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Ортостатические реакции и когнитивные дисфункции у больных артериальной гипертонией пожилого и старческого возраста
Ортостатические реакции и когнитивные дисфункции у больных артериальной гипертонией пожилого и старческого возраста
Атюнина И.В., Ощепкова Е.В., Рогоза А.Н., Лазарева Н.В. Ортостатические реакции и когнитивные дисфункции у больных артериальной гипертонией пожилого и старческого возраста. Системные гипертензии. 2019; 16 (2): 47–53. DOI: 10.26442/2075082X.2019.2.190357
Rogoza A.N., Lazareva N.V. Orthostatic reactions and cognitive dysfunctions in elderly and senile patients with arterial hypertension. Systemic Hypertension. 2019; 16 (2): 47–53.
DOI: 10.26442/2075082X.2019.2.190357
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Rogoza A.N., Lazareva N.V. Orthostatic reactions and cognitive dysfunctions in elderly and senile patients with arterial hypertension. Systemic Hypertension. 2019; 16 (2): 47–53.
DOI: 10.26442/2075082X.2019.2.190357
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Аннотация
Цель. Изучить взаимосвязи ортостатических гипотензивных реакций (ОГР), выявленных с использованием активной и пассивной ортостатических проб, с состоянием когнитивных функций у больных артериальной гипертонией (АГ) старших возрастных групп.
Материалы и методы. Обследованы 75 больных АГ I–III стадии (средний возраст 67±5 лет). Больные получали регулярную антигипертензивную терапию, исключая прием препаратов в день исследования. Исследование ОГР проводилось с использованием 5-минутной активной и 5-минутной пассивной ортостатических проб с ежеминутным измерением АД на плече осциллометрическим методом и непрерывным неинвазивным измерением систолического (САД) и диастолического (ДАД) артериального давления в пальцевой артерии фотокомпенсационным методом (Task Force Monitor, CNSystems, Австрия). Наличие или отсутствие классической ортостатической гипотензии (КОГ) и начальной ортостатической гипотензии (НОГ) оценивалось согласно критериям Европейского общества кардиологии (2018 г.). Изучение когнитивных функций проводилось с помощью краткого исследования психического состояния (Mini-Mental State Examination – MMSE), теста рисования часов и теста Мюнстерберга. Анализ проведен с использованием программы Statistica 6.0. Данные из совокупностей с нормальным распределением сравнивались с помощью t-критерия Стьюдента, при сравнении данных с распределением, отличающимся от нормального, применялся критерий Манна–Уитни. Для сравнения групп по качественным признакам использовали точный критерий Фишера.
Результаты. У 23 (31%) больных выявлены различные типы ОГР, из них у 9 (12%) – изолированная НОГ, у 14 (19%) – КОГ, среди которых у 7 больных имело место сочетание КОГ+НОГ. Выявленная КОГ имела нейрогенный характер у всех больных. Результат теста рисования часов у больных c ОГР был достоверно хуже по сравнению с больными без ОГР (7,5±1,5 vs 8,4±0,8, p<0,05, при норме 10 баллов). Результаты теста Мюнстерберга продемонстрировали снижение уровня внимания и концентрации у больных ОГР (21,4±2,2 vs 22,5±1,2 соответственно, p<0,05). Тест MMSE не выявил значимых отличий у лиц с ОГР (26,1±2,28 vs 27,8±0,8 балла, p>0,05). Снижение когнитивных функций отмечалось у больных с КОГ по сравнению с больными без ОГР (тест Мюнстерберга: 21,2±2,6 vs 22,5±1,2, p<0,05; тест рисования часов: 7,3±1,5 vs 8,4±0,8, p<0,05; тест MMSE: 26,3±2,3 vs 26,9±1,2, p>0,05 соответственно). У больных с НОГ этой закономерности не отмечено (больные с НОГ и без ОГР: тест Мюнстерберга: 21,9±1,27 vs 22,5±1,2, p>0,05; тест рисования часов: 7,7±1,7 vs 8,4±0,8, p>0,05; тест MMSE: 25,7±2,3 vs 26,9±1,2, p>0,05 соответственно).
Заключение. ОГР выявлены у 31% больных АГ старших возрастных групп. Наиболее выраженное снижение когнитивных функций отмечено у больных АГ с КОГ.
Ключевые слова: ортостатическая гипотензия, классическая ортостатическая гипотензия, начальная ортостатическая гипотензия, когнитивные нарушения, артериальная гипертония.
Materials and methods. 75 patients with hypertension I–III stage were examined (67±5 years). Patients received regular antihypertensive therapy, excluding medication on the day of the study. The study of the OHR was carried out using a 5-minute AOT and 5-minute POT with a minute-by-minute measurement of blood pressure on the shoulder using the oscillometric method and continuous non-invasive measurement of systolic (SBP) and diastolic (DBP) blood pressure in the finger artery by a photocompensation method (Task Force Monitor, CNSystems, Austria). The presence or absence of classical orthostatic hypotension (COH) and initial orthostatic hypotension (IOH) was assessed according to the criteria of the European Society of Cardiology (ESC-2018). The study of cognitive functions was carried out using a brief study of the mental state (Mini-Mental State Examination – MMSE), the clock drawing test and the Münstenberg test. The analysis was performed using Statistica 6.0. Data from sets with normal distribution were compared using student's t-test, Mann–Whitney test was used when comparing data with a distribution different from the normal one. To compare the groups on qualitative characteristics used Fisher's exact test.
Results. In 23 (31%) patients, different types of OHR were identified, of them, 9 (12%) had isolated IOH, 14 (19%) had COH, among which 7 patients had a combination of COH+IOH). The revealed COH was neurogenic in all patients. The test result for drawing clocks in patients with OHR was significantly worse compared with patients without OHR (7.5±1.5 vs 8.4±0.8, p<0.05 at a rate of 10 points). The results of the Munsterberg test showed a decrease in the level of attention and concentration in patients with OHR (21.4±2.2 vs 22.5±1.2 respectively, p<0.05). The MMSE test did not reveal significant differences in individuals with OHR (26.1±2.28 vs 27.8±0.8 points, p>0.05). A decrease in cognitive functions was observed in patients with COH compared with patients without OHR (Munsterberg test: 21.2±2.6 vs 22.5±1.2, p<0.05; clock drawing test: 7.3±1.5 vs 8.4±0.8, p<0.05; MMSE test: 26.3±2.3 vs 26.9±1.2, p>0.05 respectively). In patients with IOH, this pattern was not observed (patients with IOH and without OHR: Munsterberg test: 21.9±1.27 vs 22.5±1.2, p>0.05; clock drawing test: 7.7±1.7 vs 8.4±0.8, p>0.05; MMSE test: 25.7±2.3 vs 26.9±1.2, p>0.05 respectively).
Conclusion. OHR was detected in 31% of patients with AH in older age groups. The most pronounced decrease in cognitive functions was observed in patients with hypertension with COH.
Материалы и методы. Обследованы 75 больных АГ I–III стадии (средний возраст 67±5 лет). Больные получали регулярную антигипертензивную терапию, исключая прием препаратов в день исследования. Исследование ОГР проводилось с использованием 5-минутной активной и 5-минутной пассивной ортостатических проб с ежеминутным измерением АД на плече осциллометрическим методом и непрерывным неинвазивным измерением систолического (САД) и диастолического (ДАД) артериального давления в пальцевой артерии фотокомпенсационным методом (Task Force Monitor, CNSystems, Австрия). Наличие или отсутствие классической ортостатической гипотензии (КОГ) и начальной ортостатической гипотензии (НОГ) оценивалось согласно критериям Европейского общества кардиологии (2018 г.). Изучение когнитивных функций проводилось с помощью краткого исследования психического состояния (Mini-Mental State Examination – MMSE), теста рисования часов и теста Мюнстерберга. Анализ проведен с использованием программы Statistica 6.0. Данные из совокупностей с нормальным распределением сравнивались с помощью t-критерия Стьюдента, при сравнении данных с распределением, отличающимся от нормального, применялся критерий Манна–Уитни. Для сравнения групп по качественным признакам использовали точный критерий Фишера.
Результаты. У 23 (31%) больных выявлены различные типы ОГР, из них у 9 (12%) – изолированная НОГ, у 14 (19%) – КОГ, среди которых у 7 больных имело место сочетание КОГ+НОГ. Выявленная КОГ имела нейрогенный характер у всех больных. Результат теста рисования часов у больных c ОГР был достоверно хуже по сравнению с больными без ОГР (7,5±1,5 vs 8,4±0,8, p<0,05, при норме 10 баллов). Результаты теста Мюнстерберга продемонстрировали снижение уровня внимания и концентрации у больных ОГР (21,4±2,2 vs 22,5±1,2 соответственно, p<0,05). Тест MMSE не выявил значимых отличий у лиц с ОГР (26,1±2,28 vs 27,8±0,8 балла, p>0,05). Снижение когнитивных функций отмечалось у больных с КОГ по сравнению с больными без ОГР (тест Мюнстерберга: 21,2±2,6 vs 22,5±1,2, p<0,05; тест рисования часов: 7,3±1,5 vs 8,4±0,8, p<0,05; тест MMSE: 26,3±2,3 vs 26,9±1,2, p>0,05 соответственно). У больных с НОГ этой закономерности не отмечено (больные с НОГ и без ОГР: тест Мюнстерберга: 21,9±1,27 vs 22,5±1,2, p>0,05; тест рисования часов: 7,7±1,7 vs 8,4±0,8, p>0,05; тест MMSE: 25,7±2,3 vs 26,9±1,2, p>0,05 соответственно).
Заключение. ОГР выявлены у 31% больных АГ старших возрастных групп. Наиболее выраженное снижение когнитивных функций отмечено у больных АГ с КОГ.
Ключевые слова: ортостатическая гипотензия, классическая ортостатическая гипотензия, начальная ортостатическая гипотензия, когнитивные нарушения, артериальная гипертония.
________________________________________________
Materials and methods. 75 patients with hypertension I–III stage were examined (67±5 years). Patients received regular antihypertensive therapy, excluding medication on the day of the study. The study of the OHR was carried out using a 5-minute AOT and 5-minute POT with a minute-by-minute measurement of blood pressure on the shoulder using the oscillometric method and continuous non-invasive measurement of systolic (SBP) and diastolic (DBP) blood pressure in the finger artery by a photocompensation method (Task Force Monitor, CNSystems, Austria). The presence or absence of classical orthostatic hypotension (COH) and initial orthostatic hypotension (IOH) was assessed according to the criteria of the European Society of Cardiology (ESC-2018). The study of cognitive functions was carried out using a brief study of the mental state (Mini-Mental State Examination – MMSE), the clock drawing test and the Münstenberg test. The analysis was performed using Statistica 6.0. Data from sets with normal distribution were compared using student's t-test, Mann–Whitney test was used when comparing data with a distribution different from the normal one. To compare the groups on qualitative characteristics used Fisher's exact test.
Results. In 23 (31%) patients, different types of OHR were identified, of them, 9 (12%) had isolated IOH, 14 (19%) had COH, among which 7 patients had a combination of COH+IOH). The revealed COH was neurogenic in all patients. The test result for drawing clocks in patients with OHR was significantly worse compared with patients without OHR (7.5±1.5 vs 8.4±0.8, p<0.05 at a rate of 10 points). The results of the Munsterberg test showed a decrease in the level of attention and concentration in patients with OHR (21.4±2.2 vs 22.5±1.2 respectively, p<0.05). The MMSE test did not reveal significant differences in individuals with OHR (26.1±2.28 vs 27.8±0.8 points, p>0.05). A decrease in cognitive functions was observed in patients with COH compared with patients without OHR (Munsterberg test: 21.2±2.6 vs 22.5±1.2, p<0.05; clock drawing test: 7.3±1.5 vs 8.4±0.8, p<0.05; MMSE test: 26.3±2.3 vs 26.9±1.2, p>0.05 respectively). In patients with IOH, this pattern was not observed (patients with IOH and without OHR: Munsterberg test: 21.9±1.27 vs 22.5±1.2, p>0.05; clock drawing test: 7.7±1.7 vs 8.4±0.8, p>0.05; MMSE test: 25.7±2.3 vs 26.9±1.2, p>0.05 respectively).
Conclusion. OHR was detected in 31% of patients with AH in older age groups. The most pronounced decrease in cognitive functions was observed in patients with hypertension with COH.
Полный текст
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42. Romero-Ortuno R, Cogan L, Foran R et al. Continuous Noninvasive Orthostatic Blood Pressure Measurements and Their Relationship with Orthostatic Intolerance, Falls, and Frailty in Older People. JAGS 2011; 59 (4): 655–65. DOI: 10.1111/j.1532-5415.2011.03352.x
43. Freeman R, Wieling W, Axelrod FB et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res 2011; 21: 69–72. DOI: 10.1007/s10286-011-0119-5
44. Xin W, Mi S, Lin Z et al. Orthostatic hypotension and the risk of incidental cardiovascular diseases: A meta-analysis of prospective cohort studies. Preventive Med 2016; 85: 90–7. DOI: 10.1016/j.ypmed.2016.01.007
45. Lang RM, Badano LP, Mor-Avi V et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Society Echocardiography 2015; 28 (1): 1–35. DOI: 10.1016/j.echo.2014.10.003
46. Ravaglia G, Forti P, Maioli F et al. Screening for mild cognitive impairment in elderly ambulatory patients with cognitive complaints. Aging Clin Exp Res 2005; 17: 374–9.
2. Eigenbrodt ML, Rose KM, Couper DJ et al. Orthostatic hypotension as a risk factor for stroke: The atherosclerosis risk in communities (ARIC) study, 1987–1996. Stroke 2000; 31: 2307–13.
3. Verwoert GC, Mattace-Raso FU, Hofman A et al. Orthostatic hypotension and risk of cardiovascular disease in elderly people: the Rotterdam study. J Am Geriatr Soc 2008; 56 (10): 1816–20. DOI: 10.1111/j.1532-5415.2008.01946.x
4. Jones CD, Loehr L, Franceschini N et al. Orthostatic hypotension as a risk factor for incident heart failure: the atherosclerosis risk in communities study. Hypertension 2012; 59 (5): 913–21. DOI: 10.1161/HYPERTENSIONAHA.111.188151
5. Frewen J, Savva GM, Boyle G et al. Cognitive performance in orthostatic hypotension: Findings from a nationally representative sample. J Am Geriatr Soc 2014; 62: 117–22.
6. Strandgaard S, Olesen J, Skinhoj E, Lassen NA. Autoregulation of brain circulation in severe arterial hypertension. Br Med J 1973; 1: 507–10.
7. Elmstahl S, Widerstrom E. Orthostatic intolerance predicts mild cognitive impairment: incidence of mild cognitive impairment and dementia from the Swedish general population cohort Good Aging in Skåne. Clin Interv Aging 2014; 9: 1993–2002. DOI: 10.2147/CIA.S72316
8. Veronese N et al. Orthostatic Changes in Blood Pressure and Cognitive Status in the Elderly: The Progetto Veneto Anziani Study. Hypertension 2016; 68 (2): 427–35. DOI: 10.1161/HYPERTENSIONAHA.116.07334
9. Rose KM, Couper D, Eigenbrodt ML et al. Orthostatic hypotension and cognitive function: the Atherosclerosis Risk in Communities Study. Neuroepidemiology 2010; 34 (1): 1–7. DOI: 10.1159/000255459
10. Schoon Y, Lagro J, Verhoeven Y et al. Hypotensive syndromes are not associated with cognitive impairment in geriatric patients. Am J Alzheimers Dis Other Demen 2013; 28 (1): 47–53. DOI: 10.1177/1533317512466692
11. Rogoza A.N., Oshchepkova E.V., Pevzner A.V., Kuz'mina Iu.V. Varianty ortostaticheskoi gipotonii. Novye klassifikatsii i metody vyiavleniia. Therapeutic Archive. 2012; 84 (4): 46–51 (in Russian).
12. European Society of Cardiology (ESC); European Heart Rhythm Association (EHRA) et al. Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J 2009; 30 (21): 2631–71. DOI: 10.1093/eurheartj/ehp298
13. Novak V, Hajjar I. The relationship between blood pressure and cognitive function. Nat Rev Cardiol 2010; 7 (12): 686–98. DOI: 10.1038/nrcardio.2010.161
14. Rogoza A.N., Oshchepkova E.V., Kuz'mina Iu.V. et al. Diagnosticheskii test dlia vyiavleniia nachal'noi ortostaticheskoi gipotenzii u bol'nykh gipertonicheskoi bolezn'iu. Kardiol. vestn. 2008; 1: 12–22 (in Russian).
15. Wieling W, Krediet CT, van Dijk N et al. Initial orthostatic hypotension: review of a forgotten condition. Clin Sci 2007; 112 (3): 157–65.
16. Folstein MF, Folstein SE, McHugh PR. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatric Res 1975; 12 (3): 189–98.
17. Wade DT. Measurement in neurological rehabilitation. Oxford University Press, 1992; p. 78–91.
18. Rutan GH, Hermanson B, Bild DE et al. Orthostatic hypotension in older adults: the cardiovascular health study. Hypertension 1992; 19: 508–19.
19. Torres RV, Elias MF, Crichton GE et al. Systolic orthostatic hypotension is related to lowered cognitive function: Findings from the Maine-Syracuse Longitudinal Study. J Clin Hypertens (Greenwich) 2017; 19 (12): 1357–65. DOI: 10.1111/jch.13095
20. Aksenova A.V., Gorieva Sh.B., Rogoza A.N. et al. State of the art for diagnosis and treatment of orthostatic hypotension. Systemic Hypertension. 2018; 15 (2): 32–42. DOI: 10.26442/2075-082X_2018.2.32-42 (in Russian).
21. Kapasi A, Leurgans SE, James BD et al. Watershed microinfarct pathology and cognition in older persons. Neurobiol Aging 2018; 70: 10–7. DOI: 10.1016/j.neurobiolaging.2018.05.027
22. Kulikov V.P. Osnovy ul'trazvukovogo issledovaniia sosudov. Pod red. V.P. Kulikova. Moscow: Strom, 2007 (in Russian).
23. Gibbons CH, Shmidt P, Biaggioni I et al. The recommendation of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol 2017; 264: 1567–82. DOI: 10.1007/s00415-016-8375-x
24. Finucane C, O'Connell MD, Donoghue O et al. Impaired orthostatic blood pressure recovery is associated with unexplained and injurious falls. J Am Geriatr Soc 2017; 65 (3): 474–82. DOI: 10.1111/jgs.14563
25. Cremer A, Rousseau AL, Boulestreau R et al. Screening for orthostatic hypotension using home blood pressure measurements. J Hypertens 2019; 37 (5): 923–27. DOI: 10.1097/HJH.0000000000001986
26. Kuz'mina Iu.V., Oshchepkova E.V., Rogoza A.N. et al. Razlichnye tipy nachal'nykh ortostaticheskikh depressornykh reaktsii u bol'nykh GB pri aktivnoi ortostaticheskoi probe. Therapeutic Archive. 2008; 80 (4): 38–42 (in Russian).
27. Wieling W, Harms MP, Kortz RA, Linzer M. Initial orthostatic hypotension as a cause of recurrent syncope: a case report. Clin Auton Res 2001; 11: 269–70.
28. Walker KA, Power MC, Gottesman RF. Defining the Relationship Between Hypertension,Cognitive Decline, and Dementia: a Review. Current Hypertension Reports 2017; 19 (3): 24. DOI: 10.1007/s11906-017-0724-3
29. Suter OC, Sunthorn T, Kraftsik R et al. Cerebral hypoperfusion generates cortical watershed microinfarcts in Alzheimer disease. Stroke 2002; 33 (8): 1986–92.
30. Initial orthostatic hypotension among patients with unexplained syncope: An overlooked diagnosis? Int J Cardiol 2018; 271: 269–73. DOI: 10.1016/j.ijcard.2018.05.043
31. Romero-Ortuno R, Cogan L, Foran T et al. Continuous noninvasive orthostatic blood pressure measurements and their relationship with orthostatic intolerance, falls, and frailty in older people. J Am Geriatr Soc 2011; 59: 655–65. DOI: 10.1111/j.1532-5415.2011.03352.x
32. McDonald C, Pearce M, Kerr SR, Newton J. A prospective study of the association between orthostatic hypotension and falls: definition matters. Age Ageing 2016: 1–7. DOI: 10.1093/ageing/afw227
33. Gorelick PB, Scuteri A, Black SE et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 9: 2672–713. DOI: 10.1161/STR.0b013e3182299496
34. Brignole M, Moya A, de Lange FJ et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 2018; 71: 837. DOI: 10.1016/j.rec.2018.09.002
35. Metzler M, Duerr S, Granata R et al. Neurogenic orthostatic hypotension: pathophysiology, evaluation, and management. J Neurol 2013; 260: 2212–19. DOI: 10.1007/s00415-012-6736-7
36. Kaufmann H, Biaggioni I. Autonomic failure in neurodegenerative disorders. Semin Neurol 2003; 23 (4): 351–63.
37. Gribbin B, Pickering TG, Sleight P, Peto R. Effect of age and high blood pressure on baroreflex sensitivity in man. Circ Res 1971; 29: 424–31.
38. Maddens M, Lipsitz LA, Wei JY et al. Impaired heart rate responses to cough and deep breathing in elderly patients with unexplained syncope. Am J Cardiol 1987; 60: 1368–72.
39. Freeman R. Clinical practice. Neurogenic orthostatic hypotension. N Engl J Med 2008; 358: 615–24. DOI: 10.1056/NEJMcp074189
40. Claassen DO, Adler CH, Hewitt LA, Gibbons C. Characterization of the symptoms of neurogenic orthostatic hypotension and their impact from a survey of patients and caregivers. BMC Neurology 2018; 18: 125. DOI: 10.1186/s12883-018-1129-x
41. Kaliaev A.V., Zhiliaev E.V. Ortostaticheskaia gipotenziia (etiologiia, patogenez, klinika, diagnostika i lechenie). Metodicheskie rekomendatsii. Moscow, 2000 (in Russian).
42. Romero-Ortuno R, Cogan L, Foran R et al. Continuous Noninvasive Orthostatic Blood Pressure Measurements and Their Relationship with Orthostatic Intolerance, Falls, and Frailty in Older People. JAGS 2011; 59 (4): 655–65. DOI: 10.1111/j.1532-5415.2011.03352.x
43. Freeman R, Wieling W, Axelrod FB et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res 2011; 21: 69–72. DOI: 10.1007/s10286-011-0119-5
44. Xin W, Mi S, Lin Z et al. Orthostatic hypotension and the risk of incidental cardiovascular diseases: A meta-analysis of prospective cohort studies. Preventive Med 2016; 85: 90–7. DOI: 10.1016/j.ypmed.2016.01.007
45. Lang RM, Badano LP, Mor-Avi V et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Society Echocardiography 2015; 28 (1): 1–35. DOI: 10.1016/j.echo.2014.10.003
46. Ravaglia G, Forti P, Maioli F et al. Screening for mild cognitive impairment in elderly ambulatory patients with cognitive complaints. Aging Clin Exp Res 2005; 17: 374–9.
2. Eigenbrodt ML, Rose KM, Couper DJ et al. Orthostatic hypotension as a risk factor for stroke: The atherosclerosis risk in communities (ARIC) study, 1987–1996. Stroke 2000; 31: 2307–13.
3. Verwoert GC, Mattace-Raso FU, Hofman A et al. Orthostatic hypotension and risk of cardiovascular disease in elderly people: the Rotterdam study. J Am Geriatr Soc 2008; 56 (10): 1816–20. DOI: 10.1111/j.1532-5415.2008.01946.x
4. Jones CD, Loehr L, Franceschini N et al. Orthostatic hypotension as a risk factor for incident heart failure: the atherosclerosis risk in communities study. Hypertension 2012; 59 (5): 913–21. DOI: 10.1161/HYPERTENSIONAHA.111.188151
5. Frewen J, Savva GM, Boyle G et al. Cognitive performance in orthostatic hypotension: Findings from a nationally representative sample. J Am Geriatr Soc 2014; 62: 117–22.
6. Strandgaard S, Olesen J, Skinhoj E, Lassen NA. Autoregulation of brain circulation in severe arterial hypertension. Br Med J 1973; 1: 507–10.
7. Elmstahl S, Widerstrom E. Orthostatic intolerance predicts mild cognitive impairment: incidence of mild cognitive impairment and dementia from the Swedish general population cohort Good Aging in Skåne. Clin Interv Aging 2014; 9: 1993–2002. DOI: 10.2147/CIA.S72316
8. Veronese N et al. Orthostatic Changes in Blood Pressure and Cognitive Status in the Elderly: The Progetto Veneto Anziani Study. Hypertension 2016; 68 (2): 427–35. DOI: 10.1161/HYPERTENSIONAHA.116.07334
9. Rose KM, Couper D, Eigenbrodt ML et al. Orthostatic hypotension and cognitive function: the Atherosclerosis Risk in Communities Study. Neuroepidemiology 2010; 34 (1): 1–7. DOI: 10.1159/000255459
10. Schoon Y, Lagro J, Verhoeven Y et al. Hypotensive syndromes are not associated with cognitive impairment in geriatric patients. Am J Alzheimers Dis Other Demen 2013; 28 (1): 47–53. DOI: 10.1177/1533317512466692
11. Рогоза А.Н., Ощепкова Е.В., Певзнер А.В., Кузьмина Ю.В. Варианты ортостатической гипотонии. Новые классификации и методы выявления. Терапевтический архив. 2012; 84 (4): 46–51.
[Rogoza A.N., Oshchepkova E.V., Pevzner A.V., Kuz'mina Iu.V. Varianty ortostaticheskoi gipotonii. Novye klassifikatsii i metody vyiavleniia. Therapeutic Archive. 2012; 84 (4): 46–51 (in Russian).]
12. European Society of Cardiology (ESC); European Heart Rhythm Association (EHRA) et al. Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J 2009; 30 (21): 2631–71. DOI: 10.1093/eurheartj/ehp298
13. Novak V, Hajjar I. The relationship between blood pressure and cognitive function. Nat Rev Cardiol 2010; 7 (12): 686–98. DOI: 10.1038/nrcardio.2010.161
14. Рогоза А.Н., Ощепкова Е.В., Кузьмина Ю.В. и др. Диагностический тест для выявления начальной ортостатической гипотензии у больных гипертонической болезнью. Кардиол. вестн. 2008; 1: 12–22.
[Rogoza A.N., Oshchepkova E.V., Kuz'mina Iu.V. et al. Diagnosticheskii test dlia vyiavleniia nachal'noi ortostaticheskoi gipotenzii u bol'nykh gipertonicheskoi bolezn'iu. Kardiol. vestn. 2008; 1: 12–22 (in Russian).]
15. Wieling W, Krediet CT, van Dijk N et al. Initial orthostatic hypotension: review of a forgotten condition. Clin Sci 2007; 112 (3): 157–65.
16. Folstein MF, Folstein SE, McHugh PR. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatric Res 1975; 12 (3): 189–98.
17. Wade DT. Measurement in neurological rehabilitation. Oxford University Press, 1992; p. 78–91.
18. Rutan GH, Hermanson B, Bild DE et al. Orthostatic hypotension in older adults: the cardiovascular health study. Hypertension 1992; 19: 508–19.
19. Torres RV, Elias MF, Crichton GE et al. Systolic orthostatic hypotension is related to lowered cognitive function: Findings from the Maine-Syracuse Longitudinal Study. J Clin Hypertens (Greenwich) 2017; 19 (12): 1357–65. DOI: 10.1111/jch.13095
20. Аксенова А.В., Гориева Ш.Б., Рогоза А.Н. и др. Современные представления о диагностике и лечении ортостатической гипотензии. Системные гипертензии. 2018; 15 (2): 32–42. DOI: 10.26442/2075-082X_2018.2.32-42
[Aksenova A.V., Gorieva Sh.B., Rogoza A.N. et al. State of the art for diagnosis and treatment of orthostatic hypotension. Systemic Hypertension. 2018; 15 (2): 32–42. DOI: 10.26442/2075-082X_2018.2.32-42 (in Russian).]
21. Kapasi A, Leurgans SE, James BD et al. Watershed microinfarct pathology and cognition in older persons. Neurobiol Aging 2018; 70: 10–7. DOI: 10.1016/j.neurobiolaging.2018.05.027
22. Куликов В.П. Основы ультразвукового исследования сосудов. Под ред. В.П. Куликова. М.: Стром, 2007.
[Kulikov V.P. Osnovy ul'trazvukovogo issledovaniia sosudov. Pod red. V.P. Kulikova. Moscow: Strom, 2007 (in Russian).]
23. Gibbons CH, Shmidt P, Biaggioni I et al. The recommendation of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol 2017; 264: 1567–82. DOI: 10.1007/s00415-016-8375-x
24. Finucane C, O'Connell MD, Donoghue O et al. Impaired orthostatic blood pressure recovery is associated with unexplained and injurious falls. J Am Geriatr Soc 2017; 65 (3): 474–82. DOI: 10.1111/jgs.14563
25. Cremer A, Rousseau AL, Boulestreau R et al. Screening for orthostatic hypotension using home blood pressure measurements. J Hypertens 2019; 37 (5): 923–27. DOI: 10.1097/HJH.0000000000001986
26. Кузьмина Ю.В., Ощепкова Е.В., Рогоза А.Н. и др. Различные типы начальных ортостатических депрессорных реакций у больных ГБ при активной ортостатической пробе. Терапевтический архив. 2008; 80 (4): 38–42.
[Kuz'mina Iu.V., Oshchepkova E.V., Rogoza A.N. et al. Razlichnye tipy nachal'nykh ortostaticheskikh depressornykh reaktsii u bol'nykh GB pri aktivnoi ortostaticheskoi probe. Therapeutic Archive. 2008; 80 (4): 38–42 (in Russian).]
27. Wieling W, Harms MP, Kortz RA, Linzer M. Initial orthostatic hypotension as a cause of recurrent syncope: a case report. Clin Auton Res 2001; 11: 269–70.
28. Walker KA, Power MC, Gottesman RF. Defining the Relationship Between Hypertension,Cognitive Decline, and Dementia: a Review. Current Hypertension Reports 2017; 19 (3): 24. DOI: 10.1007/s11906-017-0724-3
29. Suter OC, Sunthorn T, Kraftsik R et al. Cerebral hypoperfusion generates cortical watershed microinfarcts in Alzheimer disease. Stroke 2002; 33 (8): 1986–92.
30. Initial orthostatic hypotension among patients with unexplained syncope: An overlooked diagnosis? Int J Cardiol 2018; 271: 269–73. DOI: 10.1016/j.ijcard.2018.05.043
31. Romero-Ortuno R, Cogan L, Foran T et al. Continuous noninvasive orthostatic blood pressure measurements and their relationship with orthostatic intolerance, falls, and frailty in older people. J Am Geriatr Soc 2011; 59: 655–65. DOI: 10.1111/j.1532-5415.2011.03352.x
32. McDonald C, Pearce M, Kerr SR, Newton J. A prospective study of the association between orthostatic hypotension and falls: definition matters. Age Ageing 2016: 1–7. DOI: 10.1093/ageing/afw227
33. Gorelick PB, Scuteri A, Black SE et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 9: 2672–713. DOI: 10.1161/STR.0b013e3182299496
34. Brignole M, Moya A, de Lange FJ et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 2018; 71: 837. DOI: 10.1016/j.rec.2018.09.002
35. Metzler M, Duerr S, Granata R et al. Neurogenic orthostatic hypotension: pathophysiology, evaluation, and management. J Neurol 2013; 260: 2212–19. DOI: 10.1007/s00415-012-6736-7
36. Kaufmann H, Biaggioni I. Autonomic failure in neurodegenerative disorders. Semin Neurol 2003; 23 (4): 351–63.
37. Gribbin B, Pickering TG, Sleight P, Peto R. Effect of age and high blood pressure on baroreflex sensitivity in man. Circ Res 1971; 29: 424–31.
38. Maddens M, Lipsitz LA, Wei JY et al. Impaired heart rate responses to cough and deep breathing in elderly patients with unexplained syncope. Am J Cardiol 1987; 60: 1368–72.
39. Freeman R. Clinical practice. Neurogenic orthostatic hypotension. N Engl J Med 2008; 358: 615–24. DOI: 10.1056/NEJMcp074189
40. Claassen DO, Adler CH, Hewitt LA, Gibbons C. Characterization of the symptoms of neurogenic orthostatic hypotension and their impact from a survey of patients and caregivers. BMC Neurology 2018; 18: 125. DOI: 10.1186/s12883-018-1129-x
41. Каляев А.В., Жиляев Е.В. Ортостатическая гипотензия (этиология, патогенез, клиника, диагностика и лечение). Методические рекомендации. М., 2000.
[Kaliaev A.V., Zhiliaev E.V. Ortostaticheskaia gipotenziia (etiologiia, patogenez, klinika, diagnostika i lechenie). Metodicheskie rekomendatsii. Moscow, 2000 (in Russian).]
42. Romero-Ortuno R, Cogan L, Foran R et al. Continuous Noninvasive Orthostatic Blood Pressure Measurements and Their Relationship with Orthostatic Intolerance, Falls, and Frailty in Older People. JAGS 2011; 59 (4): 655–65. DOI: 10.1111/j.1532-5415.2011.03352.x
43. Freeman R, Wieling W, Axelrod FB et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res 2011; 21: 69–72. DOI: 10.1007/s10286-011-0119-5
44. Xin W, Mi S, Lin Z et al. Orthostatic hypotension and the risk of incidental cardiovascular diseases: A meta-analysis of prospective cohort studies. Preventive Med 2016; 85: 90–7. DOI: 10.1016/j.ypmed.2016.01.007
45. Lang RM, Badano LP, Mor-Avi V et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Society Echocardiography 2015; 28 (1): 1–35. DOI: 10.1016/j.echo.2014.10.003
46. Ravaglia G, Forti P, Maioli F et al. Screening for mild cognitive impairment in elderly ambulatory patients with cognitive complaints. Aging Clin Exp Res 2005; 17: 374–9.
________________________________________________
2. Eigenbrodt ML, Rose KM, Couper DJ et al. Orthostatic hypotension as a risk factor for stroke: The atherosclerosis risk in communities (ARIC) study, 1987–1996. Stroke 2000; 31: 2307–13.
3. Verwoert GC, Mattace-Raso FU, Hofman A et al. Orthostatic hypotension and risk of cardiovascular disease in elderly people: the Rotterdam study. J Am Geriatr Soc 2008; 56 (10): 1816–20. DOI: 10.1111/j.1532-5415.2008.01946.x
4. Jones CD, Loehr L, Franceschini N et al. Orthostatic hypotension as a risk factor for incident heart failure: the atherosclerosis risk in communities study. Hypertension 2012; 59 (5): 913–21. DOI: 10.1161/HYPERTENSIONAHA.111.188151
5. Frewen J, Savva GM, Boyle G et al. Cognitive performance in orthostatic hypotension: Findings from a nationally representative sample. J Am Geriatr Soc 2014; 62: 117–22.
6. Strandgaard S, Olesen J, Skinhoj E, Lassen NA. Autoregulation of brain circulation in severe arterial hypertension. Br Med J 1973; 1: 507–10.
7. Elmstahl S, Widerstrom E. Orthostatic intolerance predicts mild cognitive impairment: incidence of mild cognitive impairment and dementia from the Swedish general population cohort Good Aging in Skåne. Clin Interv Aging 2014; 9: 1993–2002. DOI: 10.2147/CIA.S72316
8. Veronese N et al. Orthostatic Changes in Blood Pressure and Cognitive Status in the Elderly: The Progetto Veneto Anziani Study. Hypertension 2016; 68 (2): 427–35. DOI: 10.1161/HYPERTENSIONAHA.116.07334
9. Rose KM, Couper D, Eigenbrodt ML et al. Orthostatic hypotension and cognitive function: the Atherosclerosis Risk in Communities Study. Neuroepidemiology 2010; 34 (1): 1–7. DOI: 10.1159/000255459
10. Schoon Y, Lagro J, Verhoeven Y et al. Hypotensive syndromes are not associated with cognitive impairment in geriatric patients. Am J Alzheimers Dis Other Demen 2013; 28 (1): 47–53. DOI: 10.1177/1533317512466692
11. Rogoza A.N., Oshchepkova E.V., Pevzner A.V., Kuz'mina Iu.V. Varianty ortostaticheskoi gipotonii. Novye klassifikatsii i metody vyiavleniia. Therapeutic Archive. 2012; 84 (4): 46–51 (in Russian).
12. European Society of Cardiology (ESC); European Heart Rhythm Association (EHRA) et al. Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J 2009; 30 (21): 2631–71. DOI: 10.1093/eurheartj/ehp298
13. Novak V, Hajjar I. The relationship between blood pressure and cognitive function. Nat Rev Cardiol 2010; 7 (12): 686–98. DOI: 10.1038/nrcardio.2010.161
14. Rogoza A.N., Oshchepkova E.V., Kuz'mina Iu.V. et al. Diagnosticheskii test dlia vyiavleniia nachal'noi ortostaticheskoi gipotenzii u bol'nykh gipertonicheskoi bolezn'iu. Kardiol. vestn. 2008; 1: 12–22 (in Russian).
15. Wieling W, Krediet CT, van Dijk N et al. Initial orthostatic hypotension: review of a forgotten condition. Clin Sci 2007; 112 (3): 157–65.
16. Folstein MF, Folstein SE, McHugh PR. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatric Res 1975; 12 (3): 189–98.
17. Wade DT. Measurement in neurological rehabilitation. Oxford University Press, 1992; p. 78–91.
18. Rutan GH, Hermanson B, Bild DE et al. Orthostatic hypotension in older adults: the cardiovascular health study. Hypertension 1992; 19: 508–19.
19. Torres RV, Elias MF, Crichton GE et al. Systolic orthostatic hypotension is related to lowered cognitive function: Findings from the Maine-Syracuse Longitudinal Study. J Clin Hypertens (Greenwich) 2017; 19 (12): 1357–65. DOI: 10.1111/jch.13095
20. Aksenova A.V., Gorieva Sh.B., Rogoza A.N. et al. State of the art for diagnosis and treatment of orthostatic hypotension. Systemic Hypertension. 2018; 15 (2): 32–42. DOI: 10.26442/2075-082X_2018.2.32-42 (in Russian).
21. Kapasi A, Leurgans SE, James BD et al. Watershed microinfarct pathology and cognition in older persons. Neurobiol Aging 2018; 70: 10–7. DOI: 10.1016/j.neurobiolaging.2018.05.027
22. Kulikov V.P. Osnovy ul'trazvukovogo issledovaniia sosudov. Pod red. V.P. Kulikova. Moscow: Strom, 2007 (in Russian).
23. Gibbons CH, Shmidt P, Biaggioni I et al. The recommendation of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol 2017; 264: 1567–82. DOI: 10.1007/s00415-016-8375-x
24. Finucane C, O'Connell MD, Donoghue O et al. Impaired orthostatic blood pressure recovery is associated with unexplained and injurious falls. J Am Geriatr Soc 2017; 65 (3): 474–82. DOI: 10.1111/jgs.14563
25. Cremer A, Rousseau AL, Boulestreau R et al. Screening for orthostatic hypotension using home blood pressure measurements. J Hypertens 2019; 37 (5): 923–27. DOI: 10.1097/HJH.0000000000001986
26. Kuz'mina Iu.V., Oshchepkova E.V., Rogoza A.N. et al. Razlichnye tipy nachal'nykh ortostaticheskikh depressornykh reaktsii u bol'nykh GB pri aktivnoi ortostaticheskoi probe. Therapeutic Archive. 2008; 80 (4): 38–42 (in Russian).
27. Wieling W, Harms MP, Kortz RA, Linzer M. Initial orthostatic hypotension as a cause of recurrent syncope: a case report. Clin Auton Res 2001; 11: 269–70.
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Авторы
И.В. Атюнина*, Е.В. Ощепкова, А.Н. Рогоза, Н.В. Лазарева
ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия
*atyunina_i@mail.ru
Anatolii N. Rogoza, Nataliia V. Lazareva
National Medical Research Center for Cardiology, Moscow, Russia
*atyunina_i@mail.ru
ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия
*atyunina_i@mail.ru
________________________________________________
Anatolii N. Rogoza, Nataliia V. Lazareva
National Medical Research Center for Cardiology, Moscow, Russia
*atyunina_i@mail.ru
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