title: Detecting initial orthostatic hypotension: a novel approach.
abstract: Our purpose, by modification of standard bedside tilt-testing, was to search for lesser known but important initial orthostatic hypotension (IOH), occurring transiently within the first 30 seconds of standing, heretofore only detectable with sophisticated continuous photoplethysmographic monitoring systems, not readily available in most medical facilities. In screened outpatients over 60 years of age, supine blood pressure (BP) parameters were recorded. To achieve readiness for immediate BP after standing, the cuff was re-inflated prior to standing, rather than after. Immediate, 1-, and 3-minute standing BPs were recorded. One hundred fifteen patients were studied (mean age, 71.1 years; 50.5% male). Eighteen (15.6%) had OH, of whom 14 (12.1%) had classical OH, and four (3.5%) had IOH. Early standing BP detection time was 20.1 ± 5.3 seconds. Immediate transient physiologic systolic BP decline was detected in non-OH (-8.8 ± 9.9 mm Hg; P < .0001). In contrast to classical OH (with lesser but persistent orthostatic BP decrements), IOH patients had immediate mean orthostatic systolic/diastolic BP change of -32.8 (±13.8) mm Hg/-14.0 (±8.5) mm Hg (P < .02), with recovery back to baseline by 1 minute. Two of the four IOH patients had pre-syncopal symptoms. For the first time, using standard inflation-deflation BP equipment, immediate transient standing physiologic BP decrement and IOH were demonstrated. This preliminary study confirms proof of principle that manual BP cuff inflation prior to standing may be useful and practical in diagnosing IOH, and may stimulate direct comparative studies with continuous monitoring systems.
authors: Charleston Division, Department of Internal Medicine, West Virginia University Health Sciences Center, Charleston, WV, USA. Electronic address: bmcjunkin@hsc.wvu.edu.
authors: Brittain
authors: B
authors: McJunkin
authors: Charleston Division, Department of Internal Medicine, West Virginia University Health Sciences Center, Charleston, WV, USA.
authors: Brandon
authors: B
authors: Rose
authors: Department of Internal Medicine, West Virginia University Health Sciences Center, Morgantown, WV, USA.
authors: Om
authors: O
authors: Amin
authors: Charleston Division, Department of Internal Medicine, West Virginia University Health Sciences Center, Charleston, WV, USA.
authors: Nirmita
authors: N
authors: Shah
authors: Charleston Division, Department of Internal Medicine, West Virginia University Health Sciences Center, Charleston, WV, USA.
authors: Sachin
authors: S
authors: Sharma
authors: Department of Internal Medicine, West Virginia University Health Sciences Center, Morgantown, WV, USA.
authors: Sujal
authors: S
authors: Modi
authors: Charleston Division, Department of Internal Medicine, West Virginia University Health Sciences Center, Charleston, WV, USA.
authors: Suzanne
authors: S
authors: Kemper
authors: Northwestern University, Evanston, IL, USA.
authors: Muhammad
authors: M
authors: Yousaf
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D001795:Blood Pressure Determination / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007024:Hypotension, Orthostatic / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D011187:Posture / Q000502:physiology
keywords: Falls; orthostatic hypotension; pre-syncope; syncope