The essential arterial hypotension and allostasis registry is a prospective, observational research that has the purpose of demonstrating that essential blood pressure (BP) disorders and the associated comorbidities are a result of the inappropriate allostatic response to daily life stress. This required a functioning brain orchestrating the evaluation of the threat and choosing the response, this is a mind-mediated phenomenon. If the response is excessive it contributes to high BP, if deficient to low BP, and the BP itself will identify the allostatic pattern, which in turn will play an important role in the development of the comorbidities.
To do so, consecutive patients of any age and gender that visit a cardiologist's office in Medellin, Colombia, are recruited. Individuals are classified according to their arterial BP and allostasis and follow them in time to see what kind of diseases develops the most (including BP) in the follow up according to the categorization of the characteristic chosen and after adjustment for confounder's variables. In addition, stress events with their date are registered.
HYPOTHESIS
The causes of the diseases are multifactorial.
Physical, biochemical, psychological, social, and cultural dimensions of development dynamically interact to shape the health development process.
A person´s health depends on their:
1. Biological and physiologic systems
2. External and internal environment (a) physical, b) internal behavioural and arousal state as registered by the brain.
3. Their interaction.
The allostatic mechanisms to the internal and external stressors (allostatic load) involves a network composed by:
1. Functional systems; mediated by:
1. The Autonomic Nervous System
2. The endocrine system
3. The immune system
2. Structural changes: whenever the internal and/or external stressors are long lasting and/or strength enough, they may induce changes in:
1. Epigenetic, endophenotypes, polyphenism.
2. Plasticity
3. The interaction between a) and b).
The network response do not affect exclusively the BP, propitiating the development of comorbidities, which may prompt strategies for prevention, recognition and ultimately, treatment.
The allostatic model defines health as a state of responsiveness.
The concept of psycho-biotype: The allostasis is the result of both: biological (allostasis) and psychological (psychostasis) abilities. It is proposed that both components behave in similar direction and magnitude.
Immune disorders may be associated with the development of cancer. High BP population has a higher sympathetic and lower vagal tone, this has been associated with a decrease in the immune´s system function.
Resources and energy depletion: Terms like weathering have been used to describe how exposures to different allostatic loads gradually scrape away at the protective coating that keeps people healthy. It is postulated that High BP individuals have more resources and energy.
Conditions
Conditions (19)
Free-text conditions as registered, with the CancerIndex entity they were reconciled to and the match type.
Consecutive patients who consult a cardiologist - electrophysiologist since June 2006, regardless of the age or gender in the city of Medellin, Colombia. They could have consulted previously (considered as the enrollment date) if they had, at least, one measurement of their BP in supine position, and an immediate measurement of their BP in standing position that allows diagnosing their group of blood pressure. All patients have a record in paper and/or magnetic file and in OpenClinica.
No interventions.
Primary outcomes (3)
measure
Relationship between Blood pressure group and comorbidities
timeFrame
A 7-year prospective study
description
Blood pressure group: 1) Essential arterial hypotension, 2) normotension and 3) Essential arterial hypertension.
Comorbidities: As describe in the protocol, as a summary: 1) cardiovascular, 2) metabolic, 3) Endocrine, 4) psychiatric disorders: depression and panic disorder, 5) orthostatic intolerance: neurally mediated syncope, vasovagal syncope, inappropriate sinus tachycardia, Postural orthostatic syndrome, carotid sinus hypersensitivity; 6) others: chronic fatigue syndrome, fibromyalgia, arthritis, autoimmune diseases, pulmonary thromboembolism, OSA (obstructive sleep apnea), Alzheimer disease, Parkinson disease, others dementias, epilepsia, nephropathies, and others.
Cardiovascular mortality Total mortality
Eligibility
Eligibility (as posted)
Sex
All
Show eligibility criteria text
Inclusion Criteria:
* Any patient regardless of the age of gender
Exclusion Criteria:
* Any non-correctable secondary cause of increase or decrease in blood pressure
* or a pathology that alters the prognosis before the entrance of the patient into this registry.
* nephropathy prior to the admission,
* familial dyslipidemia,
* previous gastric bypass,
* pre-existing heart failure,
* chemotherapy-induced cardiotoxicity,
* arrhythmogenic right ventricular dysplasia,
* long QT syndrome,
* hypertrophic cardiomyopathy
* restrictive cardiomyopathy or sudden death syndromes other than coronary disease
* Down syndrome,
* having one single kidney before entering to this registry,
* polycystic kidney,
* disability to continue with the treatment
* organ transplantation (other than cornea),
* HIV positive,
* homocystinuria,
* myelomeningocele,
* autoimmune diseases,
* paraplegia,
* chronic infections (TB),
* myocarditis of any cause,
* blood dyscrasia with coagulation disorders,
* history of pulmonary embolism,
* sustained or non-sustained ventricular tachycardia,
* idiopathic tachycardia associated with syncope which is not cured by radiofrequency ablation,
* pulmonary hypertension,
* diabetes insipidus,
* COPD,
* Gitelman syndrome,
* Cervical cancer associated with human Papillomavirus,
* multiple sclerosis,
* hemochromatosis,
* not compact ventricle.
It is important to emphasize that all of these patients, currently excluded from the registry, may be studied in the future, they keep on follow-up and taken 6 BP.
Additionally it is planned to compare the evolution of patients with secondary causes of hypertension or hypotension with essential disorders
References
Publications (107)
BACKGROUNDMedina E, Uribe W, Duque M, Alzate L. Past Medical History in patients with Orthostatic Intolerance. XIth International Symposium on the Autonomic Nervous System, Puerto Rico, 24-30. October 2000. Clin Auton Res 2000, 10:258. Summary.
BACKGROUNDMedina E, Uribe W, Duque M, Alzate L. Initial Medical Complain and Symptoms in Patients with Orthostatic Intolerance. XIth International symposium on the autonomic nervous system, Puerto Rico, 24-30 October 2000. Clin Auton Res 2000, 10:258. Summary
BACKGROUNDMedina E, Uribe W, Duque M, Alzate L. Syncope characterization in patients with orthostatic intolerance. XIth International symposium on the autonomic nervous system, Puerto Rico, 24-30 October 2000. Clin Auton Res 2000, 10:243. Summary.
BACKGROUNDMedina E, Uribe W, Duque M, Alzate L. Patients with orthostatic Intolerance: are those with syncope different from those without? Is syncope an acceptable endpoint for therapy? XIth International Symposium on the Autonomic Nervous System, Puerto Rico, 24-30 October 2000. Clin Auton Res 2000, 10:243. Summary
BACKGROUNDMedina E, Uribe W, Duque M, Alzate L. Variation of arterial blood pressure and heart rate during follow up in patients with orthostatic intolerance. XIth International symposium on the autonomic nervous system, Puerto Rico, 24-30 October 2000. Summary.
BACKGROUNDMedina E, Uribe W, Duque M, Alzate L. Severity of Compromise and level of Limitation in patients with Orthostatic Intolerance. XIth International Symposium on the autonomic nervous system, Puerto Rico, 24-30 October 2000. Summary
BACKGROUNDMedina E, Uribe W, Duque M, Alzate L. Diagnosis of orthostatic intolerance based on blood pressure and heart rate characterization. Could symptoms be enough?. XIth International symposium on the autonomic nervous system, Puerto Rico, 24-30 October 2000. Summary
BACKGROUNDMedina L, Mármol A, Duque M, Ossaba S, Uribe W, Olaya M, Marín J, Torres Y, Velásquez J. The tilt table test protocol: How can be improved? Clinical Autonomic Research. Vol 14, Number 5, 2004, page. 310. October 2000. Summary
Medina L, Olaya M, Duque M, Restrepo F, Uribe W, Marín J, Velásquez J, Torres Y. Fatigue: a clue symptom in chronic orthostatic disorder. How can it be explained? Clinical Autonomic Research. Vol 14, Number 5, 2004, page. 310. October 2000. Summar
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Diabetes Mellitus
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Diastolic Heart Failure
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Fibromyalgia
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Inappropriate Sinus Tachycardia
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Panic Attack
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POTS
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Syncope
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Systolic Heart Failure
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Transient Ischemic Attack (TIA)
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Vasovagal Syncope
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measure
Relationship between adaptability group and comorbidities
timeFrame
A 7-year prospective study
description
Adaptability group: Hyper adaptable, normal adaptability, hypo adaptable. Comorbidities: As describe in the protocol, as a summary: 1) cardiovascular, 2) metabolic, 3) Endocrine, 4) psychiatric disorders: depression and panic disorder, 5) orthostatic intolerance: neurally mediated syncope, vasovagal syncope, inappropriate sinus tachycardia, Postural orthostatic syndrome, carotid sinus hypersensitivity; 6) others: chronic fatigue syndrome, fibromyalgia, arthritis, autoimmune diseases, pulmonary thromboembolism, OSA (obstructive sleep apnea), Alzheimer disease, Parkinson disease, others dementias, epilepsia, nephropathies, and others.
Cardiovascular mortality Total mortality
measure
Relationship between blood pressure group, adaptability group and comorbidities
timeFrame
A 7-year prospective study
description
Blood pressure group: 1) Essential arterial hypotension, 2) normotension and 3) Essential arterial hypertension.
Adaptability group: Hyper adaptable, normal adaptability, hypo adaptable. Comorbidities: As describe in the protocol, as a summary: 1) cardiovascular, 2) metabolic, 3) Endocrine, 4) psychiatric disorders: depression and panic disorder, 5) orthostatic intolerance: neurally mediated syncope, vasovagal syncope, inappropriate sinus tachycardia, Postural orthostatic syndrome, carotid sinus hypersensitivity; 6) others: chronic fatigue syndrome, fibromyalgia, arthritis, autoimmune diseases, pulmonary thromboembolism, OSA (obstructive sleep apnea), Alzheimer disease, Parkinson disease, others dementias, epilepsia, nephropathies, and others.
Cardiovascular mortality Total mortality
Secondary outcomes (4)
measure
Relationship between blood pressure group, habits and anthropometric, metabolic, endocrine, Electrocardiogram, Holter, ambulatory blood pressure monitoring (ABPM)
timeFrame
A 7-year prospective study
description
Blood pressure group: 1) Essential arterial hypotension, 2) normotension and 3) Essential arterial hypertension.
Habits: smoke and drink
Anthropometric variables: Body mass index, waist, hip
Metabolic variables: Fasting glucose, 2 hs postprandial plasma glucose, insulin plasma levels, homoeostasis model assessment (HOMA), total cholesterol, LDL, HDL, triglycerides.
Endocrine variables: plasma cortisol, free cortisol in 24 hs. urine, epinephrine, norepinephrine, metanephrines, vanilmandelic acid, ACTH, aldosterone, renin, thyrotropine, free thyroxine, triiodothyronine, testosterone
Electrocardiogram: HR; PR interval, QRS complex, cQT interval
Holter variables: HR, standard deviation of NN intervals (SDNN) and sympathovagal balance, at day, night and 24 hs.
ABPM: Systolic, diastolic, and heart rate, at day, night and 24 hs., BP matinal surge.
Blood pressure group: 1) Essential arterial hypotension, 2) normotension and 3) Essential arterial hypertension.
Adaptability group: Hyper adaptable, normal adaptability, hypo adaptable.
Habits: smoke and drink
Anthropometric variables: Body mass index, waist, hip
Metabolic variables: Fasting glucose, 2 hs postprandial plasma glucose, insulin plasma levels, HOMA, total cholesterol, LDL, HDL, triglycerides.
Endocrine variables: plasma cortisol, free cortisol in 24 hs. urine, epinephrine, norepinephrine, metanephrines, vanilmandelic acid, ACTH, aldosterone, renin, thyrotropine, free thyroxine, triiodothyronine, testosterone
Electrocardiogram: PR interval, QRS complex, Heart rate, cQT interval
Holter variables: HR, SDNN and sympathovagal balance, at day, night and 24 hs.
ABPM: Systolic, diastolic, and heart rate, at day, night and 24 hs., BP matinal surge.
measure
For metabolic disorders what it matters the most: the anthropometric variables vs blood pressure group vs adaptability group
timeFrame
A 7-year prospective study
description
Blood pressure group: 1) Essential arterial hypotension, 2) normotension and 3) Essential arterial hypertension.
Adaptability group: 1) Hyper adaptable, 2) normal adaptability and 3) hypo adaptable.
Habits: smoke and drink, exercise
Anthropometric variables: Body mass index, waist, hip
Metabolic and other variables: Fasting glucose, 2 hs postprandial plasma glucose, insulin plasma levels, HOMA, total cholesterol, LDL, HDL, triglycerides; thyrotropine,
Holter variables: HR, standard deviation of NN intervals (SDNN) and sympathovagal balance, at day, night and 24 hs.
ABPM: Systolic, diastolic, and heart rate, at day, night and 24 hs., BP matinal surge.
measure
Relationship between adaptability group, habits and anthropometric, metabolic, endocrine, Electrocardiogram, Holter, ambulatory blood pressure monitoring (ABPM)
timeFrame
A 7-year prospective study
description
Adaptability group: Hyper adaptable, normal adaptability, hypo adaptable.
Habits: smoke and drink Anthropometric variables: Body mass index, waist, hip
Metabolic variables: Fasting glucose, 2 hs postprandial plasma glucose, insulin plasma levels, HOMA, total cholesterol, LDL, HDL, triglycerides.
Endocrine variables: plasma cortisol, free cortisol in 24 hs. urine, epinephrine, norepinephrine, metanephrines, vanilmandelic acid, ACTH, aldosterone, renin, thyrotropine, free thyroxine, triiodothyronine, testosterone
Electrocardiogram: PR interval, QRS complex, Heart rate, cQT interval
Holter variables: HR, SDNN and sympathovagal balance, at day, night and 24 hs.
ABPM: Systolic, diastolic, and heart rate, at day, night and 24 hs., BP matinal surge.
BACKGROUND
BACKGROUNDL Medina, W Uribe, M Duque, I Melguizo, JM Cotes, Y Torres, MA Restrepo, J Marín, E Gil, J Velasquez. Cardiology and autonomic nervous system department. Clínica Medellín, Universidad CES, Universidad Nacional. Medellín, Colombia. Personality type: a variable associated with biological measures in patients with orthostatic intolerance. 16th International symposium on the autonomic nervous system. Los Cabos, Mexico. October 6-9 2005. Clinical Autonomic Research. Vol 15, number 5, page 346, 2005. Summary.
BACKGROUNDL Medina, W Uribe, M Duque, I Melguizo, JM Cotes, Y Torres, MA Restrepo, J Marín, E Gil, J Velasquez. Cardiology and autonomic nervous system department. Clínica Medellín, Universidad CES, Universidad Nacional. Medellín, Colombia. Descriptive analysis and confidence limits at 95% of stress, depression, SF36, and tilt-test variables in an orthostatic intolerant population. 16th International symposium on the autonomic nervous system. Los Cabos, Mexico, October 6-9 2005. Clinical Autonomic Research. Vol 15, number 5, page 342, 2005. Summary.
BACKGROUNDL Medina, D Aristizabal, M Duque, W Uribe, I Melguizo, JM Cotes, Y Torres, MA Restrepo, J Marín, E Gil, J Velásquez, BLF Restrepo. Cardiology and autonomic nervous system department. Clínica Medellín, Universidad CES, Universidad Nacional and Universidad de Antioquia. Medellín, Colombia. Insulin and glucose metabolism in patients with orthostatic intolerance. 16th International symposium on the autonomic nervous system. Los Cabos, Mexico. October 6-9 2005. Clinical Autonomic Research. Vol 15, number 5, page 333, 2005. Summary.
BACKGROUNDL Medina, M Duque, E Gil, JM Cotes, Marín J, D Bravo, E Gonzalez, MA Restrepo, D Aristizabal, Y Torres, M Jimenez, W Uribe. Cardiology and autonomic nervous system department. Clínica Medellín, Medellín, Colombia. Applying tilt testing to diagnose sick sinus syndrome: Does it play role beyond syncope? 17th International symposium on the autonomic nervous system. Westin Riomar, Rio Grande, Puerto Rico, November 1-4 2006. Clinical Autonomic Research. Vol 16, number 5, page 349, 2006. Summary.
BACKGROUNDL Medina , J McEween, J Mendez, W Uribe, M Duque, Marín J E Gil, D Bravo, E Gonzalez, MA Restrepo, Torres Y, Cotes JM. Cardiology and autonomic nervous system department. Clínica Medellín, Medellín, Colombia. Hemodynamic effects of the 16 Gly/Arg polymorphism at the ADRB2 gene in hypotensive and hypertensive patients. 17th International symposium on the autonomic nervous system. Westin Riomar, Rio Grande, Puerto Rico, November 1-4 2006. Clinical Autonomic Research. Vol 16, Number 5, page 333, 2006. Summary.
BACKGROUNDL Medina, D Aristizabal, J McEween, J Mendez, W Uribe, Duque M, Marín J E Gil, D Bravo, E Gonzalez, MA Restrepo, Torres Y, Cotes JM. Cardiology and autonomic nervous system department. Clínica Medellín, Medellín, Colombia. Diagnostic impact of the syncope symptom score in structurally normal hearts in patients undergoing tilt table testing. 17th International Symposium on the Autonomic Nervous System. Westin Riomar, Rio Grande, Puerto Rico, November 1-4 2006. Clinical Autonomic Research. Vol 16, Number 5, page 342, 2006. Summary.
BACKGROUNDLE Medina, D Aristizabal, J Gallo, J Ochoa, Y Torres, L Montoya, M Correa, R Restrepo, D Moreno, MO Correa, N Zapata, PA Gil, M Franco. Medellin heart study. Study design and distribution by blood pressure, including hypotension. Clinical Autonomic Research. Vol 18, Number 5, page 277, 2008. (Summary).
BACKGROUNDMedina L, Duque M, Marin J, Gonzalez E, Astudillo V, Aristizabal J, Bernal J, Restrepo MA, Arroyave A, Jaramillo G, Torres Y, Uribe W. Essential hypotension registry: Sympathovagal balance at 24 hours, day and night in ambulatory Holter monitoring according to blood pressure groups in real-life settings. Clinical Autonomic Research. Vol 19, Number 5, page 300, 2009. Summary.
BACKGROUNDMedina LE, Duque M, Uribe W, Aristizabal J, Velasquez J, Restrepo MA, Miranda A, Torres Y, Marin J. The essential hypotension registry. Blood pressure at the office and at 24 h ambulatory monitoring is different between groups of essential hypertension, normotension and essential hypotension. Clinical Autonomic Research. Vol 20, number 2, page 139, 2010. Summary.
BACKGROUNDMedina LE, Marin J, Duque M, Uribe W, Mesa S, Aristizabal J, Velasquez J, Restrepo MA, Miranda A, Bernal J, Torres Y. Vasovagal syncope and their relationship with hypotension: What is the current conception and how it may change if essential hypotensive population emerges. The essential hypotension registry. Clinical Autonomic Research. Vol 21, number 2, page 127, 201. Summary
BACKGROUNDMedina L, Duque M, Marin J, Gonzalez E, Astudillo V, Aristizabal J, Bernal J, Restrepo MA, Arroyave A, Jaramillo G, Torres Y, Uribe W. Syncope diagnosis in patients with not apparent structurally heart disease and components for both: neurally mediated and cardiac origin (mixed syncope): is it a quantitative history score reliable? Clinical Autonomic Research. Vol 19, number 5, page 308, 2009. Summary.
BACKGROUNDMedina L. Essential hypotension registry. Cardiovascular Reactivity: A search for the integration of the neuro-cardiovascular relationship and their association with glucose challenge and depression. Clinical Autonomic Research. Vol 19, number 5, page 300, 2009. Summary
BACKGROUNDLE Medina, Aristizabal D, McEween J, W Uribe, Duque M, Marín J Gil E, Bravo D, Gonzalez E, Restrepo MA, Torres Y, Cotes JM. Cardiology and autonomic nervous system department. Clínica Medellín, Medellín, Colombia. Are there insulin sensitivity differences expected along the blood pressure spectrum? 17th International symposium on the autonomic nervous system. Westin Riomar, Rio Grande, Puerto Rico, November 1-4 2006. Clinical Autonomic Research. Vol 16, number 5, page 332, 2006. Summary
BACKGROUNDLE Medina, W Uribe, M Duque, E Gonzalez, G Montero, D Bravo, MA Restrepo, M Jimenez, D Aristizábal, T Torres, J Marín. Cardiology and autonomic nervous system department. Clínica Medellín, Medellín, Colombia. Does essential or primary hypotension matter? Second joint meeting of the European Federation of Autonomic Societies and the American Autonomic Society. Palais Ferstel. Vienna, Austria. October 10-13, 2007. Clinical Autonomic Research. Vol 17, number 5, page 304, 2007. Summary.
BACKGROUNDLE Medina, J Marín, W Uribe, M Duque, E Gonzalez, G Montero, D Bravo, MA Restrepo, M Jimenez, D Aristizabal. Cardiology and autonomic nervous system department. Clínica Medellín, Medellín, Colombia. Population characterization according to blood pressure. Are essential hypotensive different from other blood pressure groups? Second joint meeting of the European Federation of Autonomic Societies and the American Autonomic Society. Palais Ferstel. Vienna, Austria. October 10-13, 2007. Clinical Autonomic Research. Vol 17, number 5, page 304, 2007. Summary
BACKGROUNDLE Medina, W Uribe, J Marín, E Gonzalez, G Montero, D Bravo, MA Restrepo, M Jimenez, D Aristizabal, M Duque. Cardiology and autonomic nervous system department. Clínica Medellín, Medellín, Colombia. The importance of arterial hypotension in the chronic fatigue syndrome. Second joint meeting of the European Federation of Autonomic Societies and the American Autonomic Society. Palais Ferstel. Vienna, Austria. October 10-13, 2007. Clinical Autonomic Research. Vol 17, number 5, page 318, 2007. Summary.
BACKGROUNDLE Medina, M Duque, J Marín, E Gonzalez, G Montero, D Bravo, MA Restrepo, M Jimenez, D Aristizabal, W Uribe. Cardiology and autonomic nervous system department. Clínica Medellín, Medellín, Colombia. Are there differences in the variables hemoglobin, hematocrit and ferritin between normotensive patients and essential hypertensive and hypotensive? Second joint meeting of the European Federation of Autonomic Societies and the American Autonomic Society. Palais Ferstel. Vienna, Austria. October 10-13, 2007. Clinical Autonomic Research. Vol 17, number 5, page 311, 2007. Summary
BACKGROUNDLE Medina, J Ospina, MA Lemos, G Cuartas, D Aristizabal, J Calle, Gutierrez, Y Torres. Relationship between blood pressure, depression and anxiety. A step into the concept of psychobiotype (mind-body relationship). Clinical Autonomic Research. Vol 18, number 5, page 277, 2008. Summary
BACKGROUNDLE Medina, W Uribe, J Marin, G Montero, B Astudillo, MA Restrepo, J Bernal, Y Torres, M Duque. Blood pressure characterization in essentials hypotension and/or orthostatic hypotension. Clinical Autonomic Research. Vol 18, number 5, page 277, 2008. Summary.
BACKGROUNDMedina L, Uribe W, Marin J, Gonzalez E, Astudillo V, Aristizabal J, Velasquez J, Bernal J, Torres Y, Duque M. Chronotropic incompetence in the head-up tilt testing: a useful diagnostic marker or clinically irrelevant finding? Accepted for publication at the European Heart Journal, 2009 (Summary).
BACKGROUNDMedina L. Essential Hypotension registry: Definition, blood pressure and demographic report. Clinical Autonomic Research. Vol 19, number 5, page 308, 2009. Summary
BACKGROUNDMedina LE, Ospina J, Lemos MA, Cuartas G, Calle J, Gutierrez M, Torres Y. Essential hypotension registry: Psychometric measurements for anxiety, depression and coping strategies: Hypotension is associated with depression and anxiety. Is there a psycho-biotype? Preliminary Report. Clinical Autonomic Research. Vol 19, number 5, page 296, 2009. Summary
BACKGROUNDMedina LE, Duque M, Uribe W, Aristizabal J, Velasquez J, Restrepo MA, Miranda A, Torres Y, Marin J. It is glucose metabolism (HOMA and the relation: 2 h postprandial plasma glucose/fasting glucose) different between blood pressure groups? The essential hypotension registry. Clinical Autonomic Research. Vol 20, number 2, page 139, 2010. Summary.
BACKGROUNDMedina LE, Duque M, Marin J, Aristizabal J, Velasquez J, Miranda A, Torres Y, Restrepo MA, Uribe W. The essential hypotension registry. Rationale for the blood pressure classification and the importance of the stress response. Clinical Autonomic Research. Vol 20, number 2, page 139, 2010. Summary
BACKGROUNDMedina LE, Uribe W, Marin J, Aristizabal J, Velasquez J, Miranda A, Torres Y, Restrepo MA, Duque M. What do patients with classical and initial orthostatic hypotension, without an identifiable cause have to teach us? The essential hypotension registry. Description of the population and the blood pressure measurements. Clinical Autonomic Research. Vol 20, number 2, page 140, 2010. Summary
BACKGROUNDMedina LE, Uribe W, Marin J, Aristizabal J, Velasquez J, Miranda A, Torres Y, Restrepo MA, Duque M. The importance of essential hypotension in syncope. A report of 877 patients. The essential hypotension registry. Clinical. Autonomic Research. Vol 20, number 2, page 140, 2010. Summary
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