title: Orthostatic hypotension among outpatients with ischemic stroke.
abstract: BACKGROUND
  The treatment of hypertension is an essential component of stroke prevention; however, the clinical management of patients with cerebrovascular disease is complicated by orthostatic hypotension (OH). The primary objectives were to: determine the prevalence of OH in a stroke outpatient clinic; describe categories of OH; and identify factors independently associated with the presence of OH.
  
  
  METHODS
  Veterans with stroke, cared for in a multidisciplinary stroke clinic, were included. OH was defined as a ≥20 mmHg fall in systolic blood pressure (BP), a ≥10 mmHg fall in diastolic BP, or a ≥10 mmHg fall in systolic BP with symptoms. Multivariable logistic regression was used to identify factors associated with OH including demographics, comorbidites, stroke severity, and baseline BP.
  
  
  RESULTS
  Among 60 patients with stroke, 16 (27%) patients had OH. Among those with OH, half were hypertensive, seven were normotensive, and one was hypotensive. A history of coronary artery disease was independently associated with the presence of OH.
  
  
  CONCLUSIONS
  Orthostatic hypotension is present in about one quarter of outpatients with stroke, and coronary artery disease appears to be a risk factor. Stroke patients should be screened for OH given that the presence of positional BP changes may alter clinical management.
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, CT, USA. michael.phipps@yale.edu
authors.forename: Michael S
authors.initials: MS
authors.lastname: Phipps
authors.forename: Arlene A
authors.initials: AA
authors.lastname: Schmid
authors.forename: John R
authors.initials: JR
authors.lastname: Kapoor
authors.forename: Aldo J
authors.initials: AJ
authors.lastname: Peixoto
authors.forename: Linda S
authors.initials: LS
authors.lastname: Williams
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Bravata
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D002545:Brain Ischemia / Q000150:complications* / Q000503:physiopathology; D003324:Coronary Artery Disease / Q000150:complications; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D007024:Hypotension, Orthostatic / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010146:Pain / Q000150:complications; D020521:Stroke / Q000150:complications* / Q000503:physiopathology; D014728:Veterans
chemical_list: D000959:Antihypertensive Agents