Orthostatic change in systolic blood pressure associated with cold pressor reflection and heart rate variability in the elderly

Background: Impaired orthostatic blood pressure (BP) response is a frequent finding in the elderly. The goal of the study was to investigate the association of variability of supine-to-orthostatic BP with cold pressor reflection and heart rate variability in the elderly. Methods: From June 2010 to September 2013, 287 elderly aged ? 60?years were enrolled in Jinan area, China. The elderly were classified into lower (n =?96), intermediate (n =?95), and higher (n =?96) tertile groups according to the tertile of the percentage change of supine-to-orthostatic systolic BP. Results: There were significant increasing trends in systolic BP response to the CPT at 0 and 60?sec; the plasma levels of epinephrine, norepinephrine, and angiotensin II; and decreasing trends in DNN, SDNN index, and SDANN from the lower to the higher tertile group, and differences between any two groups were significant (P <?.05). The percentage change of supine-to-orthostatic systolic BP was positively correlated with systolic BP response to CPT at 0 and 60?sec, VLF, epinephrine, norepinephrine, and angiotensin II (P <?.001) and negatively correlated with SDNN, SDNN index, SDANN, rMSSD, pNN50, LF, and ratio of LF/HF (P <?.001). The BP response to CPT, parameters of HRV, and the plasma levels of norepinephrine and angiotensin II were independently associated with the percentage change of supine-to-orthostatic systolic BP after adjustment for confounders. Conclusion: Aggressive variability of supine-to-orthostatic systolic BP might be significantly associated with the imbalance of sympathetic and parasympathetic activity, especially high sensitivity sympathetic response in the elderly.