Symptom Recognition Is Impaired in Patients With Orthostatic Hypotension

Author:

Freeman Roy1,Illigens Ben M.W.1,Lapusca Razvan2,Campagnolo Marta3,Abuzinadah Ahmad R.4,Bonyhay Istvan1,Sinn Dong-In5,Miglis Mitchell5,White Jeffrey6,Gibbons Christopher H.1

Affiliation:

1. From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.F., B.M.W.I., I.B., C.H.G.)

2. Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Germany (R.L.)

3. Department of Neurosciences, University of Padova, Italy (M.C.)

4. Department of Internal Medicine, King Abdulaziz University Hospital, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (A.R.A.)

5. Department of Neurology, Stanford Medical Center, Palo Alto, CA (D.-I.S., M.M.)

6. University of Virginia School of Medicine, Charlottesville (J.W.).

Abstract

Failure to recognize symptoms of orthostatic hypotension (OH) may result in falls, syncope, and injuries. The relationship between orthostatic changes in blood pressure and symptom occurrence and severity is not known. The goal of the present study was to define the relationship between the occurrence and severity of the symptoms of orthostatic hypotension (OH) and (1) the upright systolic blood pressure (SBP) and (2) the fall in SBP after tilting in patients with OH. We prospectively studied 89 patients with OH. Reported BP values include the lowest BP in the first 3 minutes of tilt and the change in blood pressure during tilt. Subjects were queried about symptoms of orthostatic intolerance while supine and during the first 3 minutes of tilt testing using Question 1 of the Orthostatic Hypotension Questionnaire. Mean tilted SBP was 101.6±26.1 mm Hg and mean SBP fall 47.9±18.1 mm Hg. Mean symptom scores when upright were: light-headedness (2.3/10±2.7), dizziness (1.6/10±2.5), and impending blackout (0.8/10±1.9). The majority of patients were asymptomatic or mildly symptomatic and no discrete cutoff for symptoms was observed. The magnitude of the SBP fall ( r =−0.07, P =NS) and the lowest upright SBP ( r =0.08, P =NS) did not correlate with any reported symptom. These results suggest a poor relationship between the magnitude of the orthostatic BP fall, the upright orthostatic BP, and symptoms. Many patients are asymptomatic despite substantial SBP falls and low orthostatic blood pressures. These findings have implications for clinical care of patients with OH and clinical trials to treat patients with OH.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Internal Medicine

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