New horizons in the ageing autonomic nervous system: orthostatic hypotension and supine hypertension
Author(s)
Type
Journal Article
Abstract
Blood pressure regulation is an automatic, moment-by-moment buffering of the blood pressure in response to physiological changes such as orthostasis, exercise and haemorrhage. This finely orchestrated reflex is called the baroreflex. It is a regulated arc of afferent, central and efferent arms. Multiple physiological changes occur with ageing that can disrupt this reflex, making blood pressure regulation less effective. In addition, multiple changes can occur with ageing-related diseases such as neurodegeneration, atherosclerosis, deconditioning and polypharmacy. These changes commonly result in orthostatic hypotension, hypertension or both, and are consistently associated with multiple adverse outcomes. In this article, we discuss the healthy baroreflex, and physiological and pathophysiological reasons for impaired baroreflex function in older people. We discuss why the common clinical manifestations of orthostatic hypotension and concomitant supine hypertension occur, and strategies for balancing these conflicting priorities. Finally, we discuss strategies for treating them, outlining our practice alongside consensus and expert guidance.
Date Issued
2022-08-01
Date Acceptance
2022-08-01
Citation
Age and Ageing, 2022, 51 (8)
ISSN
0002-0729
Publisher
Oxford University Press
Journal / Book Title
Age and Ageing
Volume
51
Issue
8
Copyright Statement
© The Author(s) 2022. Published by Oxford University Press on behalf of the British Geriatrics Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000836705800008&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=a2bf6146997ec60c407a63945d4e92bb
Subjects
ATOMOXETINE
autonomic nervous system
baroreflex
BAROREFLEX FUNCTION
BED REST
BLOOD-PRESSURE
DOUBLE-BLIND
Geriatrics & Gerontology
hypertension
Life Sciences & Biomedicine
MANAGEMENT
MIDODRINE
older people
orthostatic hypotension
parasympathetic
POSTURAL HYPOTENSION
PREVALENCE
Science & Technology
sympathetic
SYNCOPE
Publication Status
Published
Coverage Spatial
England
Article Number
afac150
Date Publish Online
2022-08-02