Haemodynamic and neurohumoral responses in elderly patients with postural hypotension


University Department of Geriatric Medicine, Royal Liverpool Hospital, Prescot Street, Liverpool, L69 3BX, UK


Abstract. Haemodynamic and neurohumoral responses to head-up tilt were measured in 28 elderly patients with postural hypotension (EPPH) and 12 healthy elderly subjects (HE). There were no differences in catecholamines between the groups and only noradrenaline increased on tilt (P< 0.001). Plasma renin activity and aldosterone were similar in HE and EPPH in the supine and tilt positions. In both groups vasopressin increases (P=0.032), and plasma volume decreases were the same (P=0.673). Supine EPPH had higher heart rates (P=0.019) but similar cardiac indices (P = 0.621). Both had similar changes on tilting (P=0.975 and P=0.341). Stroke volume decrease was higher in HE (35%) than EPPH (23%; P< 0.001). HE showed an increase in peripheral resistance on tilting with no change in EPPH (P=0.005). EPPH had larger coefficients of variation for all variables. The differences in haemodynamic responses and the similarity of neurohumoral responses during tilting suggest end-organ failure in EPPH with individual variations. Postural hypotension in old age is not a single entity.