Orthostatic Hypotension in the First Minute After Standing Up
What Is the Clinical Relevance and Do Symptoms Matter?
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See related article, pp 946–954
After 1980, techniques became available to monitor rapid hemodynamic changes continuously and noninvasively.1 These extraordinary scientific developments enabled clinicians and researchers at the end of the 20th century to noninvasively study the physiological mechanisms underlying the transient fall in blood pressure (BP) that occurs in the first 30 s of standing. TILDA (The Irish Longitudinal Study on Ageing), a large prospective randomly selected population-based study of over 8000 community-dwelling adults aged >50 years, has shown that an impaired recovery of BP after the initial fall is associated with long-term adverse cardiovascular health outcomes (see later).2 In this issue of Hypertension, the longitudinal association between symptomatic orthostatic hypotension (OH) at 30 s of standing and the occurrence of incident late-life depression in the TILDA cohort is reported.3
In this editorial commentary, we address the clinical and prognostic significance of symptomatic OH in the first 30 s after standing up because of impaired orthostatic BP recovery patterns and incident late-life depression. For this, we will focus first on the classification and pathophysiology of short-term (first 180 s) orthostatic adjustments because it is important to ground observational associations in physiology.
It is useful to classify the short-term orthostatic circulatory response on active standing in
the initial response (first 30 s) and
the early phase of stabilization (30–180 s).2
Details of the physiological mechanisms underlying the typical transient fall in BP that occurs in the first minute of standing in healthy subjects (Figure, top) …