Blood Pressure Variability and Ocular Vestibular-Evoked Myogenic Potentials Are Independently Associated With Orthostatic Hypotension.

IF 2.9 3区 医学 Q2 CLINICAL NEUROLOGY Journal of Clinical Neurology Pub Date : 2024-11-01 DOI:10.3988/jcn.2024.0092
Keun-Tae Kim, Jeong-Heon Lee, Jun-Pyo Hong, Jin-Woo Park, Sun-Uk Lee, Euyhyun Park, Byung-Jo Kim, Ji-Soo Kim
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Abstract

Background and purpose: We delineated the association between otolithic dysfunction and blood pressure (BP) variability.

Methods: We prospectively recruited 145 consecutive patients (age=71 [59-79] years, median [interquartile range]; 76 females) with orthostatic intolerance between December 2021 and December 2023 at a tertiary hospital in South Korea. Each patient underwent evaluations of cervical and ocular vestibular-evoked myogenic potentials (oVEMPs), 24-h noninvasive ambulatory BP monitoring (ABPM), and a head-up tilt-table test using the Finometer device. As measures of BP variability, the standard deviations (SDs) of the systolic BP (SBPSD) and the diastolic BP were calculated based on serial ABPM recordings. Patients were divided into those with orthostatic hypotension (OH, n=68) and those with a normal head-up tilt-table test despite orthostatic intolerance (NOI, n=77) groups.

Results: A multivariable logistic regression analysis showed that OH was associated with bilateral oVEMP abnormalities (p=0.021), SBPSD (p=0.012), and female sex (p=0.004). SBPSD was higher in patients with OH than in those with NOI (p<0.001), and was not correlated with n1-p1 amplitude (p=0.491) or normalized p13-n23 amplitude (p=0.193) in patients with OH. The sensitivity and specificity for differentiating OH from NOI were 72.1% and 67.5%, respectively, at a cutoff value of 12.7 mm Hg for SBPSD, with an area under the receiver operating characteristic curve of 0.73.

Conclusions: Bilaterally deficient oVEMP responses may be associated with OH regardless of 24-h BP variability, reflecting the integrity of the otolith-autonomic reflex during orthostasis. Alternatively, 24-h BP variability is predominantly regulated by the baroreflex, which also participates in securing orthostatic tolerance complementary to the vestibulo-autonomic reflex.

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血压变化和眼前庭诱发肌源性电位与直立性低血压有独立关联
背景和目的:我们研究了耳石功能障碍与血压(BP)变异性之间的关系:2021年12月至2023年12月期间,我们在韩国一家三甲医院连续招募了145名患有正压性不耐受症的患者(年龄=71 [59-79]岁,中位数[四分位间差];76名女性)。每位患者都接受了颈部和眼部前庭诱发肌源性电位(oVEMPs)评估、24 小时无创动态血压监测(ABPM)以及使用 Finometer 设备进行的仰头倾斜台测试。作为测量血压变异性的指标,根据连续的 ABPM 记录计算收缩压(SBPSD)和舒张压的标准差(SD)。患者被分为正交性低血压组(OH,68 人)和正交性不耐受但抬头仰卧试验正常组(NOI,77 人):多变量逻辑回归分析显示,OH 与双侧 oVEMP 异常(p=0.021)、SBPSD(p=0.012)和女性性别(p=0.004)有关。OH患者的SBPSD高于NOI患者(pp=0.491)或OH患者的正常化p13-n23振幅(p=0.193)。在 SBPSD 临界值为 12.7 mm Hg 时,区分 OH 和 NOI 的敏感性和特异性分别为 72.1%和 67.5%,接收者操作特征曲线下面积为 0.73:无论 24 小时血压变化如何,双侧 oVEMP 反应不足可能与 OH 相关,这反映了正位时耳石-自律神经反射的完整性。或者,24 小时血压变异性主要由气压反射调节,气压反射也与前庭-自律神经反射互补,参与确保正位耐受性。
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来源期刊
Journal of Clinical Neurology
Journal of Clinical Neurology 医学-临床神经学
CiteScore
4.50
自引率
6.50%
发文量
0
审稿时长
>12 weeks
期刊介绍: The JCN aims to publish the cutting-edge research from around the world. The JCN covers clinical and translational research for physicians and researchers in the field of neurology. Encompassing the entire neurological diseases, our main focus is on the common disorders including stroke, epilepsy, Parkinson''s disease, dementia, multiple sclerosis, headache, and peripheral neuropathy. Any authors affiliated with an accredited biomedical institution may submit manuscripts of original articles, review articles, and letters to the editor. The JCN will allow clinical neurologists to enrich their knowledge of patient management, education, and clinical or experimental research, and hence their professionalism.
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