Variability of Blood Pressure Response to Orthostatism and Reproducibility of the Diagnosis of Orthostatic Hypotension in Elderly Subjects

Belmin, Joël; Abderrhamane, Malika; Medjahed, Smahane; Sibony-Prat, J.; Bruhat, Anne; Bojic, N.; Marquet, Thierry

doi:10.1093/gerona/55.11.m667

Cited by 47 publications

(27 citation statements)

References 22 publications

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“…Irreproducibility of orthostatic BP change has been reported in an experimental study in frail elderly subjects 21 and in a cohort study of older community residents. 22 In contrast, masked HT has been reported to have fair-to-moderate reproducibility, 23-26 even over a measurement period of 6 months.…”

Section: Discussionmentioning

confidence: 82%

Orthostatic hypertension as a predisposing factor for masked hypertension: the J-SHIPP study

et al. 2016

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Masked hypertension (HT) is a known risk factor for cardiovascular outcomes. Postural blood pressure (BP) dysregulation is another BP phenomenon representing cardiovascular frailty. Given their several shared risk factors, we suspected an inter-relationship between these two BP phenomena. Here we investigated a possible relationship between masked HT and postural BP dysregulation in a general population. Study subjects were 884 apparently healthy individuals (aged 66.3±8.9 years). Masked HT was assessed on the basis of the ambulatory monitored average awake BP and office-measured BP values. Orthostatic BP change was measured at our office after a subject was asked to actively stand up. A strong inverse relationship was noted for orthostatic systolic BP (SBP) change and office-to-awake SBP differences (office-awake BP) (r=-0.422, P<0.001), and these relationships were replicated in the second-visit measurements (n=101, r=-0.326, P=0.001). Multivariate analysis revealed that the inverse association was independent (β=-0.23, P<0.001) of possible covariates, including baseline office BP and antihypertensive treatment. Orthostatic HT (OHT), which is defined as postural increases in SBP >10 mm Hg, 3 min after standing (P=0.001), but not transient HT at only 1 min (P=0.767), was associated with greater office-to-awake SBP differences than in orthostatic normotensive subjects. Among apparently normotensive subjects, the frequency of masked HT was therefore significantly greater in subjects who showed OHT 3 min after standing (52.1%) compared with controls (27.5%) (odds ratio=3.01, P=0.001). We observed an intra-individual relationship between the postural BP change and the office-to-awake BP differences, and subjects who showed OHT were likely to have masked HT irrespective of antihypertensive treatment.

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Section: Discussionmentioning

confidence: 82%

Orthostatic hypertension as a predisposing factor for masked hypertension: the J-SHIPP study

et al. 2016

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“…Previous studies have noted that orthostatic BP measurements have relatively poor reproducibility [29][30], with the reproducibility thought to be higher in those with neurogenic OH [31]. Others have also noted low levels of agreement in OH definitions (kappa 0.17-0.32) based on active stands performed at the same time on different days [32], suggesting that at least in this relatively healthy population, OH can be transient for a numbers of people.…”

Section: Discussionmentioning

confidence: 98%

Reliability of orthostatic beat-to-beat blood pressure tests: implications for population and clinical studies

Finucane

Kenny

2017

Clin Auton Res

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ObjectiveTo assess the test-retest reliability of orthostatic beat-to-beat blood pressure responses to active standing and related clinical definitions of orthostatic hypotension. MethodsA random sample of community dwelling older adults from the pan-European Survey of Health, Ageing and Retirement in Europe, Ireland underwent a health assessment which mimicked that of the Irish Longitudinal Study on Ageing. An active stand test was performed using continuous blood pressure measurements. Participants attended a repeat assessment 4-12 weeks after the initial measurement. A mixed-effects regression model estimated the reliability and minimum detectable change while controlling for fixed observer and time of day effects. ResultsA total of 125 individuals underwent repeat assessment (mean age 66.2±7.5;55.6% women).Mean time between visits was 84.3±23.3 days. There was no significant mean difference in heart rate or blood pressure recovery variables between the first and repeat assessments.Minimum detectable change was noted for changes from resting values in systolic blood pressure(26.4mmHg) and diastolic blood pressure(13.7mmHg) at 110 seconds and for changes in heart rate(10.9bpm) from resting values at 30 seconds after standing. Intra-class correlation values ranged from 0.47 for nadir values to 0.80 for heart rate and systolic blood pressure values measured 110 seconds after standing. ConclusionContinuous orthostatic beat-to-beat blood pressure and related clinical definitions show moderate reliability and substantial natural variation over a 4-12 week period.Understanding variation in measures is essential for study design or estimating the effects of orthostatic hypotension, while clinically it can be used when evaluating longer term treatment effects.

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“…None of these factors affects the data on reproducibility. The data from patients whose BP was measured in the afternoon have been excluded because a different response of BP to the postural change has been described as occurring as the day passes [19].…”

Section: Discussionmentioning

confidence: 99%

“…The size of our sample in this study is sufficient to assess the reproducibility of postural changes of BP [4,6,19] but it reduced our ability to detect any relationship of reproducibility to some factors such as the type of hypertension (isolated systolic or combined), the disease comorbidity, the presence of symptoms related to a change of position, or the specific medications used by the patients. This could be an issue to address in future studies.…”

Section: Discussionmentioning

confidence: 99%

Reproducibility of postural changes of blood pressure in hypertensive elderly patients in primary care

Vara-González

et al. 2006

Blood Pressure Monitoring

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Variability of Blood Pressure Response to Orthostatism and Reproducibility of the Diagnosis of Orthostatic Hypotension in Elderly Subjects

Abstract: BPRO exhibits significant within-day variability in elderly patients. Within-day and day-to-day reproducibility of the diagnosis of OH, based on conventional criteria, were found to be poor.

Cited by 47 publications

References 22 publications

Orthostatic hypertension as a predisposing factor for masked hypertension: the J-SHIPP study

Orthostatic hypertension as a predisposing factor for masked hypertension: the J-SHIPP study

Reliability of orthostatic beat-to-beat blood pressure tests: implications for population and clinical studies

Reproducibility of postural changes of blood pressure in hypertensive elderly patients in primary care

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