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Tilt Testing with Combined Lower Body Negative Pressure: a "Gold Standard" for Measuring Orthostatic Tolerance
Published on: March 21, 2013
Orthostatic blood pressure variability is associated with lower visual contrast sensitivity function: Findings from
Bláithín Ní Bhuachalla1, Christine A McGarrigle2, Neil O'Leary2
1Department of Medical Gerontology, School of Medicine, Trinity College Dublin, The University of Dublin, Old Stone Building, Trinity Centre for Health Sciences, St James's Hospital, James's Street, Dublin 8, Ireland.
Insights
Blood pressure variability after standing is linked to poorer vision, specifically contrast sensitivity. This finding suggests blood pressure changes could indicate early eye problems, even without diagnosed hypertension.
Area of Science:
- Ophthalmology and Visual Science
- Cardiovascular Health
- Autonomic Nervous System Function
Background:
- Hypertension is a known cause of vascular end-organ damage.
- Abnormal blood pressure (BP) regulation, including orthostatic hypotension, is linked to cardiovascular events.
- The eye's susceptibility to BP dysregulation depends on ocular circulation autoregulation.
Purpose of the Study:
- To investigate the relationship between abnormal BP stabilization phenotypes after orthostasis and contrast sensitivity.
- To determine if visual function, measured by contrast sensitivity, is associated with specific orthostatic BP behaviors.
Main Methods:
- Cross-sectional study using data from The Irish Longitudinal Study on Ageing (TILDA).
- Defined 4 orthostatic BP phenotypes (normal, hypotension, hypertension, variability) from beat-to-beat BP measurements.
- Assessed contrast sensitivity using a Functional Visual Analyzer in 4289 adults aged ≥50 years, with multivariable regression analyses.
Main Results:
- Systolic orthostatic blood pressure variability was significantly associated with worse contrast sensitivity.
- This association persisted in primary and sensitivity analyses, even after adjusting for cardiovascular risk factors and retinal pathologies.
- Adjusting for clinical cataract reduced the observed association by 18%.
Conclusions:
- Orthostatic blood pressure variability is independently associated with reduced contrast sensitivity.
- This suggests orthostatic BP variability may serve as a cardiovascular biomarker for early ocular pathology.
- The findings highlight a potential link between autonomic BP regulation and subtle visual function deficits.
Background:
Hypertension is established to cause vascular end-organ damage. Other forms of dysregulated blood pressure (BP) behaviour, such as orthostatic hypotension have also been associated with cardiovascular (CV) events. The eye is potentially vulnerable to dysregulated systemic BP if ocular circulation autoregulation is impaired. We investigated whether phenotypes of abnormal BP stabilisation after orthostasis, an autonomic stressor, had a relationship with contrast sensitivity (CS), an outcome measure of subtle psychophysical visual function.
Methods:
This was a cross-sectional study from wave 1 of The Irish Longitudinal Study on Ageing (TILDA). From beat-to-beat orthostatic BP (BP), measured by digital photoplethysmography during active stand, 4 phenotypes have been defined 1) normal stabilisation 2) orthostatic hypotension, 3) orthostatic hypertension 4) BP variability. Contrast sensitivity was measured using a Functional Visual Analyzer. Multivariable linear regression models investigated the relationship between orthostatic BP phenotypes and contrast sensitivity in 4289 adults aged ≥50 years adjusting for, demographics, cardiovascular risk factors, self-reported eye pathologies, objective hypertension and antihypertensives. A sensitivity analysis adjusted for age-related macular degeneration, glaucoma, diabetic retinopathy and maculopathy identified on retinal photographs. Finally models were compared, adjusting for alternative measures of cataract versus not, to examine the potential effect of cataract on any associations.
Results:
Systolic orthostatic BP variability was associated with worse contrast sensitivity, in the primary and the sensitivity analysis. Adjusting for alternative measures of clinical cataract attenuated the association by 18%.
Conclusions:
Orthostatic BP variability is associated with worse contrast sensitivity, independent of hypertension and retinal pathology and may be a cardiovascular biomarker of early ocular pathology.
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