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Reproducibility of orthostatic hypotension in symptomatic elderly.
Am J Med. 1996 Apr; 100(4):418-22.AJ

Abstract

PURPOSE

Variations in the reported prevalence of orthostatic hypotension (4% to 33%) are attributed to population selection and varied criteria used to define orthostatic hypotension. Variation in the reproducibility of hemodynamic responses to orthostasis could be a further confounding variable. The purpose of this study was to evaluate reproducibility of orthostatic blood pressure changes in patients with documented symptomatic orthostatic hypotension.

PATIENTS AND METHODS

Forty outpatients (mean age 77+/- 8 years; 24 women) were recruited after initial presentation to a morning outpatient clinic with postural symptoms of dizziness (92%), falls (67.5%), or syncope (30%). Patients had a symptomatic drop in orthostatic systolic blood pressure of >20 mm Hg documented in clinic. Subsequent cardiovascular assessment included autonomic function tests, carotid sinus massage (supine and erect), and prolonged head-up tilt tests. Blood pressure and heart rate measurements were repeated during standing and head-up tilt on two further attendances in the morning.

RESULTS

A total of 67.5% patients had a drop in systolic blood pressure of >20 mm Hg on both visits during orthostatic stimuli; in the remainder, the response was not reproducible, and 5% had no significant orthostatic drop at either attendance. In 19 patients autonomic function tests were abnormal; orthostatic hypotension was reproducible in 79% of this group. In patients with normal autonomic function tests, 57% had reproducible orthostatic hypotension, of which only 60% were reproducible in those patients when further assessed in the afternoon.

CONCLUSIONS

Orthostatic blood pressure responses may not be reproducible in patients with documented symptomatic orthostatic hypotension, particularly if autonomic function is normal and measurements are taken in the afternoon. Repeated systolic blood pressure measurements in the morning may be necessary to make a diagnosis in older patients with suspected orthostatic hypotension.

Authors+Show Affiliations

Cardiovascular Investigation Unit, Department of Medicine, Geriatric Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

8610728

Citation

Ward, C, and R A. Kenny. "Reproducibility of Orthostatic Hypotension in Symptomatic Elderly." The American Journal of Medicine, vol. 100, no. 4, 1996, pp. 418-22.
Ward C, Kenny RA. Reproducibility of orthostatic hypotension in symptomatic elderly. Am J Med. 1996;100(4):418-22.
Ward, C., & Kenny, R. A. (1996). Reproducibility of orthostatic hypotension in symptomatic elderly. The American Journal of Medicine, 100(4), 418-22.
Ward C, Kenny RA. Reproducibility of Orthostatic Hypotension in Symptomatic Elderly. Am J Med. 1996;100(4):418-22. PubMed PMID: 8610728.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reproducibility of orthostatic hypotension in symptomatic elderly. AU - Ward,C, AU - Kenny,R A, PY - 1996/4/1/pubmed PY - 1996/4/1/medline PY - 1996/4/1/entrez SP - 418 EP - 22 JF - The American journal of medicine JO - Am J Med VL - 100 IS - 4 N2 - PURPOSE: Variations in the reported prevalence of orthostatic hypotension (4% to 33%) are attributed to population selection and varied criteria used to define orthostatic hypotension. Variation in the reproducibility of hemodynamic responses to orthostasis could be a further confounding variable. The purpose of this study was to evaluate reproducibility of orthostatic blood pressure changes in patients with documented symptomatic orthostatic hypotension. PATIENTS AND METHODS: Forty outpatients (mean age 77+/- 8 years; 24 women) were recruited after initial presentation to a morning outpatient clinic with postural symptoms of dizziness (92%), falls (67.5%), or syncope (30%). Patients had a symptomatic drop in orthostatic systolic blood pressure of >20 mm Hg documented in clinic. Subsequent cardiovascular assessment included autonomic function tests, carotid sinus massage (supine and erect), and prolonged head-up tilt tests. Blood pressure and heart rate measurements were repeated during standing and head-up tilt on two further attendances in the morning. RESULTS: A total of 67.5% patients had a drop in systolic blood pressure of >20 mm Hg on both visits during orthostatic stimuli; in the remainder, the response was not reproducible, and 5% had no significant orthostatic drop at either attendance. In 19 patients autonomic function tests were abnormal; orthostatic hypotension was reproducible in 79% of this group. In patients with normal autonomic function tests, 57% had reproducible orthostatic hypotension, of which only 60% were reproducible in those patients when further assessed in the afternoon. CONCLUSIONS: Orthostatic blood pressure responses may not be reproducible in patients with documented symptomatic orthostatic hypotension, particularly if autonomic function is normal and measurements are taken in the afternoon. Repeated systolic blood pressure measurements in the morning may be necessary to make a diagnosis in older patients with suspected orthostatic hypotension. SN - 0002-9343 UR - https://www.unboundmedicine.com/medline/citation/8610728/Reproducibility_of_orthostatic_hypotension_in_symptomatic_elderly_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9343(97)89517-4 DB - PRIME DP - Unbound Medicine ER -