J Clin Neurol.  2018 Jul;14(3):283-290. 10.3988/jcn.2018.14.3.283.

Patterns of Orthostatic Blood Pressure Changes in Patients with Orthostatic Hypotension

• Seok HY
• Kim YH
• Kim H
• Kim BJ

• KMID: 2415042
• DOI: http://doi.org/10.3988/jcn.2018.14.3.283

Abstract

BACKGROUND AND PURPOSE
The objective of this study was to determine the patterns of blood pressure (BP) changes during the head-up tilt (HUT) test, particularly in terms of its clinical significance for patients with orthostatic hypotension (OH).
METHODS
OH was divided into four categories based on systolic BP changes occurring within the first 10 minutes of the HUT test: sustained orthostatic hypotension (SOH), progressive orthostatic hypotension (POH), orthostatic hypotension with partial recovery (OHPR), and transient orthostatic hypotension (TOH).
RESULTS
In total, 151 patients were analyzed: 65 with SOH, 38 with POH, 21 with OHPR, and 27 with TOH. POH patients exhibited the greatest reduction in systolic BP after HUT and were also the most likely to develop symptoms requiring early termination of the HUT test (42.1%, p < 0.001). Additionally, SOH patients exhibited smaller heart-rate variation with deep breathing values (p=0.003) and Valsalva ratios (p=0.022) compared to POH patients. The sweat volume was greatest in OHPR patients.
CONCLUSIONS
Clinical characteristics, including the findings of autonomic function tests, differed between the OH patient groups. This might reflect differences in the underlying pathophysiologic mechanisms. Determining the patterns of BP changes during the HUT test may facilitate the development of effective management strategies in patients with OH.

Keyword

orthostatic intolerance; blood pressure; tilt table test

MeSH Terms

Blood Pressure*
Humans
Hypotension, Orthostatic*
Orthostatic Intolerance
Respiration
Sweat
Tilt-Table Test

Figure

• 

  Fig. 1 Patterns of changes in systolic BP. Upper line is a schematic representation and lower line shows data from an example patient with orthostatic hypotension. SOH is defined as occurring when a patient has a relatively stable systolic BP after it has decreased within 3 minutes of tilting. POH is defined by a continuous decrease in BP extending beyond 3 minutes of tilting. OHPR is defined by an incomplete recovery in BP (remaining ≥20 mm Hg below baseline) within 5 minutes of tilting. TOH is defined by a recovery in BP to a level that no longer satisfies the definition of OH (i.e., within 20 mm Hg of baseline). BP: blood pressure, OHPR: orthostatic hypotension with partial recovery, POH: progressive orthostatic hypotension, SOH: sustained orthostatic hypotension, TOH: transient orthostatic hypotension.

• 

  Fig. 2 An example of fluctuating systolic BP. Patients with fluctuating systolic BP that did not conform to any of the four patterns were excluded from the analysis. BP: blood pressure.

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