Tags

Type your tag names separated by a space and hit enter

Sitting and standing blood pressure measurements are not accurate for the diagnosis of orthostatic hypotension.
QJM. 2009 May; 102(5):335-9.QJM

Abstract

INTRODUCTION

Orthostatic hypotension (OH) is associated with troublesome symptoms and increased mortality. It is treatable and deserving of accurate diagnosis. This can be time consuming. The current reference standard for its diagnosis is head-up tilt (HUT) testing with continuous beat-to-beat plethysmography. Our objective was to assess the accuracy of sit-stand testing with semi-automatic sphygmomanometry for the diagnosis of OH.

DESIGN

Retrospective test of diagnostic accuracy.

METHODS

This was a retrospective study performed using a database maintained by a busy syncope unit. HUT testing was performed using an automated tilt table with Finometer monitoring. A 3 min 70 degrees HUT was performed following 5 min supine. Sitting blood pressure (BP) was measured following 3 min rest. Standing BP was measured within 30 s of assuming the upright posture. The results of sit-stand testing were compared with HUT testing as a reference standard. Both tests happened within 5 min of each other and patients underwent no intervention between tests.

RESULTS

From a total of 1452 consecutive HUTs, we identified 730 with pre-test measures of sitting and standing BP. The mean age of this group was 70.57 years (SD = 15.1), 62% were female. The sensitivity of sit-stand testing was calculated as 15.5%, specificity as 89.9%, positive predictive value as 61.7%, negative predictive value as 50.2% and the likelihood ratio as 1.6. The area under the Receiver Operator Curve was 0.564.

CONCLUSION

We have demonstrated that sit-stand testing for OH has very low diagnostic accuracy. We recommend that the more time-consuming reference standard method of diagnosis be used if the condition is suspected.

Authors+Show Affiliations

Clinical Age Assessment Unit, Mid-Western Regional Hospital, Dooradoyle, Limerick, Ireland. john.cooke@hse.ieNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19273552

Citation

Cooke, J, et al. "Sitting and Standing Blood Pressure Measurements Are Not Accurate for the Diagnosis of Orthostatic Hypotension." QJM : Monthly Journal of the Association of Physicians, vol. 102, no. 5, 2009, pp. 335-9.
Cooke J, Carew S, O'Connor M, et al. Sitting and standing blood pressure measurements are not accurate for the diagnosis of orthostatic hypotension. QJM. 2009;102(5):335-9.
Cooke, J., Carew, S., O'Connor, M., Costelloe, A., Sheehy, T., & Lyons, D. (2009). Sitting and standing blood pressure measurements are not accurate for the diagnosis of orthostatic hypotension. QJM : Monthly Journal of the Association of Physicians, 102(5), 335-9. https://doi.org/10.1093/qjmed/hcp020
Cooke J, et al. Sitting and Standing Blood Pressure Measurements Are Not Accurate for the Diagnosis of Orthostatic Hypotension. QJM. 2009;102(5):335-9. PubMed PMID: 19273552.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sitting and standing blood pressure measurements are not accurate for the diagnosis of orthostatic hypotension. AU - Cooke,J, AU - Carew,S, AU - O'Connor,M, AU - Costelloe,A, AU - Sheehy,T, AU - Lyons,D, Y1 - 2009/03/09/ PY - 2009/3/11/entrez PY - 2009/3/11/pubmed PY - 2009/11/5/medline SP - 335 EP - 9 JF - QJM : monthly journal of the Association of Physicians JO - QJM VL - 102 IS - 5 N2 - INTRODUCTION: Orthostatic hypotension (OH) is associated with troublesome symptoms and increased mortality. It is treatable and deserving of accurate diagnosis. This can be time consuming. The current reference standard for its diagnosis is head-up tilt (HUT) testing with continuous beat-to-beat plethysmography. Our objective was to assess the accuracy of sit-stand testing with semi-automatic sphygmomanometry for the diagnosis of OH. DESIGN: Retrospective test of diagnostic accuracy. METHODS: This was a retrospective study performed using a database maintained by a busy syncope unit. HUT testing was performed using an automated tilt table with Finometer monitoring. A 3 min 70 degrees HUT was performed following 5 min supine. Sitting blood pressure (BP) was measured following 3 min rest. Standing BP was measured within 30 s of assuming the upright posture. The results of sit-stand testing were compared with HUT testing as a reference standard. Both tests happened within 5 min of each other and patients underwent no intervention between tests. RESULTS: From a total of 1452 consecutive HUTs, we identified 730 with pre-test measures of sitting and standing BP. The mean age of this group was 70.57 years (SD = 15.1), 62% were female. The sensitivity of sit-stand testing was calculated as 15.5%, specificity as 89.9%, positive predictive value as 61.7%, negative predictive value as 50.2% and the likelihood ratio as 1.6. The area under the Receiver Operator Curve was 0.564. CONCLUSION: We have demonstrated that sit-stand testing for OH has very low diagnostic accuracy. We recommend that the more time-consuming reference standard method of diagnosis be used if the condition is suspected. SN - 1460-2393 UR - https://www.unboundmedicine.com/medline/citation/19273552/Sitting_and_standing_blood_pressure_measurements_are_not_accurate_for_the_diagnosis_of_orthostatic_hypotension_ L2 - https://academic.oup.com/qjmed/article-lookup/doi/10.1093/qjmed/hcp020 DB - PRIME DP - Unbound Medicine ER -