Key result
Orthostatic hypotension affects ~52% of patients with precapillary pulmonary hypertension, driven by blunted hemodynamic responses.
Why the study?
PAH and CTEPH may exhibit cardiovascular abnormalities that impair systemic arterial pressure regulation during gravitational challenges, prompting an investigation into the prevalence, subtypes, and haemodynamic mechanisms of orthostatic hypotension.
Cross-Sectional (n=60)
No
More than half of patients with PAH or CTEPH experience orthostatic hypotension, which is driven by subtype-specific impairments in stroke volume and peripheral resistance rather than baseline clinical disease severity markers.
Orthostatic hypotension may be common in precapillary PH; cross-sectional data leaves open whether subtype-specific hemodynamics warrant screening or intervention.
Background In addition to critical alterations in the pulmonary arterial network, pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) may exhibit cardiovascular abnormalities that impair systemic arterial pressure regulation during gravitational challenges. Therefore, we investigated the prevalence, subtypes and haemodynamic mechanisms of orthostatic hypotension (OH) in PAH or CTEPH. Methods OH was assessed using a 10-min active standing manoeuvre from supine baseline, with heart rate (HR; ECG) and arterial pressure (volume-clamp finger photoplethysmography) measured beat by beat. Stroke volume (SV) was estimated from the arterial pressure waveform, and cardiac output (CO) and total peripheral resistance (TPR) were calculated. Results Among 60 patients, 31 (52%) had OH. Patients with and without OH did not differ in clinical characteristics and OH related symptoms (all p>0.050). HR, SV, CO and TPR responses (% change from supine baseline) were not different between groups with and without initial OH (p>0.05). However, SV decrease was greater in the group with than without delayed arterial pressure recovery (−31±21 versus −19±14%; p=0.033). Additionally, a compensatory increase in TPR was blunted in the group with classic/delayed OH compared with without OH (−6±21 versus 7±15%; p=0.023). Conclusion OH is common in patients with PAH or CTEPH but is not associated with specific clinical characteristics. Initial OH lacks a clear haemodynamic cause, whereas delayed recovery and classic/delayed OH are linked to impaired SV and TPR responses to standing, respectively.
No takes yet. Share an insight, caveat, or question.
Trindade et al. (2025) conducted a cross-sectional in Precapillary pulmonary hypertension (PAH and CTEPH) (n=60). Orthostatic challenge (10-minute active standing) vs. Supine baseline / Patients without orthostatic hypotension was evaluated on Prevalence of orthostatic hypotension (OH). Orthostatic hypotension was present in 52% of patients with precapillary pulmonary hypertension, with subtypes linked to impaired stroke volume and blunted total peripheral resistance responses.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: