A community-based cross-sectional survey of orthostatic hypotension among elderly from south India

Background: Orthostatic hypotension (OH) increases the risk of falls and associated morbidity and mortality in elderly. Hence, determining the prevalence of OH and its associated factors is important, especially in understudied LMIC settings. Methods: A community-based cross-sectional study was conducted among randomly selected 240 community-dwelling elderly from Thiruvananthapuram, Kerala. The OH symptoms were assessed by standard clinical measurements and frailty was assessed by modified Fried frailty phenotype. Logistic regression analysis was conducted to assess the factors associated with OH. Results: The prevalence of OH and frailty among participants was 9.6 and 29.2 percent respectively. In the first minute, OH was associated with increased odds of falls (OR ¼ 1.97 [95%CI ¼ 1.05, 3.72]). Increase in number of co-morbidities (ORadj ¼ 1.82 [95%CI ¼ 1.36, 2.48]), number of medicines used (ORadj ¼ 1.73 [95%CI ¼ 1.28, 2.34]), and orthostatic intolerance (ORadj ¼ 3.67 [95%CI ¼ 1.13, 11.94]) increased the odds of having OH. Elderly with diabetes (ORadj ¼ 4.81 [95%CI ¼ 1.57, 14.77]), hypertension (ORadj ¼ 4.97 [95% CI ¼ 1.01, 24.46]) and cognitive impairment (ORadj ¼ 5.01 [95%CI ¼ 1.40, 18.51]) were at a higher odds of having OH. Conclusions: OH and frailty are prevalent in community dwelling elderly in Thiruvananthapuram district. Frailty may be a risk factor for OH in the first minute. The number of co-morbidities may be an independent risk factor for OH. Hence, elderly people with comorbidities and cognitive impairment may be actively assessed for OH to prevent falls and associated injuries.

Study of Cardiovascular Autonomic Dysfunction in Type II Diabetes Mellitus.

Autonomic neuropathy is a common complication of diabetes mellitus which may affect major systems like cardiovascular system that may cause early death in diabetics. In our study attempt was made to asses different cardiovascular autonomic function parameters like change of blood pressure from supine to standing posture (postural BP changes) and ratio of longest and shortest R-R interval during deep expiration and inspiration respectively (E/I ratio) on ECG in type 2 diabetics and age sex matched non diabetic controls. Level of fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1C) were also measured in the same subjects. Diabetics were subdivided into <5 years and >5 years groups. Findings were compared between diabetics and the controls and also between the subgroups of diabetics. Correlation between glycaemic control , duration of disease and autonomic function parameters were tested. We found, a significant difference in postural BP changes and E/I ratios between diabetics and the controls, no significant correlation could be found out between glycaemic control or duration of disease and autonomic function parameters. Therefore, our study concludes that diabetes may lead to autonomic dysfunction that may cause postural hypotension and altered E/I ratio irrespective of the duration of disease and glycemic control.

Clinical assessment of the autonomic nervous system in diabetes mellitus and its correlation with glycemic control.

Aim: Clinical assessment of the autonomic nervous system in Diabetes mellitus (DM) and its correlation with glycemic control. STUDY DESIGN: Cross sectional study of 50 adult diabetes patients. Materials and Methods: Fifty patients with DM who were on regular treatment with either insulin and/or oral hypoglycemic agents were studied. Cardiovascular autonomic neuropathy (CAN) score was calculated using the clinical test variables. Results: Of the 50 patients 30 had no CAN, 10 had early CAN and 10 had severe CAN. The mean of CAN score increased with duration of diabetes. The mean HbA 1C was 7.73. The mean CAN score was higher in patients who had complication of diabetes as compared to patients without complications. The heart rate variability with respiration was found to be 15.84 ± 7.02/min. The mean valsalva ratio was 1.31 ± 0.23. The mean drop in BP on standing was 7.30 ± 7.24 mmHg. The mean 30:15 ratio was 1.06 ± 0.04. The mean rise in diastolic BP on sustained hand grip was 16.04 ± 4.11 mmHg. Conclusions: The prevalence of autonomic neuropathy in DM as assessed by CAN score was 40%. The CAN score did not correlate with the duration of DM. The HbA 1C had a significant correlation with the severity of autonomic neuropathy. Occurrence of CAN correlated with the presence of peripheral neuropathy but not with the presence of retinopathy or nephropathy. All individual tests in the battery of CAN score were significantly associated with the presence of autonomic neuropathy, except 30:15 ratio.

Sildenafil: eficácia, segurança e efeito sobre a pressão arterial postural em homens com 70 ou mais anos portadores de disfunção erétil / Sildenafil: efficacy, safety and impact on postural blood pressure in men aged 70 years or older with erectile dysfunction

Justificativa e objetivos: Avaliar a segurança, a eficácia e o impacto sobre a pressão arterial postural do citrato de sildenafila (100mg) em homens com 70 ou mais anos portadores de disfunção erétil. Método: Os pacientes iniciaram tratamento com o citrato de sildenafila 100 mg sob demanda. Após seis semanas foram divididos em dois grupos: respondedores e não respondedores ao tratamento. Os respondedores continuaram o mesmo tratamento por mais 12 semanas. Os não respondedores passaram a fazer uso do citrato de sildenafila, 100 mg, em dose diária e foram reavaliados após quatro semanas, quando optaram por descontinuar o estudo ou continuar tomando as doses diárias por mais oito semanas. Em todos os pacientes a avaliação final foi feita após 18 semanas. Resultados: Dos 47 pacientes incluídos, 39 foram avaliados. A idade média foi de 74 anos (70 a 88 anos). O escore do domínio da função erétil do Índice Internacional de Função Erétil aumentou significativamente de 13,4 ± 5,0 (basal) para 23,3 ± 8,0 (P<0.0001) (pós-tratamento). Aproximadamente 25% da amostra apresentaram efeitos colaterais leves que não resultaram em abandono do estudo. Hipotensão postural foi detectada em um paciente (2,6%) no pós-tratamento. Conclusões: O tratamento da disfunção erétil com o citrato de sildenafila em pacientes com 70 ou mais anos resultou em um aumento significativo no escore do domínio da função erétil do Índice Internacional de Função Erétil, efeitos colaterais leves e praticamente nenhum efeito negativo aparente sobre a pressão arterial postural.

Disautonomia na doença de Parkinson. Revisão da literatura / Dysautonomy in Parkinson's disease. Review of the literature

Desde o trabalho original, são conhecidos alguns distúrbios autonômicos associados à doença de Parkinson, tais como, sialorréia, disfagia e constipação intestinal. Nesta revisão, descrevemos as principais alterações gastrointestinais, cardiovasculares, urinárias, sexuais, termorregulatórias e cutâneas. Apesar da alta prevalência (14 a 80%), continuam inadequadamente diagnosticadas.

Since the original manuscript, it has become known that some autonomic disorders are associated with Parkinson´s disease, such as sialorrhea, dysphagia and constipation. In this review we describe the main gastrointestinal, cardiovascular, urinary, sexual, thermoregulatory and cutaneous dysfunctions. Despite the high prevalence of these disorders (14 to 80%), they remain underdiagnosed.

Autonomic dysfunction in the elderly: postural hypotension and related symptoms

BACKGROUND: Aging brings organic change and functional decline in men. An example of those functional declines is the functional change of autonomic nervous system, which is usually experienced as having postural hypotension as a typical symptom, and many other related symptoms as well. Thus, in order to study the autonamic dysfunctian caused by aging, we surveyed the occurring frequency of postural hypotension and its related symptoms, and investigated the relationship between such symptoms and the influence of external factors, in order care and treat the aged patients. METHODS: 396 people over the age of 65 years who visited the geriatric clinic located in Kwangju Park, during the period from April 1996 to August 1996, were investigated their characteristics, the related symptoms and external factors through interview, and examination to determine the presence of postural hypotension, checking the blood pressure and pulse rate in a recombent position after resting, one minute later when seated and then one minute later when standing. After in put of the data with SPSS/PC+, the statistical analysis was carried out using the Chi square and t-test. RESULTS: The 369 subjects consisted of 267 males and 129 females. The 93(23.5%) subjects showed postural hypotension, which appeared to have significant relationship with growing age but no significant relationship with the external factors such as sex, drinking, smoking, disease, medications, etc. However, under the pathological factors like disease and medication, the occurrence of postural hypotension were found to be somewhat high. The most frequent symptoms in order of seguence were postural symptoms (60.6%), impotence(58.8%), incantinence(21.0%), constipation(17.7%), diplopia(17.2%), decreased sweating(12.9%) and swallowing difficulty(7.3%), and all of these symptoms showed the significant relation with growing age. Postural symptoms were significantly related to postural hypotension, but other symptoms were not. And, postural symptoms had significant relationship with cerebrovascular disease. Also, postural symptoms showed the significant relationship with impotence, incontinence, constipation, diplopia and swallowing difficulty, but other symptoms were found to have no such relationship with each other and with the external factors. CONCLUSIONS: The aged people generally report symptoms caused by autonomic dysfunction. Especially postural symptoms are the most commonly experienced symptoms and, for the most part, accompanied by other symptoms, thus, the evaluation of autonomic dysfunction, especially on postural hypotension is important. And, since risk factors such as disease and medication influences the occurrence of postural hypotension, it should be appropriately considered when diagnosing and treating aged people. We think that continuous research on other risk factors and study to establish the proper guidelines to assess the autonomic dysfunction should be conducted in the future.