Office orthostatic blood pressure measurements and ambulatory blood pressure monitoring in the prediction of autonomic dysfunction

Abstract

BackgroundIn this retrospective analysis we investigated the predictive performance of orthostatic hypotension (OH) and ambulatory blood pressure monitoring (ABP) to predict autonomic dysfunction.MethodsStatistical associations among the candidate variables were investigated and comparisons of predictive performances were performed using Receiver Operating Characteristics (ROC) curves.ResultsNinety-four patients were included for analysis. No significant correlations could be demonstrated between OH and components of ABP (reversal of circadian pattern, postprandial hypotension and heart rate variability), nor between OH and autonomic reflex screen. Reversal of circadian pattern did not demonstrate significant correlation (r = 0.12, p = 0.237) with autonomic reflex screen, but postprandial hypotension (r = 0.39, p = 0.003) and heart rate variability (r = 0.27, p = 0.009) demonstrated significant correlations. Postprandial hypotension was associated with a five-fold (OR 4.83, CI95% 1.6–14.4, p = 0.005) increased risk and heart rate variability with a four-fold (OR 3.75, CI95% 1.3–10.6, p = 0.013) increased risk for autonomic dysfunction. Per ROC curves, heart rate variability (0.671, CI95% 0.53–0.81, p = 0.025) and postprandial hypotension (0.668, CI95% 0.52–0.72, p = 0.027) were among the best predictors of autonomic dysfunction in routine clinical practice.ConclusionPostprandial hypotension and heart rate variability on ambulatory blood pressure monitoring are among the best predictors of autonomic dysfunction in routine clinical practice.

Clinical applications for out-of-office blood pressure monitoring

“…A study by Cremer and colleagues showed that HBPM is better than OBPM in screening for orthostatic hypotension. 78 Another study showed that ABPM can predict autonomic dysfunction in orthostatic hypotension, 79 and may be useful when assessing patients for orthostatic hypoten sion. 80 Postprandial hypotension occurs when systolic BP decreases by more than 20 mm Hg within 2 h after a meal.…”

Syncope: new solutions for an old problem

“…ABPM is becoming recognized as a syncope diagnostic tool, with findings of both persistent and episodic hypotension (Table 2). ABPM may also reveal orthostatic, post-prandial, and post-exercise hypotension [1,[45][46][47], or hypotensive episodes following drug administration, as may be observed in Parkinsonian patients receiving dopaminergic drugs [46]. Moreover, ABPM may help to identify hypotensive susceptibility in reflex syncope.…”

Clinical Conditions and Predictive Markers of Non-Dipper Profile in Hypertensive Patients

“…[30] Alquadan et al demonstrated that postprandial hypotension and cardiac rhythm variability computed on ABPM are potent predictors of autonomic dysfunction in routine clinical practice. [31] Frequently, patients with orthostatic hypotension may develop non-dipper hypertension profile, which is a treatment challenge for physicians. [18] Obesity Compared to normal weight, obesity is responsible for five times increase in hypertension incidence.…”