Vol 8, No 6 (2004)
Original paper
Published online: 2004-12-14

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The influence of orthostatic stimulus on pulse pressure in older patients

Dorota Zyśko, Jacek Gajek, Małgorzata Wawrzynek, Maria Witkowska, Walentyna Mazurek
Nadciśnienie tętnicze 2004;8(6):425-430.

Abstract

Background Pulse pressure is an independent risk factor for cardiovascular death. The purpose of this study is an assessment of the influence of orthostatic stimulus on pulse pressure in patients older than 70 years of age with regard to well known risk factors of cardiovascular events.
Material and methods The study population consisted of 75 patients (pts), aged 76 ± 4.4 years (57 F, 18 M) diagnosed because of unexplained syncope. The blood pressure measurements were taken during diagnostic head-up tilt test (HUT): in baseline, immediately after beginning of HUT (period I) and at the end of passive phase of HUT (period II). The patients were divided into hypertensive individuals (group I - 60 pts), and normotensive individuals - 15 pts (group II). All studied pts were examined using ultrasound carotid arteries evaluation, echocardiographic evaluation and serum concentration and clearance of creatinine. In 8 pts diabetes was diagnosed, 10 pts had a history of myocardial infarction, in 36 pts significant atherosclerotic lesions in carotid arteries were identified, in 44 pts left ventricular hypertrophy (LVH) was diagnosed.
Results Blood pressure values were significantly higher in group I than in II. There was a progressively decrease in pulse pressure during tilting: 59 ± 16 vs. 54 ± 18 vs. 41 ± 14 mm Hg (group I) and 47 ± 11 vs. 38 ± 12 vs. 36 ± 12 mm Hg (group II) - baseline vs. period I vs. period II, respectively. In the whole studied group baseline pulse pressure correlated with age (r = 0.28; p < 0.05). Pulse pressure was higher in group I, in patients with carotid atherosclerosis, with lower creatinine clearance and with LVH. In regression analysis the presence of hypertension, decreased creatinine clearance and LVH correlated independently with pulse pressure. Pulse pressure immediately after the beginning of tilt test did not correlate with any studied parameter and was higher in group I than in II (54 ± 18 vs. 38 ± 12 mm Hg; p < 0.005).
Conclusions In patients older than 70 years of age pulse pressure under influence of orthostatic stimulus decreases. Pulse pressure at baseline and immediately after beginning of tilt test is higher in patients with hypertension comparing to normotensive individuals. Pulse pressure in vertical position do not correlate with age nor target organ damage.

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