Journal of ISSN: 2373-4396JCCR

Cardiology & Current Research
Mini Review
Volume 7 Issue 5 - 2016
Orthostatic Hypotension of Elderly Patients with Hypertension: A Retrospective Analysis of the Effects of Smoking
Aurelio Leone1,2,3*
1Fellow of the American Society of Hypertension (FASH), USA
2Fellow of the Royal Society for Promotion of Health (FRSPH), UK
3Editor-in-Chief of the Journal of Cardiology6&Current Research, USA
Received: September 14, 2016 | Published: December 30, 2016
*Corresponding author: Aurelio Leone, Fellow of the Royal Society for Promotion of Health, Via Provinciale 27, 19030 Castelnuovo Magra (SP), Italy, Tel: +393472272215; Email:
Citation: Leone (2016) Orthostatic Hypotension of Elderly Patients with Hypertension: A Retrospective Analysis of the Effects of Smoking. J Cardiol Curr Res 7(5): 00264. DOI: 10.15406/jccr.2016.07.00264

Abstract

Orthostatic hypotension is a common outcome in elderly patients treated with antihypertensive drugs. The purpose of this paper to analyze and compare the rate and type of orthostatic hypotension observed in two groups of elderly patients, partly smokers and partly non-smokers considered as a control group. The results observed clearly documented a major incidence of orthostatic hypotension in elderly never smokers when compared with similar smoker individuals as a demonstration of the protective effects of smoking compound towards this type of pathology.

Keywords: Orthostatic hypotension; Elderly; Cigarette smoking

Introduction

Orthostatic hypotension is a common occurrence in elderly patients (pts) with hypertension, primarily when they are treated with antihypertensive drugs [1]. In addition, there is evidence that orthostatic hypotension could be increased by the more advanced age [2-3]. Little attention has been specifically directed to the role of smoking on the rate and role of orthostatic hypotension in elderly chronic smokers. Smoking, usually, exerts sympathetic effects that reduce hypotension rate [4,5]. There is also evidence that sympathetic stimulation enhances adrenergic response able, itself, to increase blood pressure [6,7]. The purpose of this retrospective study was to assess the rate of orthostatic hypotension in hypertensive male smokers and non-smokers treated with antihypertensive drugs.

Methods

Study population consisted of 78 patients (Table 1), 36 (46%) hypertensive smokers aged from 75 to 88 years (mean: 80.5+/-4.5 years, mean Systolic Blood Pressure 135+/-11 mmHg and mean Diastolic Blood Pressure 92+/-8 mmHg), and 42 (54%) hypertensive non-smokers (age from 75 to 86 years, mean: 81.6+/-3 years, mean Systolic Blood Pressure 129+/- 9 mmHg, and mean Diastolic Blood Pressure 88+/- 8 mmHg), used as a control group.  The antihypertensive therapy in smokers consisted of diuretics (18 patients), ACEI-Inhibitors (12 cases) and the association of both drugs (6 cases) (Table 2). Statistical analysis was conducted by using t-test with a P<0.05 significant. Symptomatic orthostatic hypotension was recorded and compared in both groups, smoker and never smoker elderly individuals.

Number (total)

78 (100%)

Sex

Male

78 (100%)

Smokers

36 (46%)

Non-smokers (control group)

42 (54%)

Mean age (ys.) smokers

80.5+/-4.5

Mean age (ys.) non-smokers

81.6+/-6.3

Systolic blood pressure smokers (mean mmHg)

135+/-11

Diastolic blood pressure smokers (mm Hg mean)

92+/-8

Systolic blood pressure non-smokers (mean mmHg)

129+/-9

Diastolic blood pressure non-smokers (mean mmHg)

88-/-8

Table 1: Characteristics of study population.

Diuretics

18/36 patients

ACEI-Inhibitors

12/36 patients

Diuretics+ ACEI-Inhibitors

6/ 36 patients

Table 2: Antihypertensive therapy in smoker individuals.

Results

Table 3 shows the outcome of blood pressure in the study population. 5 patients (5/36, 14%) with orthostatic hypotension, aged from 80 to 87 years, were smokers, while non-smokers, acting as a control group, displayed 14 events characterized by orthostatic hypotension (14/42, 33%) distributed in individuals aging from 78 to 86 years. The P - value was less than 0.05 statistically significant, although CI (confidence interval) 95% was comprised between 4 to 25 for smoker individuals versus 25 to 51 for non-smokers.

Smokers

Orthostatic hypotension

5/36 (14%)

No orthostatic hypotension

31/36 (86%)

Non-smokers

Orthostatic hypotension

14/42 (33%)

No orthostatic hypotension

38/42 (67%)

P-value smokers/non smokers

< 0.05

CI 95% smoker

Apr-25

CI 95% non-smokers

25-51

Table 3: Outcome of blood pressure in the study population.

Conclusion

These observations clearly show that in the elderly patients treated with antihypertensive drugs, orthostatic hypotension is a prevalent occurrence in non-smokers while cigarette smoking seems to reduce the rate of this outcome probably because of the sympathetic and adrenergic effects attributed to smoking compounds usually able to induce hypertension.

References

  1. Gupta V, Lipsitz LA (2007) Orthostatic hypotension in the elderly: diagnosis and treatment. Am J Med 120(10): 841-847.
  2. World Health Organization (WHO) (2014) Global Health Observatory (GHO) data.
  3. Leone A (2015) The control of blood pressure worldwide: a glimmer of success. J Cardiol Curr Res 3(5): 00177.
  4. Baer L, Radichevich I (1985) Cigarette smoking in hypertensive patients. Blood pressure and endocrine responses. Am J Med 78(4): 564-568.
  5. Leone A, Landini L, Leone A (2010) What is tobacco smoke? Sociocultural dimensions of the association with cardiovascular risk. Curr Pharm Des 16(23): 2510-2517.
  6. Watts DT (1960) The effects of nicotine and smoking on the secretion of epinephrine. Ann NYAcad Sci 90: 74-80.
  7. Samuels MA (1993) Neurally-induced cardiac damage: definition of the problem. Neurol Clin 11(2): 273-292.
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