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Phenotypes of orthostatic blood pressure behaviour and association with visual acuity

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Abstract

Background

Manifestations of neurocardiovascular instability (NCVI), including orthostatic hypotension (OH) orthostatic hypertension (OHTN) and impaired blood pressure variability (BPV), have been associated with cardiovascular (CV) events. The eye is highly vascular and we propose an ideal target end organ to investigate pathological implications of NCVI.

Objective

To identify and define clinically applicable phenotypes of orthostatic blood pressure (BP) behaviour, analogous to OH, OHTN, and orthostatic BPV and to investigate their relationship to vision.

Methods

Wave one data from the Irish Longitudinal Study on Ageing (TILDA) were used. Orthostatic BP (OBP) phenotypes were identified and defined from beat-to-beat BP data, measured by digital photoplethysmography during an active stand (AS) lasting 110 s (s). Visual acuity (VA) was assessed using the Early Treatment Diabetic Retinopathy Study (EDTRS) LogMAR chart. The relationship between OBP phenotypes and VA in 4355 adults aged ≥50 years was investigated through multivariate linear regression models.

Results

There was a wide fluctuation in the prevalence of OH and OHTN up to 20 s after standing. After 30 s, four distinct OBP phenotypes were identified: in 70 % BP stabilised to within 20/10 mmHg of baseline BP, 4 % had persistent OH, 2 % had persistent OHTN and 25 % had exaggerated orthostatic blood pressure variability BPV. Systolic BPV was associated with worse VA (P = 0.02) as was diastolic BPV (P = 0.03), following adjustment for demographics, health behaviours, self-report eye diseases and diabetes, uncorrected refractive error, objective hypertension and antihypertensives.

Conclusions

The hypothesis that NCVI may independently modulate CV risk is supported the independent association of exaggerated BPV and worse VA.

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References

  1. WHO (2011) Global atlas on cardiovascular disease prevention and control Policies, strategies and interventions [Web page (link to download)]. http://www.who.int/cardiovascular_diseases/publications/atlas_cvd/en/

  2. Cronin H, O’Regan C, Finucane C, Kearney P, Kenny RA (2013) Health and aging: development of the Irish longitudinal study on ageing health assessment. J Am Geriatr Soc 61(Suppl 2):S269–S278

    Article  PubMed  Google Scholar 

  3. Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I et al (2011) Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Autonomic Res Off J Clin Autonomic Res Soc 21(2):69–72

    Article  Google Scholar 

  4. Angelousi A, Girerd N, Benetos A, Frimat L, Gautier S, Weryha G et al (2014) Association between orthostatic hypotension and cardiovascular risk, cerebrovascular risk, cognitive decline and falls as well as overall mortality: a systematic review and meta-analysis. J Hypertens 32(8):1562–1571 (discussion 71)

    Article  CAS  PubMed  Google Scholar 

  5. Frewen J, Savva GM, Boyle G, Finucane C, Kenny RA (2014) Cognitive performance in orthostatic hypotension: findings from a nationally representative sample. J Am Geriatr Soc 62(1):117–122

    Article  PubMed  Google Scholar 

  6. Romero-Ortuno R, Cogan L, Foran T, Kenny RA, Fan CW (2011) Continuous noninvasive orthostatic blood pressure measurements and their relationship with orthostatic intolerance, falls, and frailty in older people. J Am Geriatr Soc 59(4):655–665

    Article  PubMed  Google Scholar 

  7. Nardo CJ, Chambless LE, Light KC, Rosamond WD, Sharrett AR, Tell GS et al (1999) Descriptive epidemiology of blood pressure response to change in body position. The ARIC study. Hypertension 33(5):1123–1129

    Article  CAS  PubMed  Google Scholar 

  8. Kario K, Eguchi K, Hoshide S, Hoshide Y, Umeda Y, Mitsuhashi T et al (2002) U-curve relationship between orthostatic blood pressure change and silent cerebrovascular disease in elderly hypertensives: orthostatic hypertension as a new cardiovascular risk factor. J Am Coll Cardiol 40(1):133–141

    Article  PubMed  Google Scholar 

  9. Rothwell PM, Howard SC, Dolan E, O’Brien E, Dobson JE, Dahlof B et al (2010) Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet 375(9718):895–905

    Article  PubMed  Google Scholar 

  10. Parati G, Mancia G, Di Rienzo M, Castiglioni P (2006) Point: cardiovascular variability is/is not an index of autonomic control of circulation. J Appl Physiol 101(2):676–678 discussion 81–2

    Article  PubMed  Google Scholar 

  11. Kur J, Newman EA, Chan-Ling T (2012) Cellular and physiological mechanisms underlying blood flow regulation in the retina and choroid in health and disease. Prog Retin Eye Res 31(5):377–406

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Reiner A, Del Mar N, Zagvazdin Y, Li C, Fitzgerald ME (2011) Age-related impairment in choroidal blood flow compensation for arterial blood pressure fluctuation in pigeons. Invest Ophthalmol Vis Sci 52(10):7238–7247

    Article  PubMed Central  PubMed  Google Scholar 

  13. Kenny RA (2013) An introduction to the irish longitudinal study on ageing. J Am Geriatr Soc 61(Suppl 2):S263–S264

    Article  PubMed  Google Scholar 

  14. Colenbrander A (2002) Visual standards, aspects and range of vision loss with emphasis on population surveys. Report prepared for the International Council of Ophthalmology at the 29th International Congress of Ophthalmology Sydney

  15. Akuffo KO, Nolan J, Stack J, Moran R, Feeney J, Kenny RA, et al (2015) Prevalence of age-related macular degeneration in the Republic of Ireland. Br J Ophthalmol

  16. Romero-Ortuno R, O’Connell MD, Finucane C, Soraghan C, Fan CW, Kenny RA (2013) Insights into the clinical management of the syndrome of supine hypertension–orthostatic hypotension (SH–OH): the Irish Longitudinal Study on Ageing (TILDA). BMC Geriatr 13:73

    Article  PubMed Central  PubMed  Google Scholar 

  17. Ni Bhuachalla BM, McGarrigle C, Kenny RA (2013) An investigation of the relationship between neurocardiovascular instability and vision. Ir J Med Sci 183(Suppl 7):299

  18. Finucane C, O’Connell MD, Fan CW, Savva GM, Soraghan CJ, Nolan H, et al. (2014) Age-related normative changes in phasic orthostatic blood pressure in a large population study: findings from The Irish Longitudinal Study on Ageing (TILDA). Circulation 130(20):1780–1789

  19. Kario K (2013) Orthostatic hypertension-a new haemodynamic cardiovascular risk factor. Nat Rev Nephrol 9(12):726–738

    Article  CAS  PubMed  Google Scholar 

  20. Mayfield D, McLeod G, Hall P (1974) The CAGE questionnaire: validation of a new alcoholism screening instrument. Am J Psychiatry 131(10):1121–1123

    CAS  PubMed  Google Scholar 

  21. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G et al (2007) 2007 ESH-ESC practice guidelines for the management of arterial hypertension: ESH-ESC task force on the management of Arterial hypertension. J Hypertens 25(9):1751–1762

    Article  CAS  PubMed  Google Scholar 

  22. Rothwell PM (2011) Does blood pressure variability modulate cardiovascular risk? Curr Hypertens Rep 13(3):177–186

    Article  PubMed  Google Scholar 

  23. Routledge HC, Townend JN (2006) Why does the heart rate response to exercise predict adverse cardiac events? Heart Br Cardiac Soc 92(5):577–578

    Article  CAS  Google Scholar 

  24. Hodos W, Miller RF, Ghim MM, Fitzgerald ME, Toledo C, Reiner A (1998) Visual acuity losses in pigeons with lesions of the nucleus of Edinger-Westphal that disrupt the adaptive regulation of choroidal blood flow. Vis Neurosci 15(2):273–287

    Article  CAS  PubMed  Google Scholar 

  25. Grunwald JE, Hariprasad SM, DuPont J (1998) Effect of aging on foveolar choroidal circulation. Archives Ophthalmol 116(2):150–154

    Article  CAS  Google Scholar 

  26. Mimura T, Funatsu H, Kitano S, Amano S, Haruyama K, Shimizu E et al (2003) Diabetic retinopathy with repeated amaurosis fugax caused by orthostatic hypotension. Am J Ophthalmol 136(5):930–931

    Article  PubMed  Google Scholar 

  27. Wong CW, Wong TY, Cheng CY, Sabanayagam C (2014) Kidney and eye diseases: common risk factors, etiological mechanisms, and pathways. Kidney Int 85(6):1290–1302

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank all the participants in the study, the TILDA research, the team of interviewers and the study nurses and administrators. Funding is by The Atlantic. Philanthropies (research grant to TILDA), Irish Life plc, the Irish Government (research grant to TILDA), the health Research Board, The National Institutes of Health (NIH) /National Institute of Aging (NIA) and the European Union Horizon 2020. Dr Peto is funded by the NIHR BMRC at Moorfields Eye Hospital Foundation Trust and the UCL Institute of Ophthalmology.

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Authors and Affiliations

  1. Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, St James’s Hospital, Old Stone Building, James’s Street, Dublin 8, Ireland

    Bláithín Ní Bhuachalla & Rose Anne Kenny

  2. The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, College Green, Lincoln Gate, Dublin 2, Ireland

    Christine A. McGarrigle & Rose Anne Kenny

  3. Macular Pigment Research Group, Vision Research Centre Carriganore House, Waterford Institute of Technology, Waterford, Ireland

    Kwadwo Owusu Akuffo & Stephen Beatty

  4. Department of Research and Development, National Institute of Health Research Biomedical Research Centre at Moorfields Eye Hospital National Health Service Foundation Trust and UCL Institute of Ophthalmology, London, UK

    Tunde Peto

Authors
  1. Bláithín Ní Bhuachalla
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  2. Christine A. McGarrigle
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  3. Kwadwo Owusu Akuffo
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  4. Tunde Peto
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  5. Stephen Beatty
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  6. Rose Anne Kenny
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Correspondence to Bláithín Ní Bhuachalla.

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The authors report no conflicts of interest.

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Informed consent was obtained for all participants, and all protocols and procedures were approved by the institutional review board.

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Ní Bhuachalla, B., McGarrigle, C.A., Akuffo, K.O. et al. Phenotypes of orthostatic blood pressure behaviour and association with visual acuity. Clin Auton Res 25, 373–381 (2015). https://doi.org/10.1007/s10286-015-0315-9

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  • DOI: https://doi.org/10.1007/s10286-015-0315-9

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