title: Wave reflections, arterial stiffness, and orthostatic hypotension.
abstract: BACKGROUND
  The effect of wave reflections on blood pressure change associated with posture remains unclear. We therefore applied a wave separation technique to investigate the relations of the backward pressure wave amplitude with orthostatic pressure changes and orthostatic hypotension (OH).
  
  
  METHODS
  We analyzed data from 613 subjects who had participated in our hemodynamic studies. Measurements of brachial systolic (SBP) and diastolic blood pressures (DBP), carotid-femoral pulse wave velocity (cf-PWV), and backward pressure wave amplitude from a decomposed carotid pressure wave (Pb) were obtained at supine position. SBP and DBP were measured again 3 minutes after standing. OH was defined as a fall of ≥20 mm Hg in SBP and/or ≥10 mm Hg in DBP.
  
  
  RESULTS
  Subjects with OH (n = 100) were characterized with significantly higher supine SBP and DBP and significantly lower standing SBP and DBP when compared with subjects without OH. Subjects with OH were also characterized with significantly higher cf-PWV and Pb. cf-PWV and Pb separately were significantly associated with the orthostatic SBP change in univariable and multivariable analyses. Also, cf-PWV and Pb separately were significant predictors of OH in univariable and multivariable analyses. cf-PWV predicted OH in the younger but less so in the older subgroup, whereas Pb demonstrated similar prediction in both subgroups. In a final multivariable model, both cf-PWV and Pb were significant independent predictors of OH.
  
  
  CONCLUSIONS
  Wave reflections are an independent determinant of orthostatic SBP change and OH in both younger and older subjects.
authors.forename: Shih-Hsien
authors.initials: SH
authors.lastname: Sung
authors.affiliation: Department of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medicine, National Yang-Ming University Hospital, Yilan, Taiwan;
authors.forename: Zu-Yin
authors.initials: ZY
authors.lastname: Chen
authors.affiliation: Department of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Cardiology, Taipei City Hospital, Yang-Ming Branch, Taipei, Taiwan;
authors.forename: Tzu-Wei
authors.initials: TW
authors.lastname: Tseng
authors.affiliation: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Publich Health, National Yang-Ming University, Taipei, Taiwan;
authors.forename: Dai-Yin
authors.initials: DY
authors.lastname: Lu
authors.affiliation: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University, Taipei, Taiwan;
authors.forename: Wen-Chung
authors.initials: WC
authors.lastname: Yu
authors.affiliation: Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan. Department of Medicine, National Yang-Ming University, Taipei, Taiwan;
authors.forename: Hao-Min
authors.initials: HM
authors.lastname: Cheng
authors.affiliation: Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan. chench@vghtpe.gov.tw.
authors.forename: Chen-Huan
authors.initials: CH
authors.lastname: Chen
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology*; D002339:Carotid Arteries / Q000503:physiopathology*; D005260:Female; D006339:Heart Rate; D006801:Humans; D007024:Hypotension, Orthostatic / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011187:Posture / Q000502:physiology*; D011379:Prognosis; D011673:Pulsatile Flow / Q000502:physiology*; D063177:Pulse Wave Analysis / Q000379:methods*; D059289:Vascular Stiffness / Q000502:physiology*
keywords: arterial stiffness; arterial wave reflections; blood pressure; hypertension; orthostatic hypotension.