In patients ≤30 years with clinically diagnosed initial orthostatic hypotension, an abnormally large fall in systolic BP (≥40 mmHg) upon standing was documented in 58% (15/26).
Observational (n=371)
In young patients with initial orthostatic hypotension, a typical clinical history is sufficient for diagnosis as an abnormally large fall in systolic BP is only documented in 58%, with differing hemodynamic mechanisms depending on the starting position.
OBJECTIVE: To assess: (1) the frequency of an abnormally large fall in blood pressure (BP) upon standing from supine in patients with initial orthostatic hypotension (IOH); (2) the underlying hemodynamic mechanisms of this fall in BP upon standing from supine and from squatting. METHODS: In a retrospective study of 371 patients (≤30 years) visiting the syncope unit, the hemodynamic response to standing and squatting were studied in 26 patients who were diagnosed clinically with IOH, based on history taking only. In six patients changes in cardiac output (CO) and systemic vascular resistance (SVR) were determined, and the underlying hemodynamics were analyzed. RESULTS: 15/26 (58 %) patients with IOH had an abnormally large initial fall in systolic BP (≥40 mmHg). There was a large scatter in CO and SVR response after arising from supine ΔCO at BP nadir median -8 % (range -37, +27 %); ΔSVR at BP nadir median -31 % (range -46, +10 %). The hemodynamic response after squatting showed a more consistent pattern, with a fall in SVR in all six patients ΔCO at BP nadir median +23 % (range -12, +31 %); ΔSVR at BP nadir median -42 %, (range -52, -35 %). INTERPRETATION: The clinical diagnosis of IOH is based on history taking, as an abnormally large fall in systolic BP can only be documented in 58 %. For IOH upon standing after supine rest, the hemodynamic mechanism can be either a large fall in CO or in SVR. For IOH upon arising from squatting a large fall in SVR is a consistent finding.
Wijnen et al. (Fri,) conducted a observational in Initial orthostatic hypotension (IOH) (n=371). Standing and squatting was evaluated on Abnormally large initial fall in systolic BP (≥40 mmHg) upon standing from supine. In patients ≤30 years with clinically diagnosed initial orthostatic hypotension, an abnormally large fall in systolic BP (≥40 mmHg) upon standing was documented in 58% (15/26).
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