Key result
The combination of syncope symptoms and an increase in systolic and diastolic blood pressure upon active standing was associated with a significantly higher likelihood of a positive head-up tilt test (RR 5.56).
Why the study?
Do ambulatory postural blood pressure changes and clinical history predict the result of a head-up tilt test in patients with syncope?
Cross-Sectional (n=215)
Yes
Do ambulatory postural blood pressure changes and clinical history predict the result of a head-up tilt test in patients with syncope?
Relative Risk: 5.56 (95% CI 1.6–18.7)
p-value: p=0.005
Simple office-based measurements of blood pressure changes upon active standing, combined with clinical history, can help identify patients with neurally mediated syncope and optimize patient selection for head-up tilt testing.
May aid tilt-test selection in syncope; leaves open prospective validation before changing practice.
BACKGROUND: Syncope is a common symptom and in most cases it is of a neurally mediated origin. Such patients have to be studied with a careful history and a physical exploration that should include simple maneuvers such as blood pressure (BP) recordings in decubitus and standing position. These tools can suggest diagnosis in a good percentage of patients without the need for expensive or invasive testing. METHODS: We carried out a prospective observational study measuring BP and heart rate (HR) with the patients in decubitus and just as they stood up. The patients were sent for a tilt table test in different specialized centers. The BP changes were compared to the results of the tilt test. RESULTS: We included 215 patients, 36.1 ± 18.8 years old, 118 (54.9%) feminine, of which 143 (66.5%) had a positive tilt test. Patients with a positive test showed a rise in systolic BP (SBP) (121.7 ± 19.1 vs. 124.2 ± 20, p < 0.005) and in diastolic BP (DBP) (75 ± 11 vs. 78 ± 11.3, p < 0.005) when compared to people with a negative one. On the other hand, percentage BP changes were significantly different (SBP 2.24% vs. 0.48%, p = 0.02; DBP 4.1% vs. 1.2%, p = 0.009). Patients with a positive test had also a lower HR on standing up (72.1 ± ± 11.1 vs. 78.3 ± 17.2, p = 0.01). CONCLUSIONS: Patients with neurally mediated syncope showed an elevation of SBP and DBP when standing up actively, unlike subjects with a negative tilt test.
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Asensio et al. (2015) conducted a cross-sectional in Syncope (n=215). Symptoms plus systolic and diastolic blood pressure increase upon active standing vs. Absence of these changes was evaluated on Positive head-up tilt test (HUTT) (RR 5.56, 95% CI 1.6-18.7, p=0.005). The combination of syncope symptoms and an increase in systolic and diastolic blood pressure upon active standing was associated with a significantly higher likelihood of a positive head-up tilt test (RR 5.56).
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