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Do we need to evaluate diastolic blood pressure in patients with suspected orthostatic hypotension?

Fedorowski, Artur LU ; Hamrefors, Viktor LU ; Sutton, Richard; van Dijk, J. Gert; Freeman, Roy; Lenders, Jacques WM and Wieling, Wouter (2017) In Clinical Autonomic Research 27(3). p.167-173
Abstract

Purpose: The contribution of diastolic blood pressure measurement to the diagnosis of classical orthostatic hypotension is not known. We aimed to explore the prevalence of isolated systolic and diastolic orthostatic hypotension components in patients with syncope and orthostatic intolerance. Methods: A total of 1520 patients aged >15 years with suspected syncope and/or symptoms of orthostatic intolerance were investigated in a tertiary center using tilt-table testing and continuous non-invasive blood pressure monitoring. Classical orthostatic hypotension was defined as a decline in systolic blood pressure ≥20 mmHg and/or diastolic blood pressure ≥10 mmHg at 3 min of tilt test. The prevalence of upright systolic blood pressure <90... (More)

Purpose: The contribution of diastolic blood pressure measurement to the diagnosis of classical orthostatic hypotension is not known. We aimed to explore the prevalence of isolated systolic and diastolic orthostatic hypotension components in patients with syncope and orthostatic intolerance. Methods: A total of 1520 patients aged >15 years with suspected syncope and/or symptoms of orthostatic intolerance were investigated in a tertiary center using tilt-table testing and continuous non-invasive blood pressure monitoring. Classical orthostatic hypotension was defined as a decline in systolic blood pressure ≥20 mmHg and/or diastolic blood pressure ≥10 mmHg at 3 min of tilt test. The prevalence of upright systolic blood pressure <90 mmHg and its overlap with isolated diastolic orthostatic hypotension was also assessed. Results: One hundred eighty-six patients (12.2%) met current diagnostic criteria for classical orthostatic hypotension. Of these, 176 patients (94.6%) met the systolic criterion and 102 patients (54.8%) met the diastolic criterion. Ninety-two patients (49.5%) met both systolic and diastolic criteria, whereas ten patients (5.4%) met the diastolic criterion alone. Of these, three had systolic blood pressure <90 mmHg during tilt test and were diagnosed with orthostatic hypotension on the grounds of low standing blood pressure. Based on patient history and ancillary test results, causes of orthostatic intolerance and syncope other than orthostatic hypotension were present in the remaining seven patients. Conclusions: An abnormal orthostatic fall in diastolic blood pressure without an abnormal fall in systolic blood pressure is rare among patients with syncope and orthostatic intolerance. Approximately 95% of patients with classical orthostatic hypotension can be identified by systolic criterion alone.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Blood pressure, Diastolic, Orthostatic hypotension, Orthostatic intolerance, Syncope
in
Clinical Autonomic Research
volume
27
issue
3
pages
7 pages
publisher
Springer
external identifiers
  • scopus:85014020666
  • wos:000401920400008
ISSN
0959-9851
DOI
10.1007/s10286-017-0409-7
language
English
LU publication?
yes
id
c36ee324-f64c-49a4-b8a0-4c158e7f1363
date added to LUP
2017-03-13 10:34:35
date last changed
2018-09-30 04:39:45
@article{c36ee324-f64c-49a4-b8a0-4c158e7f1363,
  abstract     = {<p>Purpose: The contribution of diastolic blood pressure measurement to the diagnosis of classical orthostatic hypotension is not known. We aimed to explore the prevalence of isolated systolic and diastolic orthostatic hypotension components in patients with syncope and orthostatic intolerance. Methods: A total of 1520 patients aged &gt;15 years with suspected syncope and/or symptoms of orthostatic intolerance were investigated in a tertiary center using tilt-table testing and continuous non-invasive blood pressure monitoring. Classical orthostatic hypotension was defined as a decline in systolic blood pressure ≥20 mmHg and/or diastolic blood pressure ≥10 mmHg at 3 min of tilt test. The prevalence of upright systolic blood pressure &lt;90 mmHg and its overlap with isolated diastolic orthostatic hypotension was also assessed. Results: One hundred eighty-six patients (12.2%) met current diagnostic criteria for classical orthostatic hypotension. Of these, 176 patients (94.6%) met the systolic criterion and 102 patients (54.8%) met the diastolic criterion. Ninety-two patients (49.5%) met both systolic and diastolic criteria, whereas ten patients (5.4%) met the diastolic criterion alone. Of these, three had systolic blood pressure &lt;90 mmHg during tilt test and were diagnosed with orthostatic hypotension on the grounds of low standing blood pressure. Based on patient history and ancillary test results, causes of orthostatic intolerance and syncope other than orthostatic hypotension were present in the remaining seven patients. Conclusions: An abnormal orthostatic fall in diastolic blood pressure without an abnormal fall in systolic blood pressure is rare among patients with syncope and orthostatic intolerance. Approximately 95% of patients with classical orthostatic hypotension can be identified by systolic criterion alone.</p>},
  author       = {Fedorowski, Artur and Hamrefors, Viktor and Sutton, Richard and van Dijk, J. Gert and Freeman, Roy and Lenders, Jacques WM and Wieling, Wouter},
  issn         = {0959-9851},
  keyword      = {Blood pressure,Diastolic,Orthostatic hypotension,Orthostatic intolerance,Syncope},
  language     = {eng},
  month        = {02},
  number       = {3},
  pages        = {167--173},
  publisher    = {Springer},
  series       = {Clinical Autonomic Research},
  title        = {Do we need to evaluate diastolic blood pressure in patients with suspected orthostatic hypotension?},
  url          = {http://dx.doi.org/10.1007/s10286-017-0409-7},
  volume       = {27},
  year         = {2017},
}