Статья
Современные представления о проблеме ортостатической гипотензии
На сегодняшний день имеется много литературных данных, о том, что частота встречаемости ортостатической гипотензии (ОГ) увеличивается с возрастом и при наличии сопутствующей патологии. Кроме того, ОГ ассоциируется с повышенным риском серьезных неблагоприятных цереброваскулярных и коронарных событий, может способствовать нарушению когнитивных функций и развитию деменции, а также является одним из главных факторов риска падений, особенно у пожилых пациентов. В данном обзоре обобщены современные отечественные и зарубежные литературные данные о данной проблеме, представлены обновленное определение ОГ, её современная классификация, патофизиология, особенности течения ОГ у пожилых людей, рекомендации по диагностике и лечению. Особое внимание в обзоре уделено одной из форм вторичной ОГ - лекарственно индуцированной ОГ, частота встречаемости которой увеличивается с увеличением количества принимаемых лекарственных препаратов. Подробно представлены перечень лекарственных препаратов, вызывающих ОГ и методы борьбы с полипрагмазией.
1. Freeman R., Wieling W., Axelrod F.B., Benditt D.G., Benarroch E., Biaggioni I., Cheshire W.P, Chelimsky T., Cortelli P., Gibbons C.H., Goldstein D.S., Hainsworth R., Hilz M.J., Jacob G., Kaufmann H., Jordan J., Lipsitz L.A., Levine B.D., Low P.A., Mathias C., Raj S.R., Robertson D., Sandroni P., Schatz I.J., Schondorf R., Stewart J.M., van Dijk J.G. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21(2):69-72. doi: 10.1007/s10286-011-0119-5
2. Brignole M., Moya A., de Lange F.J., Deharo J.C., Elliott P.M., Fanciulli A., Fedorowski A., Furlan R., Kenny R.A., Martiin A., Probst V, Reed M.J., Rice C.P, Sutton R., Ungar A., van Dijk J.G. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J. 2018;39(21):1883-948. doi:10.1093/eurheartj/ehy037
3. Strogatz D.S., Keenan N.L., Barnett E.M., Wagner E.H. Correlates of postural hypotension in a community sample of elderly blacks and whites. J Am Geriatr Soc. 1991;39(6):562-6
4. Shin C., Abbott R.D., Lee H., Kim J., Kimm K. Prevalence and correlates of orthostatic hypotension in middleged men and women in Korea: the Korean Health and Genome Study. J Hum Hypertens. 2004;18(10):717-23. doi: 10.1038/sj.jhh.1001732
5. Fedorowski A., Burri P, Melander O. Orthostatic hypotension in genetically related hypertensive and normotensive individuals. J Hypertens. 2009;27(5):976-82
6. Raiha I., Luutonen S., Piha J., SeppanenA., Toikka T., Sourander L. Prevalence, predisposing factors, and prognostic importance of postural hypotension. Arch Intern Med. 1995;155(9): 930-5
7. Lagro J., Laurenssen N.C., Schalk B.W., Schoon Y., Claassen J.A., Olde Rikkert M.G. Diastolic blood pressure drop after standing as a clinical sign for increased mortality in older falls clinic patients. J Hypertens. 2012;30(6):1195-202. doi: 10.1097/HJH.0b013e328352b9fd
8. Poon I.O., Braun U. High prevalence of orthostatic hypotension and its correlation with potentially causative medications among elderly veterans. J Clin Pharm Ther. 2005;30(2):173-8. doi: 10.1111/j.1365-2710.2005.00629.x
9. Fedorowski A., Engstrom G., Hedblad B., Melander O. Orthostatic hypotension predicts incidence of heart failure: the Malmo Preventive Project. Am J Hypertens. 2010;23(11):1209-15. doi: 10.1038/ajh.2010.150
10. Krolewski A.S., Warram J.H., Cupples A., Gorman C.K., Szabo A.J., Christlieb A.R. Hypertension, orthostatic hypotension and the microvascular complications of diabetes. J Chronic Dis. 1985;38(4):319-26
11. Sasaki O., Nakahama H., Nakamura S., Yoshihara F., Inenaga T., Yoshii M., Kohno S., Kawano Y. Orthostatic hypotension at the introductory phase of haemodialysis predicts all-cause mortality. Nephrol Dial Transplant. 2005;20(2):377-81. doi: 10.1093/ndt/gfh614
12. Masaki K.H., Schatz I.J., Burchfiel C.M., Sharp D.S., Chiu D., Foley D., Curb J.D. Orthostatic hypotension predicts mortality in elderly men: the Honolulu Heart Program. Circulation. 1998;98(21):2290-5
13. Verwoert G.C., Mattace-Raso F.U., Hofman A., Heeringa J., Stricker B.H., Breteler M.M., Witteman J.C. Orthostatic hypotension and risk of cardiovascular disease in elderly people: the Rotterdam study. J Am Geriatr Soc. 2008;56(10):1816-20. doi: 10.1111/j.1532-5415.2008.01946.x
14. Fedorowski A., Hedblad B., Engstrom G., Gustav Smith J., Melander O. Orthostatic hypotension and long-term incidence of atrial fibrillation: the Malmo Preventive Project. J Intern Med. 2010;268(4):383-9. doi: 10.1111/j.1365-2796.2010.02261.x
15. Fleg J.L., Evans G.W., Margolis K.L., Barzilay J., Basile J.N., Bigger J.T., Cutler J.A., Grimm R., Pedley C., Peterson K., Pop-Busui R., Sperl-Hillen J., Cushman W.C. Orthostatic Hypotension in the ACCORD Blood Pressure Trial: Prevalence, Incidence, and Prognostic Significance. Hypertension. 2016;68(4):888-95. doi:10.1161/HYPERTENSIONAHA.116.07474
16. Fedorowski A., Hedblad B., Melander O. Early postural blood pressure response and cause-specific mortality among middle-aged adults. Eur J Epidemiol. 2011;26(7):537-46. doi: 10.1007/s10654-011-9578-1
17. Ricci F., Fedorowski A. Cardiovascular morbidity and mortality related to orthostatic hypotension: a meta-analysis of prospective observational studies. Eur Heart J. 2015;36:1609-17. doi:10.1093/eurheartj/ehv093
18. Eigenbrodt M.L., Rose K.M., Couper D.J., Arnett D.K., Smith R., Jones D. Orthostatic hypotension as a risk factor for stroke: the Atherosclerosis Risk in Communities (ARIC) study, 1987-1996. Stroke. 2000;31(10):2307-13.
19. Rosamond W.D., Folsom A.R., Chambless L.E., Wang C.H., McGovern PG., Howard G., Copper L.S., Shahar E. Stroke incidence and survival among middleaged adults: 9-year follow-up of the Atherosclerosis Risk in Communities (ARIC) cohort. Stroke. 1999;30(4):736-43.
20. Rose K.M., Eigenbrodt M.L., Biga R.L., Couper D.J., Light K.C., Sharrett A.R., Heiss G. Orthostatic hypotension predicts mortality in middle-aged adults: the Atherosclerosis Risk in Communities (ARIC) study. Circulation. 2006;114(7):630-6. doi: 10,1161/CIRCULATIONAHA.105.598722
21. Manolio T.A., Kronmal R.A., Burke G.L., O'Leary D.H., Price T.R. Short-term predictors of incident stroke in older adults. The Cardiovascular Health Study. Stroke. 1996;27(9):1479-86
22. Matsubayashi K., Okumiya K., Wada T., Osaki Y, Fujisawa M., Doi Y, Ozawa T. Postural dysregulation in systolic blood pressure is associated with worsened scoring on neurobehavioral function tests and leukoaraiosis in the older elderly living in a community. Stroke. 1997;28(11):2169-73
23. Allan L.M., Ballard C.G., Allen J., Murray A., Davidson A.W., McKeith I.G., Kenny R.A. Autonomic dysfunction in dementia. J Neurol Neurosurg Psychiatry. 2007;78(7):671-7. doi: 10.1136/jnnp.2006.102343
24. Elmstahl S., Widerstrom E. Orthostatic intolerance predicts mild cognitive impairment: incidence of mild cognitive impairment and dementia from the Swedish general population cohort Good Aging in Skane. Clin Interv Aging. 2014;9:1993-2002. doi: 10.2147/CIA.S72316
25. Peralta C., Stampfer-Kountchev M., Karner E., Kollensperger M., Geser F., Wolf E., Seppi K., Benke T., Poewe W., Wenning G.K. Orthostatic hypotension and attention in Parkinson’s disease with and without dementia. J Neural Transm (Vienna). 2007;114(5):585-8. doi: 10.1007/s00702-006-0615-2
26. Sonnesyn H., Nilsen D.W., Rongve A., Nore S., Ballard C., Tysnes O.B., Aarsland D. High prevalence of orthostatic hypotension in mild dementia. Dement Geriatr Cogn Disord. 2009;28(4):307-13. doi: 10.1159/000247586
27. Mehrabian S., Duron E., Labouree F., Rollot F., Bune A., Traykov L., Hanon O. Relationship between orthostatic hypotension and cognitive impairment in the elderly. J Neurol Sci. 2010;299(1-2):45-8. doi: 10.1016/j.jns.2010.08.056
28. Bengtsson-Lindberg M., Larsson V, Minthon L., Wattmo C., Londos E. 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
29. Frewen J., Finucane C., Savva G.M., Boyle G., Kenny R.A. Orthostatic hypotension is associated with lower cognitive performance in adults aged 50 plus with supine hypertension. J Gerontol A Biol Sci Med Sci. 2014;69(7):878-85. doi: 10.1093/gerona/glt171
30. Aung A.K., Corcoran S.J., Nagalingam V, Paul E., Newnham H.H. Prevalence, associations, and risk factors for orthostatic hypotension in medical, surgical, and trauma inpatients: an observational cohort study. Ochsner J. 2012;12(1):35-41
31. Wolters F.J., Mattace-Raso F.U., Koudstaal P.J., Hofman A., Ikram M.A., Heart Brain Connection Collaborative Research Group. Orthostatic Hypotension and the Long-Term Risk of Dementia: A Population-Based Study. PLOS Med. 2016;13(10):e1002143. doi:10.1371/journal.pmed.1002143
32. Franceschini N., Rose K.M., Astor B.C., Couper D., Vupputuri S. Orthostatic hypotension is associated with incident chronic kidney disease: The Atherosclerosis Risk In Communities Study. Hypertension. 2010;56(6):1054-9. doi:10.1161/HYPERTENSIONAHA.110.156380
33. Craig G. Clinical presentation of orthostatic hypotension in the elderly. Postgrad Med J 1994;70:638-42.
34. Zia A., Kamaruzzaman S.B., Tan M.P. Blood pressure lowering therapy in older people: does it really cause postural hypotension or falls? Postgrad Med 2015;127:186-193.
35. Mets T. Drug-induced orthostatic hypotension in older patients. Drugs Aging. 1995;6:219-28
36. Grubb B.P. Pathophysiology and differential diagnosis of neurocardiogenic syncope. Am J Cardiol. 1999;84(8A):3Q-9Q
37. Головина ГА., Дупляков Д.В. Ортостатическая гипотензия. Взгляд кардиолога. Артериальная гипертензия. 2014;20(2):75-85.
38. 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
39. Shannon J.R., Diedrich A., Biaggioni I., Tank J., Robertson R. M., Robertson D., Jordan J. Water drinking as a treatment for orthostatic syndromes. Am J Med. 2002;112(5):355-60
40. Sutton R. Clinical classification of syncope. Prog Cardiovasc Dis. 2013;55(4):339-44. doi: 10.1016/j.pcad.2012.11.005
41. Thompson W.O., Thompson P.K., Dailey M.E. The effect of posture upon the composition and volume of the blood in man. Proc Natl Acad Sci U S A. 1928;14(1):94-8
42. Grubb B.P., Karas B. Clinical disorders of the autonomic nervous system associated with orthostatic intolerance: an overview of classification, clinical evaluation, and management. Pacing Clin Electrophysiol. 1999;22(5):798-810
43. Hainsworth R. Vascular capacitance: its control and importance. Rev Physiol Biochem Pharmacol. 1986;105:101-73
44. Robertson D. Mechanisms of orthostatic hypotension. Curr Cardiol. 1993;8:737-45
45. Агаханов Ш.Э., Робертсон Д. Ортостатическая гипотония и вегетативная недостаточность (механизмы и классификации). Кардиология. 1995;3:41-9.
46. Masuo K., Mikami H., Ogihara T., Tuck M.L. Changes in frequency of orthostatic hypotension in elderly hypertensive patients under medications. Am J Hypertens. 1996;9(3):263-8
47. Lagi Lagi A., Rossi A., Comelli A., Rosati E., Cencetti S. , FADOI Hypertension Group. Postural hypotension in hypertensive patients. Blood Press. 2003;12(5-6):340-4
48. Mader S.L. Orthostatic hypotension. Med Clin North Am. 1989;73(6):1337-49
49. Fedorowski A., Melander O. Syndromes of orthostatic intolerance: a hidden danger. J Intern Med. 2013;273(4):322-35. doi: 10.1111/joim.12021
50. Robertson D. The pathophysiology and diagnosis of orthostatic hypotension. Clin Auton Res. 2008;18 Suppl 1:2-7. doi: 10.1007/s10286-007-1004-0
51. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure and multiple system atrophy. J Neurol Sci. 1996;144(1-2):218-9
52. Lipsitz L.A. Aging and the autonomous nervous system. In: Robertson D., Low P.A., Polinski R.J., eds. Primer on the Autonomic Nervous System. San Diego: Academic Press; 1996. pp. 79-83.
53. Rutan G.H., Hermanson B., Bild D.E., Kittner S.J., LaBaw F., Tell G.S. Orthostatic hypotension in older adults: the cardiovascular health study. Hypertension. 1992;19(6 Pt 1):508-19
54. Остроумова О.Д., Черняева М.С., Петрова М.М., Головина О.В. Ортостатическая гипотензия: определение, патофизиология, классификация, прогностические аспекты, диагностика и лечение. Рациональная фармакотерапия в кардиологии. 2018;14(5):747-756. doi: 10.20996/1819-6446-2018-14-5-747-756
55. Goldstein D.S., Sharabi Y. Neurogenic orthostatic hypotension: a pathophysiological approach. Circulation. 2009; 119(1): 139-46. doi: 10.1161/aRCULAHONAHA108.805887
56. Черняева М.С., Остроумова О.Д., Сычев Д.А. Лекарственно индуцированная ортостатическая гипотензия. Клин фармакол тер. 2018;27(5):57-63. doi 10.32756/0869-5490-2018-5-57-63.
57. Low P.A. Neurogenic orthostatic hypotension: pathophysiology and diagnosis. Am J Manag Care. 2015;21(13 Suppl):s248-57.
58. Gibbons C.H., Schmidt P., Biaggioni I., Frazier-Mills C. , Freeman R., Isaacson S., Karabin B., Kuritzky L, Lew M., Low P., Mehdirad A., Raj S.R., Vernino S., Kaufmann H. 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
59. Biaggioni I. Treatment: special conditions: orthostatic hypotension. JAm Soc Hypertens. 2015;9(1):67-9. doi:10.1016/j. jash. 2014.12.005
60. White N.J. Heart-rate changes on standing in elderly patients with orthostatic hypotension. Clin Sci (London). 1980;58(5):411-3
61. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Journal of the American Geriatrics Society. 2015;63(11):2227-46. doi:10.1111/jgs.13702
62. Gallagher P, Ryan C., Byrne S., Kennedy J., O’Mahony D. STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. IntJ Clin Pharmacol Ther. 2008;46:72-83
63. Darowski A., Dwight J. Medicines and Falls in Hospital: Guidance Sheet. National Institute for Health and Clinical Excellence guidelines, 2011