Key result
SBP drops and lowest upright SBP during tilt testing show no correlation with orthostatic intolerance.
Why the study?
Failure to recognize orthostatic hypotension symptoms may lead to falls and syncope, but the relationship between orthostatic blood pressure changes and symptom occurrence and severity is not known.
Does the magnitude of orthostatic blood pressure fall or upright systolic blood pressure correlate with symptom severity in patients with orthostatic hypotension?
Observational (n=89)
Does the magnitude of orthostatic blood pressure fall or upright systolic blood pressure correlate with symptom severity in patients with orthostatic hypotension?
Many patients with orthostatic hypotension are asymptomatic despite substantial blood pressure falls, indicating a poor correlation between orthostatic BP changes and symptoms.
Answers are grounded in this paper and cite their sources.
Symptoms should guide orthostatic hypotension management over tilt BP metrics; leaves open predictors of intolerance beyond pressure changes.
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.
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Freeman et al. (2020) conducted an observational in Orthostatic hypotension (n=89). Tilt testing was evaluated on Correlation between symptoms of orthostatic intolerance and upright SBP or fall in SBP (r = -0.07 and r = 0.08, p=NS). The magnitude of systolic blood pressure fall (r=-0.07, P=NS) and lowest upright systolic blood pressure (r=0.08, P=NS) during tilt testing did not correlate with symptoms of orthostatic intolerance.
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