TIA, stroke and orthostatic hypotension: a disease spectrum related to ageing vasculature?
OBJECTIVE
We sought to identify the determinants of orthostatic hypotension (OH) among patients referred to the transient ischaemic attack (TIA) clinic.


METHODS
We conducted a retrospective analysis of prospectively collected data on patients who attended the TIA clinic in a UK hospital between January 2006 and September 2009. Each patient had their supine and standing or sitting blood pressure measured. Logistic regression was used to estimate the univariate and multivariate odds of OH for the subgroups of patients based on their diagnosis. A 10% significance level for the univariate analysis was used to identify variables in the multivariate model.


RESULTS
A total of 3222 patients were studied of whom 1131 had a TIA, 665 a stroke and 1426 had other diagnoses. The prevalence of either systolic or diastolic OH in the TIA, stroke and patients with other diagnoses was similar being 22% (n = 251), 24% (n = 162) and 20% (n = 292), respectively. Multivariate analyses showed age, prior history of TIA, and diabetes were independently significantly associated with systolic OH alone or diastolic OH alone or either systolic or diastolic OH [ORs 1.03 (1.02-1.05); 1.56 (1.05-2.31); 1.65 (1.10-2.47), respectively]. Among the patients with the diagnosis of stroke, peripheral vascular disease (PVD) was significantly associated with increased odds of OH (3.56, 1.53-8.31), whereas male gender had a significantly lower odds of OH (0.61, 0.42-0.88). In patients with other diagnoses, age (1.04, 1.02-1.05) and diabetes (1.47, 1.04-2.09) were associated with OH, whereas male gender was (0.76, 0.58-1.00) not associated with OH.


CONCLUSIONS
Orthostatic hypotension is prevalent among patients presenting to TIA clinic. Previous history of vascular disease (prior TIA/stroke/PVD) appears to be a significant associate of OH in this patient population.
Cardiovascular Institute, University of Manchester, Manchester, UK; NRP Cardiovascular Research Group, Norwich Medical School, University of East Anglia, Norfolk, UK; AGEING (Aberdeen Gerontological & Epidemiological INterdisciplinary Research Group), Epidemiology Group, School of Medicine & Dentistry, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
C S
CS
Kwok
A C L
AC
Ong
J F
JF
Potter
A K
AK
Metcalf
P K
PK
Myint
D000375:Aging / Q000502:physiology; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000209:etiology*; D002546:Ischemic Attack, Transient / Q000150:complications*; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D020521:Stroke / Q000150:complications