Haemodynamic responses in young and elderly, healthy subjects during ambient and warm head-up tilt

1. Postural hypotension is common in elderly people and is usually multifactorial in origin. In young subjects increased ambient temperature is associated with postural symptoms. We hypothesized that such increases in skin temperature due to the use of bed clothes might contribute to nocturnal postural hypotension in the elderly. We therefore studied haemodynamic responses to head-up tilt in healthy elderly and young subjects, with and without passive heating induced by covering with blankets. 2. Nine young (28.7 +/- 1.5 years; mean +/- S.E.M.) and nine elderly (71.9 +/- 1.8 years) subjects were studied. All had been carefully screened to exclude factors likely to affect responses to tilt. All subjects underwent a standard head-up tilt procedure at ambient room temperature while haemodynamic responses were monitored. The subjects were then covered in blankets for 55 min and the tilt repeated. Skin temperature before the second tilt had increased from approximately 32.5 degrees C to approximately 35.2 degrees C (P < 0.001). 3. The elderly subjects maintained higher blood pressures throughout both tilts (P < 0.001) and both groups showed similar qualitative responses to tilt. Supine heart rates were higher in the elderly group (P < 0.01) with a tendency to increase more in the young group in response to tilt, especially while warm (P = 0.370). Stroke volumes and cardiac indices were consistently higher in the young group who showed larger changes during both head-up tilts. In both groups the haemodynamic responses to ambient and warm tilt were essentially the same. 4. Healthy elderly subjects, who are carefully screened to exclude individuals with cardiovascular pathology, respond to head-up tilt in the same qualitative fashion as young subjects. Quantitative responses in older subjects are 'damped'. Short-term natural body warming does not impair the reflexes in young or old subjects.