Bruïne, E. de (Eline) (2015) Physical performance with a dynamic component is associated with orthostatic hypotension in geriatric outpatients. thesis, Medicine.
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Abstract
Background & aims: The association between physical performance and orthostatic hypotension (OH), a decrease in blood pressure (BP) after postural change, is not clearly established. Regarding the symptoms of OH associated with postural change, e.g. dizziness and instability, it can be hypothesized that physical performance with a dynamic component, in which the body moves between two consecutive places, is associated with OH by provoking temporary BP decrease. The aim of this study was to determine whether physical performance with a dynamic component is more associated with OH, compared with physical performance with a static component, which are tests without movement of the body, and other geriatric domains (cognitive, physical and nutritional domain). This could provide insights in diagnostic and therapeutic strategies in the management of OH. Methods: This cross-sectional study included 280 geriatric outpatients visiting a mobility clinic (mean age 82.2 years, 65% female) in which OH was assessed using intermittently measured BP. In a subgroup of 58 patients OH was assessed using continuously measured BP, including assessment of initial OH (iOH) which is defined as an immediate BP decrease during 15 seconds after standing up. A distinction was made between physical performance with a dynamic component (four meter walk test (4m WT), Chair Stand Test (CST) and Timed Up and Go (TUG)) and physical performance with a static component (balance tests and handgrip strength). Cognitive domain was assessed by using the Mini Mental State Examination, Montreal Cognitive Assessment and Visual Association Test. Physical domain was assessed by determining lean mass and appendicular lean mass. Nutritional domain was assessed by the Short Nutritional Assessment Questionnaire, fat free mass index and body mass index. Variables of all the geriatric domains (independent variables) were categorized in tertiles in case a linear relation with OH (dependent variable) could not be assumed. Associations between geriatric domains and the different types of OH were analysed using multivariate logistic regression models with adjustments for potential confounders. Results: 4m WT, CST and TUG all provided statistically significant associations with OH assessed with continuously measured BP compared with only one association between physical performance with a static component and iOH and no significant associations between other geriatric domains and the different types of OH. OH assessed with continuously measured BP provided more statistically significant associations between the geriatric domains and OH than the use of intermittently measured BP. Conclusion: Physical performance with a dynamic component was more associated with OH compared with physical performance with a static component and other geriatric domains. The role of physical performance with a dynamic component in OH is of special interest as this may offer an opening towards non-pharmacological treatment of patients with OH.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Zeeman, Dr. M. |
| Supervisor name: | Maier, Prof. dr. dr. A.B. and Interne Ouderengeneeskunde and Vrije Universiteit medisch centrum |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:46 |
| Last Modified: | 25 Jun 2020 10:46 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/770 |
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