Abstract
Objectives
Continuous noninvasive blood pressure (BP) measurement enables us to observe rapid
changes in BP and to study underlying hemodynamic mechanisms. This study aimed to
gain insight into the pathophysiological mechanisms underlying short-term orthostatic
BP recovery patterns in a real-world clinical setting with (pre)syncope patients.
Setting and Participants
In a prospective cohort study, the active lying-to-standing test was performed in
suspected (pre)syncope patients in the emergency department with continuous noninvasive
finger arterial BP measurement.
Measures
Changes in systolic BP, cardiac output (CO), and systemic vascular resistance (SVR)
were studied in normal BP recovery, initial orthostatic hypotension, delayed BP recovery,
and sustained orthostatic hypotension.
Results
In normal recovery (n = 47), ΔBP at nadir was −24 (23) mmHg, with a CO change of +10
(21%) and SVR of −23 (21%). In initial orthostatic hypotension (n = 7) ΔBP at nadir
was −49 (17) mmHg and CO and SVR change was −5 (46%) and −29 (58%), respectively.
Delayed recovery (n = 12) differed significantly from normal recovery 30 seconds after
standing, with a ΔBP of −32 (19) vs 1 (16) mmHg, respectively. Delayed recovery was
associated with a significant difference in SVR changes compared to normal recovery, −17
(26%) vs +4 (20%), respectively. There was no difference in CO changes. In sustained
orthostatic hypotension (n = 16), ΔBP at 180 seconds after standing was −39 (21) mmHg,
with changes in CO of −16 (31%) and SVR of −9 (20%).
Conclusions/Implications
Hemodynamic patterns following active standing are heterogeneous and differ across
orthostatic BP recovery patterns, suggesting that volume status, medication use, and
autonomic dysfunction should all be taken into account when evaluating these patients.
Moreover, results suggest that a delayed BP recovery is associated with an impaired
increase in SVR in a significant proportion of individuals, implying that physicians
treating older adults with hypertension should consider the possible negative effect
of intensive hypertension treatment on initial orthostatic blood pressure control.
Keywords
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Article info
Publication history
Published online: August 02, 2018
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
