Detecting initial orthostatic hypotension: a novel approach

McJunkin, Brittain; Rose, Brandon; Amin, Om; Shah, Nirmita; Sharma, Sachin; Modi, Sujal; Kemper, Suzanne; Yousaf, Muhammad

doi:10.1016/j.jash.2015.02.006

“…61 Additionally, a condition known as initial orthostatic hypotension is defined as a decrease in SBP of 0 mmHg and/or a decrease in DBP of >20 mmHg presenting within the first 15 seconds of standing and correcting within 30 to 60 seconds. 62 However, in most clinical settings, the equipment functionality limits the physical therapist’s ability to capture these fast adaptations within the vascular system.…”

Section: Recommendations For Bp Screening In Outpatient Physical Thermentioning

confidence: 99%

Blood Pressure Screening by Outpatient Physical Therapists: A Call to Action and Clinical Recommendations

Severin

¹

,

Sabbahi²,

Albarrati

³

et al. 2020

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Hypertension (HTN) is among the leading global preventable risk factors for cardiovascular disease and premature mortality. Early detection and effective management of HTN have demonstrated significant reductions in mortality, morbidity rate, and health care costs. Furthermore, screening for HTN by nonphysician health care providers improves detection rates and medical management. As physical therapist practice advances to a more independent care model, physical therapists may serve as the first point of contact into the health care system, thereby necessitating a need for routine blood pressure (BP) monitoring. This is especially relevant in the outpatient physical therapist practice setting, where there is evidence for elevated BP measures among patients, yet omission of routine screening in this setting is well documented. Leading physical therapy professional organizations include statements in their guidelines that suggest that physical therapists have a duty to provide a standard of care that protects the safety and optimizes the overall health of patients under their care. Therefore, it is imperative not only that physical therapists include BP examination into routine practice protocols but that the knowledge and skills to accurately measure and interpret BP at rest and during exercise be integrated into the standard of care. The authors suggest that the profession of physical therapy proactively embrace their potential to address the national and worldwide HTN epidemic through routine assessment of BP, appropriate referral for elevated BP measures, and exploration of HTN management by physical therapists.

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“…The duration of tilt is generally accepted that 5 minutes for orthostatic hypotension, 10 minutes for POTS and a longer duration for neurally mediated syncope 22 . To detect initial OH, we need to measure BP immediately after onset of tilt 23 . Delayed OH optimally requires 30 minutes in older individuals and 40 minutes required for younger individuals to detect 24 .…”

Section: Discussionmentioning

confidence: 99%

Patients with Orthostatic Intolerance: Relationship to Autonomic Function Tests results and Reproducibility of Symptoms on Tilt

Lee

¹

,

Low

²

,

Kim

³

2017

Sci Rep

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This study was designed to investigate the frequency and pattern of orthostatic symptoms during head-up tilt (HUT) in patients with orthostatic intolerance during daily life, and to identify the relationship between the orthostatic symptoms during HUT and autonomic parameters. We prospectively collected autonomic data from 464 patients with orthostatic symptoms. Adrenergic and cardiovagal function tests including HUT were performed. Based on HUT results, we divided patients into orthostatic hypotension (OH), postural tachycardia syndrome (POTS), or normal HUT groups. We also investigated orthostatic symptoms during HUT. Only 25% of the patients reported orthostatic symptoms during HUT and 75% were asymptomatic. Typical orthostatic symptoms such as orthostatic dizziness and blurred vision, and atypical symptoms like chest tightness and headache occurred in 86% and 66%, respectively. Patients with POTS had symptoms more frequently than patients with OH during HUT. There were no differences in degrees of BP or HR changes between symptomatic and asymptomatic groups within the OH and POTS groups. HUT fails to reproduce symptoms of orthostatic intolerance in the majority of patients. Clinicians need to be aware that most patients with OH are asymptomatic during HUT and patients with POTS are more likely to be symptomatic than patients with OH.

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“…The duration of tilt is generally accepted that 5 minutes for orthostatic hypotension, 10 minutes for POTS and a longer duration for neurally mediated syncope 22 . To detect initial OH, we need to measure BP immediately after onset of tilt 23 . Delayed OH optimally requires 30 minutes in older individuals and 40 minutes required for younger individuals to detect 24 .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Adrenergic Function: Tilt-Table and Valsalva Test

Lee¹,

Kim²

2018

Res Vestib Sci

1

0

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This study was designed to investigate the frequency and pattern of orthostatic symptoms during head-up tilt (HUT) in patients with orthostatic intolerance during daily life, and to identify the relationship between the orthostatic symptoms during HUT and autonomic parameters. We prospectively collected autonomic data from 464 patients with orthostatic symptoms. Adrenergic and cardiovagal function tests including HUT were performed. Based on HUT results, we divided patients into orthostatic hypotension (OH), postural tachycardia syndrome (POTS), or normal HUT groups. We also investigated orthostatic symptoms during HUT. Only 25% of the patients reported orthostatic symptoms during HUT and 75% were asymptomatic. Typical orthostatic symptoms such as orthostatic dizziness and blurred vision, and atypical symptoms like chest tightness and headache occurred in 86% and 66%, respectively. Patients with POTS had symptoms more frequently than patients with OH during HUT. There were no differences in degrees of BP or HR changes between symptomatic and asymptomatic groups within the OH and POTS groups. HUT fails to reproduce symptoms of orthostatic intolerance in the majority of patients. Clinicians need to be aware that most patients with OH are asymptomatic during HUT and patients with POTS are more likely to be symptomatic than patients with OH.Orthostatic symptoms are defined as symptoms that occur when upright and are relieved by recumbence. Common orthostatic symptoms are dizziness, lightheadedness, weakness or tiredness, cognitive difficulties, blurred vision, anxiety, tremulousness, palpitations, nausea, clamminess, or sweating 1, 2 . Two orthostatic intolerance syndromes, orthostatic hypotension (OH) and the postural tachycardia syndrome (POTS), are thought to be responsible for these symptoms. Head-up tilt (HUT) is a standard test to evaluate orthostatic intolerance. However, even in a well-defined group of patients with orthostatic symptoms and documented OH, reproducibility of OH with HUT is relatively low 3 . Furthermore, patients with prominent OH during HUT can have no symptom during daily life (i.e., asymptomatic OH) 1 or during HUT (i.e., hypotension unawareness) 4 . This discordance may relate to multiple mechanisms causing OH and the origin of orthostatic intolerance. Hence, we undertook a study with the following goals. First, we undertook a battery of autonomic function tests to separate these patients into categories of OH, POTS, and normal autonomic function. Second, we evaluated the ability of HUT to reproduce symptoms of orthostatic intolerance. Third, we evaluated if symptoms related to severity of autonomic failure. MethodsWe prospectively collected data from a series of consecutive patients with orthostatic symptoms who were seen in the Dongsan Medical Center Autonomic Reflex Laboratory from March 2014 to June 2015. We included all patients who experienced orthostatic symptoms while they were sitting or standing within the previous 6 months. We excluded patients under 10 years old. A standardize...

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Detecting initial orthostatic hypotension: a novel approach

Cited by 19 publications

References 19 publications

Blood Pressure Screening by Outpatient Physical Therapists: A Call to Action and Clinical Recommendations

Blood Pressure Screening by Outpatient Physical Therapists: A Call to Action and Clinical Recommendations

Patients with Orthostatic Intolerance: Relationship to Autonomic Function Tests results and Reproducibility of Symptoms on Tilt

Evaluation of Adrenergic Function: Tilt-Table and Valsalva Test

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