title: Initial orthostatic hypotension in teenagers and young adults.
abstract: To assess: (1) the frequency of an abnormally large fall in blood pressure (BP) upon standing from supine in patients with initial orthostatic hypotension (IOH); (2) the underlying hemodynamic mechanisms of this fall in BP upon standing from supine and from squatting.
  
  
  
  In a retrospective study of 371 patients (≤30 years) visiting the syncope unit, the hemodynamic response to standing and squatting were studied in 26 patients who were diagnosed clinically with IOH, based on history taking only. In six patients changes in cardiac output (CO) and systemic vascular resistance (SVR) were determined, and the underlying hemodynamics were analyzed.
  
  
  
  15/26 (58 %) patients with IOH had an abnormally large initial fall in systolic BP (≥40 mmHg). There was a large scatter in CO and SVR response after arising from supine [ΔCO at BP nadir median -8 % (range -37, +27 %); ΔSVR at BP nadir median -31 % (range -46, +10 %)]. The hemodynamic response after squatting showed a more consistent pattern, with a fall in SVR in all six patients [ΔCO at BP nadir median +23 % (range -12, +31 %); ΔSVR at BP nadir median -42 %, (range -52, -35 %)].
  
  
  
  The clinical diagnosis of IOH is based on history taking, as an abnormally large fall in systolic BP can only be documented in 58 %. For IOH upon standing after supine rest, the hemodynamic mechanism can be either a large fall in CO or in SVR. For IOH upon arising from squatting a large fall in SVR is a consistent finding.
authors.affiliation: Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands. v.van.wijnen@umcg.nl.
authors.forename: V K
authors.initials: VK
authors.lastname: van Wijnen
authors.affiliation: Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
authors.forename: M P M
authors.initials: MP
authors.lastname: Harms
authors.affiliation: Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: I K
authors.initials: IK
authors.lastname: Go-Schön
authors.affiliation: Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands.|Heart Failure Research Center, Laboratory for Clinical Cardiovascular Physiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: B E
authors.initials: BE
authors.lastname: Westerhof
authors.affiliation: Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: C T P
authors.initials: CT
authors.lastname: Krediet
authors.affiliation: Departments of Physiology and Pediatrics, New York Medical College, Valhalla, NY, USA.|Center for Hypotension, New York Medical College, Hawthorne, NY, USA.
authors.forename: J
authors.initials: J
authors.lastname: Stewart
authors.affiliation: Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Wieling
mesh_terms: D000293:Adolescent; D000328:Adult; D002081:Buttocks / Q000098:blood supply; D002302:Cardiac Output; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000503:physiopathology*; D008297:Male; D011187:Posture; D012039:Regional Blood Flow; D012189:Retrospective Studies; D013318:Stroke Volume; D016683:Supine Position; D018667:Tilt-Table Test; D014655:Vascular Resistance; D055815:Young Adult
keywords: Blood pressure; Cardiac output; Finapres; Initial orthostatic hypotension; Syncope; Vascular resistance