OBJECTIVE: Our aim was to investigate the effect of monotherapy of sleeping head-up (SHU) at 6 in. in a group of older inpatients with OH from all causes. METHODS: We recruited nine consecutive inpatients (mean age (SD) 76(5) years) with persistent, symptomatic OH with a mean systolic blood pressure (SBP) drop on standing and nadir SBP of 68 (27.8) and 94 (19.2) mmHg respectively. All patients underwent SHU for 1 week. Beat-to-beat haemodynamics during lying and standing, 24-hour ambulatory blood pressure, supine haematocrit, urea/electrolytes, plasma renin activity and aldosterone were measured before and after intervention. RESULTS: One week after SHU, SBP, stroke volume and cardiac output increased significantly (all P < 0.05) by 12 mmHg, 15 ml and 1.3 l/minutes respectively while heart rate and total peripheral resistance were significantly reduced by 3.6 bpm and 0.355 dynes/s/cm(5) respectively during 2 minute of standing. Serum creatinine was also significantly lower. Five patients improved in their mobility following SHU. INTERPRETATIONS: SHU for 1 week at 6 in. was well tolerated by older in-patients with OH, associated with improved orthostatic tolerance, and with haemodynamic changes in keeping with increased extracellular volume. SHU at 6 in. has a role in the acute treatment of OH for patients in hospital, but its longer-term effects and in the out-patient setting require further study.
OBJECTIVE: Our aim was to investigate the effect of monotherapy of sleeping head-up (SHU) at 6 in. in a group of older inpatients with OH from all causes. METHODS: We recruited nine consecutive inpatients (mean age (SD) 76(5) years) with persistent, symptomatic OH with a mean systolic blood pressure (SBP) drop on standing and nadir SBP of 68 (27.8) and 94 (19.2) mmHg respectively. All patients underwent SHU for 1 week. Beat-to-beat haemodynamics during lying and standing, 24-hour ambulatory blood pressure, supine haematocrit, urea/electrolytes, plasma renin activity and aldosterone were measured before and after intervention. RESULTS: One week after SHU, SBP, stroke volume and cardiac output increased significantly (all P < 0.05) by 12 mmHg, 15 ml and 1.3 l/minutes respectively while heart rate and total peripheral resistance were significantly reduced by 3.6 bpm and 0.355 dynes/s/cm(5) respectively during 2 minute of standing. Serum creatinine was also significantly lower. Five patients improved in their mobility following SHU. INTERPRETATIONS: SHU for 1 week at 6 in. was well tolerated by older in-patients with OH, associated with improved orthostatic tolerance, and with haemodynamic changes in keeping with increased extracellular volume. SHU at 6 in. has a role in the acute treatment of OH for patients in hospital, but its longer-term effects and in the out-patient setting require further study.
Authors: Michele Brignole; Paolo Alboni; David G Benditt; Lennart Bergfeldt; Jean-Jacques Blanc; Paul Erik Bloch Thomsen; J Gert van Dijk; Adam Fitzpatrick; Stefan Hohnloser; Jean Janousek; Wishwa Kapoor; Rose Anne Kenny; Piotr Kulakowski; Giulio Masotti; Angel Moya; Antonio Raviele; Richard Sutton; George Theodorakis; Andrea Ungar; Wouter Wieling Journal: Europace Date: 2004-11 Impact factor: 5.214
Authors: John R Shannon; Andre Diedrich; Italo Biaggioni; Jens Tank; Rose Marie Robertson; David Robertson; Jens Jordan Journal: Am J Med Date: 2002-04-01 Impact factor: 4.965