DAILY BLOOD PRESSURE PROFILE IN CHILDREN WITH SYNCOPE DUE TO ORTHOSTATIC HYPOTENSION
DOI:
https://doi.org/10.11603/24116-4944.2021.2.12672Keywords:
syncope due to orthostatic hypotension, active standing test, blood pressure, ambulatory blood pressure monitoring, childrenAbstract
The aim of the study – to investigate the features of circadian rhythms of blood pressure in children with syncope due to orthostatic hypotension.
Materials and Methods. 22 children with a diagnosis of syncope due to orthostatic hypotension and 41 almost healthy children aged 8–17 years were examined. The diagnostic criteria of the European Association of Cardiology (2018) were used to diagnose syncope. All patients were provided by careful history taking, physical examination, active standing test, 12-lead electrocardiography, echocardiography, electroencephalography and 24-hour ambulatory blood pressure monitoring.
Results and Discussion. Despite the fact that orthostasis in children with syncope due to orthostatic hypotension was characterized by early orthostatic hypotension with a decrease in systolic and diastolic blood pressure, and heart rate at the 1st and the 3rd minutes, the average systolic blood pressure was decreased up to the 10th minute of active standing compared with the control group (p<0.05). The daily blood pressure profile in patients with syncope due to orthostatic hypotension was associated with a decrease in the day-time systolic blood pressure percentage above normal (5.6±0.9 %; 10.7±1.5 %; p=0.0215), the index of hypertension time for day-time systolic blood pressure (4.5±1.0 %; 8.5±1.4 %; p=0.0438), and night-time diastolic blood pressure range (55.4±0.9 mm Hg; 57.7±0.7 mm Hg; p=0.0422) compared with healthy respondents. Nocturnal decline in blood pressure in the group of syncope due to orthostatic hypotension was characterized by the dominance of non-dipper pattern for systolic (68.2 %) and diastolic blood pressure (27.7 %), and over-dipper pattern for diastolic blood pressure (40.9 %).
Conclusions. The identified features of daily blood pressure fluctuations in children with syncope due to orthostatic hypotension are the evidence of autonomic nervous system imbalance and require further researches to substantiate the feasibility of using daily blood pressure monitoring as an indicator to assess the effectiveness of syncope management in children.
References
Kenny, R.A., Bhangu, J., & King-Kallimanis, B. L. (2013). Epidemiology of syncope/collapse in younger and older Western patient populations. Prog. Cardiovasc. Dis., 55 (4), 357-363. DOI: 10.1016/j.pcad.2012.11.006.
Stewart, J.M. (2012). Update on the theory and management of orthostatic intolerance and related syndromes in adolescents and children. Exp. Rev. Cardiovasc. Ther., 10 (11), 1387-1399. DOI: 10.1586/erc.12.139.
Stewart, J.M., Boris, J.R., Chelimsky, G., Fischer, P.R., Fortunato, J.E., Grubb, B.P., …, & Chelimsky, T.C. (2018). Pediatric disorders of orthostatic intolerance. Pediatrics,141, 1673. DOI: 10.1542/peds.2017-1673
Ricci, F., De Caterina, R., & Fedorowski, A. (2015). Orthostatic hypotension: epidemiology, prognosis, and treatment. J. Am. Coll. Cardiol., 66 (7), 848-860. DOI: 10.1016/j.jacc.2015.06.1084.
Naschitz, J.E., & Rosner, I. (2007). Orthostatic hypotension: framework of the syndrome. Postgrad. Med. J., 83 (983), 568-574. DOI: 10.1136/pgmj.2007.058198.
Freeman, R., Wieling, W., Axelrod, F.B., Benditt, D.G., Benarroch, E., Biaggioni, I., … & van Dijk, J.G. (2011). Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin. Auton. Res., 21 (2), 69-72. DOI: 10.1007/s10286-011-0119-5.
Brignole, M., Moya, A., J de Lange, F., Deharo, J.C., Elliott, P.M., Fanciulli A., …, & van Dijk J.G. (2018). ESC Guidelines for the diagnosis and management of syncope. Eur. Heart J., 39 (21), 1883-1948. DOI: 10.1093/eurheartj/ehy037.
Tanaka, H., Fujita, Y., Takenaka, Y., Kajiwara, S., Masutani, S., Ishizaki, Y., …, & Honda, K. (2009). Japanese clinical guidelines for juvenile orthostatic dysregulation version 1. Pediatr. Int., 51 (1), 169-179. DOI: 10.1111/j.1442-200X.2008.02783.x.
Marushko, T.V. (2017). Synkopalni stany u ditei [Syncopal states in children]. Dytiachyi likar – Pediatrician, 5-6, 56-57, 11-18 [in Ukrainian].
Fanciulli, A., Strano, S., Ndayisaba, J.P., Goebel, G., Gioffrè, L., Rizzo, M., …, & Pontieri, F.E. (2014). Detecting nocturnal hypertension in Parkinson's disease and multiple system atrophy: proposal of a decision-support algorithm. J. Neurology, 261 (7), 1291-1299. DOI: 10.1007/s00415-014-7339-2.
Parati, G., Stergiou, G., O'Brien, E., Asmar, R., Beilin, L., Bilo, G., …, & Zhang, Y. (2014). European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring. J. Hypertens., 32 (7), 1359-1366. DOI: DOI: 10.1097/HJH.0000000000000221.
Le Jeune, S., Suhl, J., Feit, B., Bally, S., Lequeux, B., Le Coz, S., …, & Mourad, J.J. (2021). Prevalence of masked orthostatic hypotension measured by home blood pressure monitoring in elderly hypertensive subjects: results of the HYPAUTTENS study. J. Hypertens., 39, e125. DOI: 10.1097/01.hjh.0000745716.55615.49.
Schmidt, C., Berg, D., Herting, Prieur, S., Junghanns, S., Schweitzer, K., Globas, C., Schöls, L., Reichmann, H., & Ziemssen, T. (2009). Loss of nocturnal blood pressure fall in various extrapyramidal syndromes. Mov. Disord., 24 (14), 2136-2142. DOI: 10.1002/mds.22767.
Voichanski, S., Grossman, C., Leibowitz, A., Peleg, E., Koren-Morag, N., Sharabi, Y., …, & Grossman, E. (2012). Orthostatic hypotension is associated with nocturnal change in systolic blood pressure. Am. J. Hypertens., 25, 159-164. DOI: 10.1038/ajh.2011.191.
Lurbe, E., Agabiti-Rosei, E., Cruickshank, J.K., Dominiczak, A., Erdine, S., Hirth, A., …, &Zanchetti, A. (2016). 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J. Hypertens., 34 (10), 1887-1920. DOI: 10.1097/HJH.0000000000001039.
Cappelleri, C., Janoschka, A., Berli, R., Kohler, S., Braun-Dullaeus, R.C., Heuss, L.T., & Wolfrum, M. (2017). Twenty-four-hour ambulatory blood pressure monitoring in very elderly patients: Comparison of in-hospital versus home follow-up results. Medicine, 96 (34), e7692. DOI: 10.1097/MD.0000000000007692.
Dadlani, A., Madan, K., Sawhney, J.P.S. (2019). Ambulatory blood pressure monitoring in clinical practice. Indian Heart J., 71 (1), 91-97. DOI: 10.1016/j.ihj.2018.11.015.
Lodhi, H.A., Peri-Okonny, P.A., Schesing, K., Phelps, K., Ngo, C., Evans, H., …, & Vongpatanasin, W. (2019). Usefulness of blood pressure variability indices derived from 24-hour ambulatory blood pressure monitoring in detecting autonomic failure. J. Am. Heart Assoc., 8 (7), e010161. DOI: 10.1161/JAHA.118.010161.
Zhixiang, Y., Cheng, W., Jibing, X., Bisheng, G., Ming, X., & Deyu, L. (2018). Ambulatory blood pressure monitoring in children suffering from orthostatic hypertension. Biomed. Eng. Online, 17 (1), 129. DOI: 10.1186/s12938-018-0530-4.
Voichanski, S., Grossman, C., Leibowitz, A., Peleg, E., Koren-Morag, N., Sharabi, Y., …, & Grossman, E. (2012). Orthostatic hypotension is associated with nocturnal change in systolic blood pressure. Am. J. Hypertens., 25 (2), 159-164. DOI: 10.1038/ajh.2011.191.
Kovalchuk, T.A., & Boyarchuk, O.R. (2020). Osoblyvosti dobovoho rytmu arterialnoho tysku u ditei iz vazovahalnymy synkope [The features of the circadian rhythm of blood pressure in children with vasovagal syncope]. Aktualni pytannia pediatrii, akusherstva ta hinekolohii – Current Problems of Pediatrics, Obstetrics and Gynecology, 1, 10-16. DOI: 10.11603/24116-4944.2020.1.11477 [in Ukrainian].
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Actual Problems of Pediatrics, Obstetrics and Gynecology
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish in this journal agree to the following terms:
1. The authors reserve the right to authorship of the work and pass the journal right of first publication of this work is licensed under a Creative Commons Attribution License, which allows others to freely distribute the work published with reference to the authors of the original work and the first publication of this magazine.
2. Authors are entitled to enter into a separate agreement on additional non-exclusive distribution of work in the form in which it was published in the magazine (eg work place in the electronic repository institution or publish monographs in part), provided that the reference to the first publication of this magazine.
3. Policy magazine allows and encourages authors placement on the Internet (eg, in storage facilities or on personal websites) manuscript of how to submit the manuscript to the editor and during his editorial processing, since it contributes to productive scientific discussion and positive impact on the efficiency and dynamics of citing published work (see. The Effect of Open Access).
