• Annals of Clinical Neurophysiology
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• v.25 no.2
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• pp.66-77
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• 2023

Orthostatic hypotension is a sustained and pathological drop in blood pressure upon standing. Orthostatic hypotension can be due to non-neurogenic conditions or autonomic disorders. Impaired baroreflex-mediated vasoconstriction and insufficient release of norepinephrine play key roles in the pathophysiology of neurogenic orthostatic hypotension. Its common symptoms mainly related to inadequate cerebral blood flow include dizziness, lightheadedness, and syncope. It is crucial to differentiate neurogenic orthostatic hypotension from non-neurogenic orthostatic hypotension. For the management of neurogenic orthostatic hypotension, physicians should implement non-pharmacological methods and, if possible, reverse combined non-neurological conditions. Depending on severity of symptoms, pharmacological intervention may be tried after or with non-pharmacological methods. Its management should be individualized based on intensity of symptoms, comorbid conditions, drug side effects, and etiology. In this review, we discuss the definition, pathophysiology, clinical approach, and management of neurogenic orthostatic hypotension.

• Journal of Korean Academy of Nursing
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• v.33 no.2
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• pp.200-209
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• 2003

Purpose: This study was to identify the prevalence of orthostatic hypotension and its association with risk factors of orthostatic hypotension aged over 60 in Seoul and Chungju, Korea. Method: The data were collected from the 22th of August, 2000 to the 7th May 2001. The participants were 74 community-dwelling aged who could stand up from sitting position without assistance. Subjects were interviewed with structured questionnaire in order to ask experience of previous falls, hours in per day, symptoms related orthostatic hypotension and demographic characteristics. Orthostatic hypotension was assessed at 1 minute after the subjects standing from sitting position and defined as 20mmHg or greater decrease in systolic blood pressure after standing. Result: The prevalence of orthostatic hypotension was 17.1%. The mean drop of systolic blood pressure was 27.46mmHg among orthostatic hypotension subjects. The significant variables which explain the occurrence of orthostatic hypotension was the basal systolic blood pressure, the hit ratio of discriminant function with basal systolic blood pressure was 69.7%. Conclusion: Finding indicate that this study will contribute to develop nursing strategies to identify risk factors and to prevent orthostatic hypotension for the aged.

• Journal of Korean Clinical Nursing Research
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• v.17 no.2
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• pp.275-285
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• 2011

Purpose: Head-up position during sleep is one of the non-pharmacologic interventions for the treatment of orthostatic hypotension. Because the head-up position causes discomfort in many patients, this approach may not be acceptable to all patients. We compared the systolic blood pressure in erect position, orthostatic hypotension, orthostatic disability score, and the improvement rates of orthostatic hypotension between the 20 cm head-up group and the 10 cm head-up group. Methods: A control pre/post-test design was used. Between August 1, 2009 and November 15, 2010, we consecutively enrolled patients who showed orthostatic hypotension in patients with Parkinsonian disorders. Sixty-seven patients were prospectively enrolled and forty-four patients were completed the study. Results: There were no statistically significant differences found in the systolic blood pressure in erect position, orthostatic hypotension, and orthostatic disability scores between the two groups. However, five patients showed improvement in 20 cm head-up group and one patient was showed improvement in 10 cm head-up Group. Conclusion: Orthostatic hypotension is decreased with 20 cm head-up position in some patients with Parkinsonian disorders (p=.034). Further research investigating the relationships between orthostatic hypotension and head-up position are warranted.

• Journal of muscle and joint health
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• v.22 no.3
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• pp.160-166
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• 2015

Purpose: The purpose of this study is to examine the effect of leg crossing on reducing orthostatic hypotension and orthostatic hypotension symptoms in hemodialysis patients. Methods: A one-group pretest-posttest design was used. A total of 40 post-hemodialysis adult patients were enrolled, excluding the case of intradialysis hypotension, unbalance of standing with leg crossing, adding antihypertensive medications. Blood pressure (BP) and heart rate (HR) were measured in supine and standing positions. After a week, BP and HR were measured in supine and standing with leg crossing position. Orthostatic hypotension symptoms were also measured by self-reported structured questionnaire in standing without leg crossing and with leg crossing position. Results: We found out that systolic blood pressure, diastolic blood pressure, and mean arterial pressure increased significantly in standing with crossing leg position applied (p=.006, p=.001, p=.006). However, presences of orthostatic hypotension symptoms were not significantly decreased in standing with leg crossing position (p=.500, p=.318, p=.306, p=.241, p=.356, p=.500, p=.241, p=.308). Conclusion: This study shows that leg crossing is effective for reducing orthostatic hypotension without additional cost or instruments. Leg crossing as one of the preventive interventions to reduce orthostatic hypotension is easier and simpler to be implemented in hemodialysis patients.

• Journal of Oriental Medical Thermology
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• v.2 no.1
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• pp.29-34
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• 2003

Purpose The purpose of this study was to verify the association between Cold Hypersensitivity and Orthostatic Hypotension(OH). Method This study was carried out on 39 women who visited outpatient department of Dept. of Gynecology. Bundang CHA oriental Hospital. College of Medicine. Pochun CHA univ. from December 2001 to November 2002. We divided them into two groups (Orthostatic Hypotension Group 24, Normal BP Group 15) and investigated general characteristics, weight, height, past history. family history through out the patient's note. OH was assessed 1 minute after the patients rose from a supine position by using tilting table. For the diagnosis of cold hypersensitivity, thermographic measurements were performed on two pairs of areas(palm-upper arm and back of hand-upper arm. And for that of the feet, other two pairs of areas(anterior thigh-top of the feet and posterior thigh-heel). And then by which verify the association between Cold Hypersensitivity and Orthostatic Hypotension(OH) Results As a results, 16 out of 24 patients, the OH group had cold hypersensitivity and 4 out of 15 Patients the normal BP group had cold hypersensitivity. It means that there was association between Cold Hypersensitivity and Orthostatic Hypotension(OH). Conclusion Above these results, we can reach the conclusion that OH is considered one of the causes of cold hypersensitivity.

• Annals of Clinical Neurophysiology
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• v.21 no.1
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• pp.66-69
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• 2019

Orthostatic hypotension (OH) is commonly associated with autonomic failure in the peripheral nervous system. Less often it is related to central lesions in brainstem and cerebellum. We describe a patient with OH associated with tuberculosis meningoencephalitis involving the brainstem including rostral ventrolateral medulla. This is the first case of OH resulting from focal lesions in the dorsal medulla in a patient with meningoencephalitis.

• Annals of Clinical Neurophysiology
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• v.25 no.1
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• pp.27-31
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• 2023

Orthostatic dizziness is feeling dizzy or lightheaded when standing up. Hemodynamic orthostatic dizziness can be caused by autonomic dysfunction such as orthostatic hypotension or postural tachycardia syndrome. The interpretation of the autonomic function test results in patients with orthostatic dizziness is crucial for diagnosing and managing the underlying condition. The head-up tilt and Valsalva tests are especially important for evaluating adrenergic function in patients with hemodynamic orthostatic dizziness. However, it is important to note that autonomic function tests do not cover the entire diagnostic process, since their findings need to be considered along with the detailed history and physical examination results of the patient because various differential diagnoses exist for orthostatic dizziness. Ensuring appropriate treatment by interpreting the autonomic function test results can help to determine the improvement of and prevents falls from orthostatic dizziness.

• The Korean Journal of Physiology and Pharmacology
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• v.19 no.3
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• pp.275-281
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• 2015

Orthostatic hypotension is most common in elderly people, and its prevalence increases with age. Attenuation of the vestibulo-sympathetic reflex (VSR) is commonly associated with orthostatic hypotension. In this study, we investigated the role of glutamate on the vestibulo-solitary projection of the VSR pathway to clarify the pathophysiology of orthostatic hypotension. Blood pressure and expression of both pERK and c-Fos protein were evaluated in the nucleus tractus solitarius (NTS) after microinjection of glutamate into the medial vestibular nucleus (MVN) in conscious rats with sodium nitroprusside (SNP)-induced hypotension that received baroreceptor unloading via sinoaortic denervation (SAD). SNP-induced hypotension increased the expression of both pERK and c-Fos protein in the NTS, which was abolished by pretreatment with glutamate receptor antagonists (MK801 or CNQX) in the MVN. Microinjection of glutamate receptor agonists (NMDA or AMPA) into the MVN increased the expression of both pERK and c-Fos protein in the NTS without causing changes in blood pressure. These results indicate that both NMDA and AMPA receptors play a significant role in the vestibulo-solitary projection of the VSR pathway for maintaining blood pressure, and that glutamatergic transmission in this projection might play a key role in the pathophysiology of orthostatic hypotension.

• Korean Journal of Adult Nursing
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• v.26 no.3
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• pp.341-351
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• 2014

Purpose: The purpose of the study was to examine preventive effects of tailored water drinking on orthostatic hypotension and heart rate variability in the elderly. Methods: A non-equivalent control group pre and post time-series design was adapted. Among a total of 64 elderly people admitted to two nursing homes, 35 elderly were assigned to the experimental group and 29 were assigned to the control group. As for the elderly people in the experimental group, tailed water drink was provided according to the scheduled time for six weeks. Blood pressure and heart rate were measured twice before the intervention in both groups. The data were analyzed with SPSS program using t-test, ${\chi}^2$-test, and repeated measure of ANOVA. Results: There were significant differences in blood pressure and heart rate variability between the two groups. Conclusion: Tailored water drinking had preventive effects on decreasing blood pressure fall as well as prevalence of orthostatic hypotension in the elderly people.

• Journal of Korean Medicine Rehabilitation
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• v.18 no.2
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• pp.131-142
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• 2008

Objectives : This study was performed to identify the influence of salivary cortisol and HRV(Heart rate variability) on hypoadrenia predisposing factors and sign. Methods : 30 patients with chronic fatigue symptom belonging to Shen xu(腎虛) were recruited for investigation from March to April 2007. The participants were divided into HS(High score) group(n=15) and LS(Low score) group(n=15) in predisposing factors of adrenal questionnaire. At the same time equal patients separated into OH(+)(Orthostatic hypotension positive) group(n=12) and OH(-)(Orthostatic hypotension negative) group(n=18). Salivary cortisol and HRV made use of evaluating hormonal imbalance and autonomic nervous system of hypoadrenia. Results : Salivary cortisol at P.M.4 in HS group was significantly(p=0.011) lower than LS group. And LF(Low frequency) of OH(+) group was considerably(p=0.014) lower than OH(-) group. Conclusions : Shen xu bian zheng(腎虛辨證), measure of orthostatic hypotension, predisposing factors of adrenal questionnaire, salivary cortisol and HRV deserve clinical application for management of subclinical hypoadrenia.