In Control - Methodological and clinical aspects of cerebral autoregulation and haemodynamics

A.M. van den Abeelen

Promotor: Marcel Olde Rikkert and C.Slump


Though highly prevalent, the pathophysiology of orthostatic hypotension (OH), postprandial hypotension (PPH) and carotid sinus hypersensitivity (CSH) are rarely studied together. Therefore, we conducted such a comprehensive study focusing on the common role of the cardiovascular autonomic system. We hypothesized that in geriatric patients, OH, PPH and CSH are manifestations of cardiovascular autonomic dysfunction and investigated state-of-the-art cardiovascular autonomic function indices in a group of geriatric falls or syncope patients. Methods In a cross-sectional study of 203 consecutive eligible falls clinic patients, we compared heart rate variability (HRV), blood pressure variability (BPV) and baroreflex sensitivity (BRS) as potential autonomic function determinants of the three different hypotensive syndromes. Results OH, PPH and CSH were diagnosed in 53%, 57% and 50% of the patients, respectively. In a population relevant for geriatric practice, we found no differences in HRV, BPV and BRS between patients with and without OH, with and without PPH, and with and without CSH, respectively, nor between patients with and without falls, dizziness, or syncope as presenting symptom,respectively. Conclusions In geriatric patients with hypotensive syndromes, cardiovascular autonomic function as measured by HRV, BPV and BRS is comparable to patients without such syndromes. These findings argue against a single or dominant etiological factor, that is, cardiac autonomic dysfunction and underline the structured, broad and multifactorial approach to elderly patients with falls and/or syncope as proposed in the current evidence-based syncope guidelines.

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