Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy

Schatz, Irwin J.; Bannister, R.; Freeman, Roy; Goetz, Christopher G.; Jankovic, Joseph; Kaufmann, Horacio; Köller, Wołfram; Low, Phillip A.; Mathias, Christopher J.; Polinsky, R. J.; Quinn, Niall; Robertson, David; Streeten, David H. P.

doi:10.1212/wnl.46.5.1470

Cited by 1,010 publications

(60 citation statements)

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“…These criteria are expert-based. In 1996, a consensus committee of the American Autonomic Society and the American Academy of Neurology met to discuss the etiological criteria of OH and to determine how OH should be diagnosed [1]. Prior to this consensus, investigators and clinicians used varying numbers to denote the presence of OH, creating confusion.…”

Section: Discussionmentioning

confidence: 99%

“…These expert-based criteria were originally defined in 1996 in a consensus statement endorsed by the American Autonomic Society and the American Academy of Neurology [1, 11], and were later adopted by the European Society of Cardiology (ESC) syncope guidelines [17]. Although the definition of OH includes separate criteria for SBP and DBP changes, in daily practice the diastolic criterion seems to be rarely used to diagnose OH.…”

Section: Introductionmentioning

confidence: 99%

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Do we need to evaluate diastolic blood pressure in patients with suspected orthostatic hypotension?

et al. 2017

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PurposeThe 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.MethodsA 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.ResultsOne 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.ConclusionsAn 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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Do we need to evaluate diastolic blood pressure in patients with suspected orthostatic hypotension?

et al. 2017

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“…Early autonomic dysfunction may exhibit no symptoms and only be detected by abnormal indices of HRV. Resting tachycardia (>100 bpm) and/or a fixed HR, as well as, orthostatic hypotension, intolerance to exercise, and syncope are present in patients with advanced CAN (The Consensus Committee of the American Autonomic Society and the American Academy of Neurology, 1996; Vinik and Ziegler, 2007; Pop-Busui, 2010; Spallone et al, 2011). In advanced stages diagnosis can be done clinically, but HRV tests may be necessary to detect early asymptomatic cardiac autonomic dysfunction.…”

Section: Detection Of Cardiac Autonomic Neuropathymentioning

confidence: 99%

Cardiac Autonomic Neuropathy in Diabetes: A Predictor of Cardiometabolic Events

et al. 2018

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Autonomic nervous system (ANS) imbalance manifesting as cardiac autonomic neuropathy in the diabetic population is an important predictor of cardiovascular events. Symptoms and signs of ANS dysfunction, such as resting heart rate elevations, diminished blood pressure responses to standing, and altered time and frequency domain measures of heart rate variability in response to deep breathing, standing, and the Valsalva maneuver, should be elicited from all patients with diabetes and prediabetes. With the recognition of the presence of ANS imbalance or for its prevention, a rigorous regime should be implemented with lifestyle modification, physical activity, and cautious use of medications that lower blood glucose. Rather than intensifying diabetes control, a regimen tailored to the individual risk of autonomic imbalance should be implemented. New agents that may improve autonomic function, such as SGLT2 inhibitors, should be considered and the use of incretins monitored. One of the central mechanisms of dysfunction is disturbance of the hypothalamic cardiac clock, a consequence of dopamine deficiency that leads to sympathetic dominance, insulin resistance, and features of the metabolic syndrome. An improvement in ANS balance may be critical to reducing cardiovascular events, cardiac failure, and early mortality in the diabetic population.

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“…Pure autonomic failure (PAF) is defined as an idiopathic sporadic disorder characterized by orthostatic hypotension (OH) usually with evidence of more widespread AF and no other neurological signs (1). PAF is a Lewy body disease with prominent loss of peripheral sympathetic noradrenergic nerves.…”

Section: Introductionmentioning

confidence: 99%

Iodine-123-meta-iodobenzylguanidine Myocardial Scintigraphy in Isolated Autonomic Failure: Potential Red Flag for Future Multiple System Atrophy

et al. 2017

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Pure autonomic failure is challenging as it can be the presenting feature of a central nervous system syncleinopathy such as Parkinson’s disease (PD) or multiple system atrophy (MSA). Because the prognosis of MSA and PD is so different, predictive features for a possible conversion can be extremely valuable. In this paper, we report three cases (two with autopsy-proven diagnosis) that had isolated AF for many years before converting to MSA or PD. Of all the tests that were performed during the premotor stage, Iodine-123-meta-iodobenzylguanidine (MIBG) myocardial scintigraphy was predictive of the conversion to MSA. We suggest that MIBG myocardial scintigraphy, when performed in patients with isolated AF, may be a valuable predictor of conversion to MSA. On the contrary, the role of such test in parkinsonian patients irrespective of the presence of AF is still to be clarified.

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Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy

Cited by 1,010 publications

References 1 publication

Do we need to evaluate diastolic blood pressure in patients with suspected orthostatic hypotension?

Do we need to evaluate diastolic blood pressure in patients with suspected orthostatic hypotension?

Cardiac Autonomic Neuropathy in Diabetes: A Predictor of Cardiometabolic Events

Iodine-123-meta-iodobenzylguanidine Myocardial Scintigraphy in Isolated Autonomic Failure: Potential Red Flag for Future Multiple System Atrophy

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