title: Application of the Sit-Up Test for orthostatic hypotension in individuals with stroke.
abstract: Orthostatic hypotension (OH) is an important consideration for individuals with stroke, given the shared occurrence of mobility limitations, fall risk and association with adverse cardiovascular outcomes. This study aimed to 1) establish the application of a simple bedside test of orthostatic challenge to identify OH after stroke, 2) examine differences in characteristics between those with and without OH and 3) determine cardiovascular correlates with hemodynamic responses. Forty-nine participants (n=29 men, mean ± SD age 66 ± 7 years, time post-stroke 4.5 ± 3.1 years) performed an orthostatic challenge (Sit-Up Test). Eleven (22%) of the 49 participants presented with OH (n=7, of which 5 were asymptomatic) or symptoms of cerebral hypoperfusion with position change (n=4). Compared to participants without OH, those with OH had higher total:high-density lipoprotein cholesterol ratios (4.2 ± 0.9 vs. 3.3 ± 0.8, P=0.009) and triglyceride levels (2.2 ± 0.8 vs. 1.4 ± 0.5 mmol/L, P=0.001). Multivariate linear regression revealed that high-density lipoprotein cholesterol and triglyceride levels explained 20% of the variance of the change in systolic blood pressure from the Sit-Up Test (F(2,45)=5.68, P=0.006). In conclusion, we used a simple bedside test of orthostatic tolerance to identify that over 20% of individuals with stroke presented with OH or symptoms of hypoperfusion. They also had more impaired cardiovascular risk profiles relative to those without OH. These individuals may be at even higher risk for mobility limitations and falls beyond that associated with stroke-related deficits alone.
authors.affiliation: Department of Physical Therapy, University of British Columbia, Canada.
authors.forename: Ada
authors.initials: A
authors.lastname: Tang
authors.forename: Janice J
authors.initials: JJ
authors.lastname: Eng
authors.forename: Andrei
authors.initials: A
authors.lastname: Krassioukov
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015308:Anaerobic Threshold / Q000502:physiology; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007024:Hypotension, Orthostatic / Q000175:diagnosis* / Q000209:etiology*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D011187:Posture / Q000502:physiology; D012044:Regression Analysis; D012307:Risk Factors; D020521:Stroke / Q000150:complications*
chemical_list: D001786:Blood Glucose; D008055:Lipids