Erişkin Bireylerde Ortostatik Hipotansiyon ile Beden Kütle İndeksi Arasındaki İlişkinin İncelenmesi

Öz

Giriş: Ortostatik hipotansiyon, klinik ortamda olası semptomlardan şikâyet edilmedikçe genel olarak kontrol edilmeyen ve hayatı tehdit eden ciddi bir sorundur. Amaç: Erişkin bireylerde Ortostatik Hipotansiyonun Beden Kütle İndeksi (BKİ) ile ilişkisini incelemek ve Ortostatik Hipotansiyonun nabız, solunum ve oksijen satürasyonu ile ilişkisini değerlendirmektir. Yöntem: Tanımlayıcı ve analitik tipte olan bu araştırma, Şubat-Nisan 2019 tarihleri arasında bir hastanenin karma cerrahi kliniğine estetik ve obezite cerrahisi nedeniyle yatışı yapılan 170 erişkin birey ile yürütülmüştür. Bireyler 10 dakika supine pozisyonda yatırılmış, yataktan kalkmadan ve kalktıktan bir dakika sonra kan basıncı, nabız, solunum ve oksijen satürasyonu değerleri ölçülerek kayıt edilmiştir. Sistolik Kan Basıncı (SKB)’nda 20 mmHg ve/veya daha fazla düşüş Ortostatik Sistolik Hipotansiyon (OSH); Diyastolik Kan Basıncı (DKB)’nda 10 mmHg ve/veya daha fazla düşüş Ortostatik Diyastolik Hipotansiyon (ODH); hem SKB’de 20 mmHg ve/veya üzeri hem de DKB’de 10 mmHg ve üzeri düşüş Ortostatik Hipotansiyon (OH) olarak değerlendirilmiştir. Birey ayağa kaldırıldıktan sonra ortostatik hipotansiyon belirtileri açısından da sorgulanmıştır. Bulgular: Araştırmaya katılan bireylerin yaş ortalaması 34.41±10.50, %87.6’sı kadındır. Bireylerin %12.9’unda OSH, %25.9’ unda ODH ve %4.1’inde OH saptanmıştır. Ortostatik Hipotansiyon saptanan bireylerin BKİ ortalaması saptanmayanlara göre anlamlı olarak daha yüksek bulunmuştur. Nabız, solunum ve oksijen satürasyonu değerlerinde postural değişiklikle birlikte istatistiksel olarak anlamlı bir değişim görülmemiştir. OSH saptanan bireylerde en sık ifade edilen belirtiler göz kararması, baş dönmesi, çarpıntı ve bulanık görme iken ODH ve OH saptanan bireylerde yorgunluk, çarpıntı, bulanık görme ve göz kararmasıdır. Sonuç: Beden Kütle İndeksi ortalamasının yüksek olması OSH, ODH ve OH riskini artırdığı, bu riskin OH saptanan bireylerde anlamlı olduğu görülmüştür.

Anahtar Kelimeler

• Hipotansiyon
• Ortostatik Hipotansiyon
• Beden Kütle İndeksi/BKİ

Investigation of the Relationship Between Orthostatic Hypotension and Body Mass Index in Adult Individuals

Öz

Background: Orthostatic hypotension is a serious, life-threatening problem in the clinical environment that is generally not controlled unless possible symptoms are complained. Objectives: The aim of this study is to examine the relationship between Orthostatic Hypotension and Body Mass Index (BMI) in adult individuals hospitalized in mixed surgery clinic and to evaluate the relationship of Orthostatic Hypotension with pulse, respiration and oxygen saturation. Methods: This quasi-experimental study was conducted from February to April in 2019 in the mixed surgery clinic within a hospital. Individuals were placed in a supine position for 10 minutes, and their blood pressure, heart rate, respiration and oxygen saturation were measured and recorded before getting out of bed and one minute after getting out. The individuals were also questioned in terms of orthostatic hypotension symptoms after standing up. Results: The mean age of the individuals participating in the study is 34.41±10.50, 87.6% of them are women. Orthostatic Systolic Hypotension (OSH) was detected in 12.9% of the individuals, Orthostatic Diastolic Hypotension (ODH) in 25.9% and Orthostatic Hypotension (OH) in 4.1%. The average BMI of individuals with orthostatic hypotension was found to be significantly higher than those without. There was no statistically significant change in pulse, respiration and oxygen saturation values with postural change. The most common symptoms in individuals with OSH are blackout, dizziness, whereas those in individuals with ODH and OH are fatigue, palpitations. Conclusion: It was observed that a high mean Body Mass Index increased the risk of OSH, ODH and OH, and this risk was significant in individuals with OH.

Anahtar Kelimeler

• Hypotension
• Orthostatic Hypotension
• Body Mass Index / BMI

Kaynakça

1. 1. Alagiakrishnan K, Bu R, Hamilton P, Senthilselvan A, Padwal R. Comparison of the assessment of orthostatic hypotension using peripheral and central blood pressure measurements. J Clin Med Res. 2018;10(4):309.
2. 2. National Heart, et al. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. No. 98. National Heart, Lung, and Blood Institute. 1998;6:51-209.
3. 3. Fedorowski A, Stavenow L, Hedblad B, Berglund G, Nilsson PM, Melander O. Orthostatic hypotension predicts all-cause mortality and coronary events in middle-aged individuals (The Malmö Preventive Project). Eur Heart J. 2010;31(1):85-91.
4. 4. Juraschek SP, Daya N, Rawlings AM, Appel LJ, Miller ER, Windham BG, et al. Association of history of dizziness and long-term adverse outcomes with early vs later orthostatic hypotension assessment times in middle-aged adults. JAMA Intern Med. 2017;177(9):1316-1323.
5. 5. Ricci F, De Caterina R, Fedorowski A. Orthostatic hypotension: Epidemiology, prognosis, and treatment. J Am Coll Cardiol. 2015;66(7):848-860.
6. 6. Turner D. A patient with autonomic imbalance: Treating symptomatic neurogenic orthostatic hypotension. Nurse Pract. 2018;43(6):18-22.
7. 7. Irvin DJ, White M. The importance of accurately assessing orthostatic hypotension. Geriatr Nurs. 2004;25(2):99-101.
8. 8. Lanier JB, Mote MB, Clay EC. Evaluation and management of orthostatic hypotension. Am Fam Physician. 2011;84(5):527-536.

9. 9. Feldstein C, Weder AB. Orthostatic hypotension: A common, serious and underrecognized problem in hospitalized patients. J Am Soc Hypertens. 2012;6(1):27-39.
10. 10. Allan LM, Ballard CG, Rowan EN, Kenny RA. Incidence and prediction of falls in dementia: A prospective study in older people. PLoS One. 2009;4(5):e5521.
11. 11. Figueroa JJ, Basford JR, Low PA. Preventing and treating orthostatic hypotension: As easy as A, B, C. Cleve Clin J Med. 2010;77(5):298–306. 12. Gupta V, Lipsitz LA. Orthostatic hypotension in the elderly: Diagnosis and treatment. Am J Med. 2007;120(10):841–847.
12. 13. Shibao C, Grijalva CG, Raj SR, Biaggioni I, Griffin MR. Orthostatic hypotension-related hospitalizations in the United States. Am J Med. 2007;120(11):975–980.
13. 14. Jones CD, Loehr L, Franceschini N, Rosamond WD, Chang PP, Shahar E, et al. Orthostatic hypotension as a risk factor for incident heart failure: The atherosclerosis risk in communities study. Hypertension. 2012;59(5):913–918.
14. 15. Kobayashi K, Yamada S. Development of a simple index, calf mass index, for screening for orthostatic hypotension in community-dwelling elderly. Arch Gerontol Geriatr. 2011;54(2):293–297.
15. 16. Lee T, Donegan C, Moore A. Combined hypertension and orthostatic hypotension in older patients: A treatment dilemma for clinicians. Expert Rev Cardiovasc Ther. 2005;3(3):433–440.
16. 17. Nakamura T, Suzuki M, Ueda M, Hirayama M, Katsuno M. Lower Body Mass Index is associated with orthostatic hypotension in Parkinson's disease. J Neurol Sci. 2017;372:14-18.
17. 18. Portney LG, Watkins MP. Foundations of clinical research. Applications to practice Norwalk, Connecticut, Appleton&Lange, 1993; 652-661.
18. 19. Luukinen H, Koski K, Laippala P, Kivelä SL. Prognosis of diastolic and systolic orthostatic hypotension in older persons. Arch Intern Med. 1999;159(3):273-280.
19. 20. Méndez AS, Melgarejo JD, Mena LJ, Chávez CA, González AC, Boggia J, et al. Risk factors for orthostatic hypotension: Differences between elderly men and women. Am J Hypertens. 2018;31(7):797-803.
20. 21. Ricci F, Fedorowski A, Radico F, Romanello M, Tatasciore A, Di Nicola M, et al. Cardiovascular morbidity and mortality related to orthostatic hypotension: a meta-analysis of prospective observational studies. Eur Heart J. 2015;36(25):1609-1617.
21. 22. Annamalai A. Orthostatic hypotension. In medical management of psychotropic side effects. Springer, Cham. 2017.
22. 23. Turner D. A patient with autonomic imbalance: Treating symptomatic neurogenic orthostatic hypotension. Nurse Pract. 2018;43(6):18-22.
23. 24. World Health Organization, global database on body mass ındex. https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi Erişim Tarihi: 17.05.2020.
24. 25. Goldstein DS, Eldadah BA, Holmes C, Pechnik S, Moak J, Saleem A, et al. Neurocirculatory abnormalities in Parkinson disease with orthostatic hypotension: independence from levodopa treatment. Hypertension. 2005;46(6):1333-1339.
25. 26. Press Y, Punchik B, Freud T. Orthostatic hypotension and drug therapy in patients at an outpatient comprehensive geriatric assessment unit. J Hypertens. 2016;34(2):351-358.
26. 27. Logan IC, Witham MD. Efficacy of treatments for orthostatic hypotension: A systematic review. Age Ageing. 2012;41(5):587–594.
27. 28. Gangavati A, Hajjar I, Quach L, Jones RN, Kiely DK, Gagnon P, et al. Hypertension, orthostatic hypotension, and the risk of falls in a community dwelling elderly population: the maintenance of balance, independent living, intellect, and zest in the elderly of Boston study. J Am Geriatr Soc. 2011;59(3):383-389.
28. 29. Frewen J, Savva GM, Boyle G, Finucane C, Kenny RA. Cognitive performance in orthostatic hypotension: findings from a nationally representative sample. J Am Geriatr Soc. 2014;62(1):117-22.
29. 30. Mager DR. Orthostatic hypotension: Pathophysiology, problems, and prevention. Home Healthc Nurse. 2012;30(9):525-530.
30. 31. Lahrmann H, Cortelli P, Hilz M, Mathias CJ, Struhal W, Tassinari M. EFNS guidelines on the diagnosis and management of orthostatic hypotension. Eur J Neurol. 2006;13(9):930-936.