脳卒中サバイバーの隠れた課題、起立性低血圧

オリジナルソース

タイトル: Hemodynamic Mechanisms Underlying Orthostatic Hypotension in Stroke Survivors: A Cross-Sectional Study

概要: BackgroundOrthostatic hypotension is an important consideration for stroke survivors, given its association with adverse outcomes, such as cardiovascular diseases and falls. Understanding the hemodynamic mechanisms underlying orthostatic hypotension is essential for selecting the appropriate treatment based on individual hemodynamic patterns. However, the relative contribution of changes in cardiac output and total peripheral resistance to orthostatic hypotension remains unclear in stroke survivors. ObjectiveTo determine whether orthostatic hypotension is more strongly associated with a marked decrease in cardiac output or an impaired increase in total peripheral resistance among individuals with stroke. MethodsThis cross-sectional study included 23 individuals with stroke (13 males, mean [SD] age 63.7 [12.1] years, mean time since stroke 85.1 [34.1] days) recruited from an intensive inpatient rehabilitation ward between June 2022 and November 2023. Participants underwent a head-up tilt test to assess orthostatic hypotension and associated changes in cardiac and total peripheral resistance indices. The head-up tilt test protocol consisted of a 5-min period in the supine position followed by a 5-min period with a 70{degrees} head-up tilt. Orthostatic hypotension was defined as a reduction in systolic blood pressure of at least 20 mmHg or diastolic blood pressure of at least 10 mmHg during the test. ResultsOrthostatic hypotension was identified in five participants (22%). During the head-up tilt test, these individuals demonstrated a significantly greater increase in the cardiac index (p = 0.023) and decrease in the total peripheral resistance index (p = 0.002) than those without orthostatic hypotension. ConclusionsOur results suggest that an impaired increase in total peripheral resistance upon standing mainly contributes to orthostatic hypotension in individuals with stroke. These findings advance the understanding of the hemodynamic mechanisms underlying orthostatic hypotension in the stroke population and may guide the implementation of targeted therapeutic strategies. HighlightsO_LIOrthostatic hypotension is associated with a higher risk of adverse outcomes. C_LIO_LIMechanisms of orthostatic hypotension were examined in stroke survivors. C_LIO_LIOrthostatic hypotension may be associated with impaired vasoconstriction. C_LIO_LIFindings may aid in managing orthostatic hypotension during stroke rehabilitation. C_LI