2013 to October 2017 were consecutively enrolled in the study. Patients with diabetes mellitus (DM) were excluded, as were patients with a history of severe atherosclerotic disease, such as evident cerebrovascular disease (CVD, including transient ischemic attack); arrhythmias (including atrial fibrillation and flutter); malignancy; or neurodegenerative disorders, such as Parkinson’s disease; and patients suspected of having an autoimmune disease (including patients with fever, inflammation, or skin disorders). These diseases were defined as described in a previous report (16). Furthermore, we excluded patients who had been diagnosed with orthostatic hypertension (change of systolic blood pressure (SBP) ≥ 20 mmHg in the upright position), which is one phenotype of orthostatic blood pressure change that might be caused by arterial stiffening and hyper-sympathetic activity. Since arterial stiffening and hyper-sympathetic activity are suggested to be common causes of both orthostatic hypertension and OH, we excluded patients with orthostatic hypertension or DM (who also has high risk of severe arterial stiffening and autonomic dysfunction) to avoid confounding of the reverse BP response to OH. The Ethics Committee of Yokohama City University Hospital approved this study. The experiments were conducted with the understanding and written informed consent of each participant.
Hemodynamic characterization of hypertensive patients with an exaggerated orthostatic blood pressure variation
Published in Clinical and Experimental Hypertension, 2018
Jessica Barochiner, Lucas S. Aparicio, José Alfie, Marcelo A. Rada, Margarita S. Morales, Carlos R. Galarza, Paula E. Cuffaro, Marcos J. Marín, Rocío Martínez, Gabriel D. Waisman
Given that orthostatic hypertension is associated with cardiovascular morbidity (12–15), elucidating the mechanisms implicated is critical in order to properly select the antihypertensive treatment in hypertensive patients with an exaggerated increase in BP while standing. For instance, in a study in 241 elderly hypertensives, α-adrenergic blockade led to decreases in the orthostatic response (3). On the other hand, β-blockers may be harmful in these patients, by potentiating the α-mediated vasoconstriction (16). Our findings may give a pathophysiological support to the α-adrenergic blockade therapeutic strategy.