Incidence and outcome of orthostatic hypotension in stroke patients undergoing rehabilitation.
OBJECTIVE
To document the incidence and outcome of orthostatic hypotension in stroke patients undergoing rehabilitation and to determine clinical variables associated with it.


METHODS
Cohort study.


METHODS
Inpatient setting of a tertiary rehabilitation center.


METHODS
Seventy-one stroke patients (41 men, 30 women; mean age, 58.4+/-10.7 y) with a first clinical stroke, admitted for rehabilitation within 4 weeks of the stroke.


METHODS
Not applicable.


METHODS
Patients' blood pressure was measured in supine position and on tilting at 90 degrees within 3 days of admission. Orthostatic hypotension was defined as a drop in systolic blood pressure (SBP) of 20 mmHg or more.


RESULTS
Orthostatic hypotension was present in 37 (52.1%) patients, of whom 13 had severe hypotension (standing SBP, < or =100 mmHg). Twelve (32.4%) patients with orthostatic hypotension were positive for hypotensive symptoms and signs, with 2 patients experiencing near syncope. Orthostatic hypotension was significantly associated with older patients, a lower admission functional status (as measured on the Modified Barthel Index), and more severe hemiparesis. It was, however, not related with the site of stroke or the use of antihypertensives. On discharge, orthostatic hypotension had resolved in 23 patients. The presence of orthostatic hypotension did not influence functional outcome or the length of stay in rehabilitation.


CONCLUSIONS
Orthostatic hypotension was common in stroke patients undergoing inpatient rehabilitation. It should be suspected in older patients who have more severe hemiparesis and a lower functional status.
Kong
Keng-He
KH
Tan Tock Seng Hospital Rehabilitation Centre, Ang Mo Kio Community Hospital, Singapore. keng_he-kong@ttsh.com.sg
Chuo
Adelene M
AM
D000367:Age Factors; D001794:Blood Pressure / Q000502:physiology; D001795:Blood Pressure Determination; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000453:epidemiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012044:Regression Analysis; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D020521:Stroke / Q000453:epidemiology*; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome