Variability of blood pressure response to orthostatism and reproducibility of the diagnosis of orthostatic hypotension in elderly subjects.
BACKGROUND
Orthostatic hypotension (OH) is a major problem in the elderly population. Its diagnosis is based on measurement of the blood pressure (BP) response to orthostatism (BPRO). This study investigates the within-day and day-to-day variability of the BPRO and the reproducibility of the diagnosis of OH in this population.


METHODS
BP was measured in the supine position and after 1 and 2 minutes of orthostatism in 53 consecutive elderly patients (43 women and 10 men aged 83.7 +/- 9.5 years) of an intermediate care geriatric ward. BPRO was assessed 4 times on the same day (8-9 AM, 10-11 AM, 1-2 PM, and 5-6 PM) and twice more on another day of the same week (8-9 AM and 1-2 PM).


RESULTS
There were significant within-day differences between the four orthostatic changes in systolic BP (OCs, supine minus standing systolic BP) after 1 minute or 2 minutes (p < .05). Day-to-day differences between the OCs measured at the same times were not significant. OH defined as an OCs of 20 mm Hg or more at 1 or 2 minutes of orthostatism, was found in ten cases (19%) in the initial set of measurements on the first day. A cumulative diagnosis of OH after the six BPRO tests was found in 23 cases (43%). The reproducibility of the diagnosis of OH was mild or poor (all kappa values were below 0.47).


CONCLUSIONS
BPRO exhibits significant within-day variability in elderly patients. Within-day and day-to-day reproducibility of the diagnosis of OH, based on conventional criteria, were found to be poor.
Belmin
J
J
Department of Médecine Interne Gériatrique, Hôpital René Muret-Bigottini and University Paris-Nord, Sevran, France. joel.belmin@rmb.ap-hop-paris.fr
Abderrhamane
M
M
Medjahed
S
S
Sibony-Prat
J
J
Bruhat
A
A
Bojic
N
N
Marquet
T
T
D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000175:diagnosis*; D008297:Male; D015203:Reproducibility of Results; D016683:Supine Position