title: Do we need to evaluate diastolic blood pressure in patients with suspected orthostatic hypotension?
abstract: OBJECTIVE
  The contribution of diastolic blood pressure measurement to the diagnosis of classical orthostatic hypotension is not known. We aimed to explore the prevalence of isolated systolic and diastolic orthostatic hypotension components in patients with syncope and orthostatic intolerance.
  
  
  METHODS
  A total of 1520 patients aged >15 years with suspected syncope and/or symptoms of orthostatic intolerance were investigated in a tertiary center using tilt-table testing and continuous non-invasive blood pressure monitoring. Classical orthostatic hypotension was defined as a decline in systolic blood pressure ≥20 mmHg and/or diastolic blood pressure ≥10 mmHg at 3 min of tilt test. The prevalence of upright systolic blood pressure <90 mmHg and its overlap with isolated diastolic orthostatic hypotension was also assessed.
  
  
  RESULTS
  One hundred eighty-six patients (12.2%) met current diagnostic criteria for classical orthostatic hypotension. Of these, 176 patients (94.6%) met the systolic criterion and 102 patients (54.8%) met the diastolic criterion. Ninety-two patients (49.5%) met both systolic and diastolic criteria, whereas ten patients (5.4%) met the diastolic criterion alone. Of these, three had systolic blood pressure <90 mmHg during tilt test and were diagnosed with orthostatic hypotension on the grounds of low standing blood pressure. Based on patient history and ancillary test results, causes of orthostatic intolerance and syncope other than orthostatic hypotension were present in the remaining seven patients.
  
  
  CONCLUSIONS
  An abnormal orthostatic fall in diastolic blood pressure without an abnormal fall in systolic blood pressure is rare among patients with syncope and orthostatic intolerance. Approximately 95% of patients with classical orthostatic hypotension can be identified by systolic criterion alone.
authors.affiliation: Department of Clinical Sciences, Faculty of Medicine, Clinical Research Center, Lund University, Malmö, Sweden. Artur.fedorowski@med.lu.se.|Department of Cardiology, Skåne University Hospital, Inga Marie Nilssons gata 46, 205 02, Malmö, Sweden. Artur.fedorowski@med.lu.se.
authors.forename: Artur
authors.identifier: http://orcid.org/0000-0002-5352-6327
authors.initials: A
authors.lastname: Fedorowski
authors.affiliation: Department of Clinical Sciences, Faculty of Medicine, Clinical Research Center, Lund University, Malmö, Sweden.|Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden.
authors.forename: Viktor
authors.initials: V
authors.lastname: Hamrefors
authors.affiliation: National Heart & Lung Institute, Imperial College, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Sutton
authors.affiliation: Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: J Gert
authors.initials: JG
authors.lastname: van Dijk
authors.affiliation: Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, USA.
authors.forename: Roy
authors.initials: R
authors.lastname: Freeman
authors.affiliation: Department of Internal Medicine, Radboud Medical Centre, Nijmegen, The Netherlands.|Department of Medicine III, Technical University Dresden, Dresden, Germany.
authors.forename: Jacques Wm
authors.initials: JW
authors.lastname: Lenders
authors.affiliation: Department of Internal Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Wouter
authors.initials: W
authors.lastname: Wieling
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D001795:Blood Pressure Determination; D003971:Diastole; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D054971:Orthostatic Intolerance / Q000175:diagnosis / Q000503:physiopathology; D015995:Prevalence; D011379:Prognosis; D013575:Syncope / Q000503:physiopathology; D018667:Tilt-Table Test
keywords: Blood pressure; Diastolic; Orthostatic hypotension; Orthostatic intolerance; Syncope