Arterial hypotension: epidemiology, etiopathogenesis, symptomatology, and diagnosis

DOI: https://doi.org/10.29296/25877305-2023-04-01
Issue: 
4
Year: 
2023

Professor K. Amlaev, MD; Associate Professor A. Znamenskaya, Candidate
of Medical Sciences; Associate Professor Kh. Dakhkilgova, Candidate of Medical Sciences
Stavropol State Medical University, Ministry of Health of Russia

Arterial hypotension is a systemic hemodynamic disorder that is defined as a decrease in blood pressure below 90/60 mm Hg, caused by changes in cardiac output or systemic vascular resistance or both of these values, and that can lead to organ and tissue hypoperfusion. The review considers the epidemiology, etiology, and pathogenesis of this condition. Particular attention is paid to the classification of hypotension based on various biometric parameters, by the rate of occurrence and time of exposure, taking into account the impact on organ perfusion. The symptomatology and diagnosis of hypotension are analyzed; its complications are described.

Keywords: 
cardiology
arterial hypotension
blood pressure
orthostatic hypotension.



References: 
  1. Hecht J.P., Mahmood S.M., Brandt M.M. Safety of high-dose intravenous labetalol in hypertensive crisis. Am J Health Syst Pharm. 2019; 76 (5): 286–92. DOI: 10.1093/ajhp/zxy045
  2. Van de Velde M. Low-dose spinal anesthesia for cesarean section to prevent spinal-induced hypotension. Curr Opin Anaesthesiol. 2019; 32 (3): 268–70. DOI: 10.1097/ACO.0000000000000712
  3. Yamada H., Doi K., Tsukamoto T. et al. Low-dose atrial natriuretic peptide for prevention or treatment of acute kidney injury: a systematic review and meta-analysis. Crit Care. 2019; 23 (1): 41. DOI: 10.1186/s13054-019-2330-z
  4. Feng Y., Huang R., Kavanagh J. et al. Efficacy and Safety of Dual Blockade of the Renin-Angiotensin-Aldosterone System in Diabetic Kidney Disease: A Meta-Analysis. Am J Cardiovasc Drugs. 2019; 19 (3): 259–86. DOI: 10.1007/s40256-018-00321-5
  5. Raina R., Lam S., Raheja H. et al. Pediatric intradialytic hypotension: recommendations from the Pediatric Continuous Renal Replacement Therapy (PCRRT) Workgroup. Pediatr Nephrol. 2019; 34 (5): 925–41. DOI: 10.1007/s00467-018-4190-1
  6. Lei L.Y., Chew D.S., Raj S.R. Differential diagnosis of orthostatic hypotension. Auton Neurosci. 2020; 228: 102713. DOI: 10.1016/j.autneu.2020.102713
  7. van Twist D.J.L., Dinh T., Bouwmans E.M.E. et al. 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
  8. Kaufmann H., Palma J.A. Neurogenic orthostatic hypotension: the very basics. Clin Auton Res. 2017; 27 (Suppl 1): 39–43. DOI: 10.1007/s10286-017-0437-3
  9. Freeman R., Abuzinadah A.R., Gibbons C. et al. Orthostatic Hypotension. J Am Coll Cardiol. 2018; 72 (11): 1294–309. DOI: 10.1016/j.jacc.2018.05.079
  10. Palma J.A., Kaufmann H. Management of Orthostatic Hypotension. Continuum (Minneap Minn). 2020; 26 (1): 154–77. DOI: 10.1212/CON.0000000000000816
  11. Meng L. Heterogeneous impact of hypotension on organ perfusion and outcomes: a narrative review. Br J Anaesth. 2021; 127 (6): 845–61. DOI: 10.1016/j.bja.2021.06.048
  12. Ackland G.L., Brudney C.S., Cecconi M. et al. Perioperative Quality Initiative consensus statement on the physiology of arterial blood pressure control in perioperative medicine. Br J Anaesth. 2019; 122 (5): 542–51. DOI: 10.1016/j.bja.2019.01.011
  13. Magkas N., Tsioufis C., Thomopoulos C. et al. Orthostatic hypotension: From pathophysiology to clinical applications and therapeutic considerations. J Clin Hypertens (Greenwich). 2019; 21 (5): 546–54. DOI: 10.1111/jch.13521
  14. Brignole M., Moya A., de Lange F.J. et al. Practical Instructions for the 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J. 2018; 39 (21): e43-e80. DOI: 10.1093/eurheartj/ehy071
  15. Brignole M., Moya A., de Lange F.J. et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Kardiol Pol. 2018; 76 (8): 1119–98. DOI: 10.5603/KP.2018.0161
  16. Gibbons C.H., Schmidt P., Biaggioni I. et al. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol. 2017; 264 (8): 1567–82. DOI: 10.1007/s00415-016-8375-x
  17. Parashar R., Amir M., Pakhare A. et al. Age Related Changes in Autonomic Functions. J Clin Diagn Res. 2016; 10 (3): CC11-CC15. DOI: 10.7860/JCDR/2016/16889.7497
  18. Centi J., Freeman R., Gibbons C.H. et al. Effects of orthostatic hypotension on cognition in Parkinson disease. Neurology. 2017; 88 (1): 17–24. DOI: 10.1212/WNL.0000000000003452
  19. Terkelsen A.J., Karlsson P., Lauria G. et al. The diagnostic challenge of small fibre neuropathy: clinical presentations, evaluations, and causes [published correction appears in Lancet Neurol. 2017 Dec; 16 (12): 954]. Lancet Neurol. 2017; 16 (11): 934–44. DOI: 10.1016/S1474-4422(17)30329-0
  20. Gibbons C.H., Freeman R. Clinical implications of delayed orthostatic hypotension: A 10-year follow-up study. Neurology. 2015; 85 (16): 1362–7. DOI: 10.1212/WNL.0000000000002030
  21. Cheshire W.P Jr. Clinical classification of orthostatic hypotensions. Clin Auton Res. 2017; 27 (3): 133–5. DOI: 10.1007/s10286-017-0414-x
  22. Palma J.A., Norcliffe-Kaufmann L., Kaufmann H. An orthostatic hypotension mimic: The inebriation-like syndrome in Parkinson disease. Mov Disord. 2016; 31 (4): 598–600. DOI: 10.1002/mds.26516
  23. Bengtsson-Lindberg M., Larsson V., Minthon L. et al. Lack of orthostatic symptoms in dementia patients with orthostatic hypotension. Clin Auton Res. 2015; 25 (2): 87–94. DOI: 10.1007/s10286-014-0244-z
  24. Дедов Д., Мукаилов Н., Евтюхин И. Качество жизни и прогноз у больных АГ и ИБС с фибрилляцией предсердий. Врач. 2013; 7: 72–4 [Dedov D., Mukailov N., Evtyuxin I Quality of life and prognosis in patients with arterial hypertension and coronary heart disease with atrial fibrillation. Vrach. 2013; 7: 72–4 (in Russ.)].
  25. Palma J.A., Kaufmann H. Epidemiology, Diagnosis, and Management of Neurogenic Orthostatic Hypotension. Mov Disord Clin Pract. 2017; 4 (3): 298–308. DOI: 10.1002/mdc3.12478
  26. Ricci F., De Caterina R., Fedorowski A. Orthostatic Hypotension: Epidemiology, Prognosis, and Treatment. J Am Coll Cardiol. 2015; 66 (7): 848–60. DOI: 10.1016/j.jacc.2015.06.1084
  27. Newton J.L., Frith J. The efficacy of nonpharmacologic intervention for orthostatic hypotension associated with aging. Neurology. 2018; 91 (7): e652-e656. DOI: 10.1212/WNL.0000000000005994
  28. Okamoto L.E., Diedrich A., Baudenbacher F.J. et al. Efficacy of Servo-Controlled Splanchnic Venous Compression in the Treatment of Orthostatic Hypotension: A Randomized Comparison With Midodrine. Hypertension. 2016; 68 (2): 418–26. DOI: 10.1161/HYPERTENSIONAHA.116.07199
  29. Norcliffe-Kaufmann L., Kaufmann H., Palma J.A. et al. Orthostatic heart rate changes in patients with autonomic failure caused by neurodegenerative synucleinopathies. Ann Neurol. 2018; 83 (3): 522–31. DOI: 10.1002/ana.25170
  30. Shaw B.H., Garland E.M., Black B.K. et al. Optimal diagnostic thresholds for diagnosis of orthostatic hypotension with a 'sit-to-stand test'. J Hypertens. 2017; 35 (5): 1019–25. DOI: 10.1097/HJH.0000000000001265
  31. Brignole M., Moya A., de Lange F.J. et al. Practical Instructions for the 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J. 2018; 39 (21): e43-e80. DOI: 10.1093/eurheartj/ehy071
  32. Wijdicks E.F., Klein C.J. Guillain-Barré Syndrome. Mayo Clin Proc. 2017; 92 (3): 467–79. DOI: 10.1016/j.mayocp.2016.12.002
  33. Barbot M., Ceccato F., Zilio M. et al. Cardiovascular autonomic dysfunction in patients with idiopathic diabetes insipidus. Pituitary. 2018; 21 (1): 50–5. DOI: 10.1007/s11102-017-0846-2