What is the minimum duration of head-up tilt necessary to detect orthostatic hypotension?

Jade A. Gehrking, Stacy M. Hines, Lisa M. Benrud-Larson, Tonette L. Opher-Gehrking, Phillip Anson Low

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Objective: There is uncertainty as to the minimum duration of head-up tilt (HUT) needed to detect orthostatic hypotension (OH). The orthostatic duration has variably been recommended to be 1, 2, 3, and 5 minutes. The purpose of the current study was 1) to determine the minimum duration of HUT necessary to detect OH and 2) to identify different patterns of orthostatic blood pressure (BP) response in patients with OH. Design/methods: We evaluated the medical records of 66 consecutive patients (mean age 70.0±10.1 years; 64% male) seen at Mayo Clinic-Rochester from 2000-2001 who fulfilled the criteria for OH (systolic blood pressure [SBP] reduction ≥ 20mm Hg within 3 minutes of HUT) during routine clinical autonomic studies. All patients completed an autonomic reflex screen with continuous monitoring of heart rate and BP during supine rest and 5 minutes of 70 degree HUT. Severity of autonomic deficits was quantified with the Composite Autonomic Severity Score (CASS). Results: Overall, BP was the lowest at 1 minute with gradual and partial recovery over the following 4 minutes. Eighty-eight percent of patients (N=58) developed OH by 1 minute of HUT, with an additional 11% (N=7) developing OH by 2 minutes and the remaining 1% (N=1) developing OH by 3 minutes. We identified two broad patterns of SBP response to HUT. Forty-eight percent (N=32) of patients demonstrated an initial drop in SBP (≥ 20 mm Hg),which remained stable until tilt-back. Thirty-six percent (N=24) demonstrated an initial drop (≥ 20mm Hg) followed by a progressive decline in SBP until tilt-back. Repeated measures analysis of variance confirmed that the SBP change in response to HUT differed significantly among patients with a stable vs. progressive pattern [F(3,32)=25.1, p<0.001). Patients with the progressive pattern also had more severe adrenergic impairment on the CASS (p=0.03) and were more likely to have their tilt test terminated early (prior to 5minutes) due to presyncope (p<0.0001) than patients with the stable pattern. Conclusions: One minute of HUT will detect OH in the great majority (88%) of patients and three minutes will detect the balance. Orthostatic stress beyond 2 minutes is necessary to detect the pattern of progressive OH. Since this group has more severe adrenergic deficits than the group with stable OH, we suggest that the progressive pattern is due to greater impairment of compensatory reflexes. Recognition of the group with progressive fall in BP is important since this group may be at greater risk of orthostatic syncope.

Original languageEnglish (US)
Pages (from-to)71-75
Number of pages5
JournalClinical Autonomic Research
Volume15
Issue number2
DOIs
StatePublished - Apr 2005

Fingerprint

Orthostatic Hypotension
Head
Blood Pressure
Syncope
Adrenergic Agents
Reflex
Hypotension
Uncertainty
Medical Records
Analysis of Variance

Keywords

  • Adrenergic
  • Autonomic failure
  • Head-up tilt
  • Orthostatic hypotension
  • Syncope

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

What is the minimum duration of head-up tilt necessary to detect orthostatic hypotension? / Gehrking, Jade A.; Hines, Stacy M.; Benrud-Larson, Lisa M.; Opher-Gehrking, Tonette L.; Low, Phillip Anson.

In: Clinical Autonomic Research, Vol. 15, No. 2, 04.2005, p. 71-75.

Research output: Contribution to journalArticle

Gehrking, Jade A. ; Hines, Stacy M. ; Benrud-Larson, Lisa M. ; Opher-Gehrking, Tonette L. ; Low, Phillip Anson. / What is the minimum duration of head-up tilt necessary to detect orthostatic hypotension?. In: Clinical Autonomic Research. 2005 ; Vol. 15, No. 2. pp. 71-75.
@article{f5431eef4e1f405eb39081109d80cd45,
title = "What is the minimum duration of head-up tilt necessary to detect orthostatic hypotension?",
abstract = "Objective: There is uncertainty as to the minimum duration of head-up tilt (HUT) needed to detect orthostatic hypotension (OH). The orthostatic duration has variably been recommended to be 1, 2, 3, and 5 minutes. The purpose of the current study was 1) to determine the minimum duration of HUT necessary to detect OH and 2) to identify different patterns of orthostatic blood pressure (BP) response in patients with OH. Design/methods: We evaluated the medical records of 66 consecutive patients (mean age 70.0±10.1 years; 64{\%} male) seen at Mayo Clinic-Rochester from 2000-2001 who fulfilled the criteria for OH (systolic blood pressure [SBP] reduction ≥ 20mm Hg within 3 minutes of HUT) during routine clinical autonomic studies. All patients completed an autonomic reflex screen with continuous monitoring of heart rate and BP during supine rest and 5 minutes of 70 degree HUT. Severity of autonomic deficits was quantified with the Composite Autonomic Severity Score (CASS). Results: Overall, BP was the lowest at 1 minute with gradual and partial recovery over the following 4 minutes. Eighty-eight percent of patients (N=58) developed OH by 1 minute of HUT, with an additional 11{\%} (N=7) developing OH by 2 minutes and the remaining 1{\%} (N=1) developing OH by 3 minutes. We identified two broad patterns of SBP response to HUT. Forty-eight percent (N=32) of patients demonstrated an initial drop in SBP (≥ 20 mm Hg),which remained stable until tilt-back. Thirty-six percent (N=24) demonstrated an initial drop (≥ 20mm Hg) followed by a progressive decline in SBP until tilt-back. Repeated measures analysis of variance confirmed that the SBP change in response to HUT differed significantly among patients with a stable vs. progressive pattern [F(3,32)=25.1, p<0.001). Patients with the progressive pattern also had more severe adrenergic impairment on the CASS (p=0.03) and were more likely to have their tilt test terminated early (prior to 5minutes) due to presyncope (p<0.0001) than patients with the stable pattern. Conclusions: One minute of HUT will detect OH in the great majority (88{\%}) of patients and three minutes will detect the balance. Orthostatic stress beyond 2 minutes is necessary to detect the pattern of progressive OH. Since this group has more severe adrenergic deficits than the group with stable OH, we suggest that the progressive pattern is due to greater impairment of compensatory reflexes. Recognition of the group with progressive fall in BP is important since this group may be at greater risk of orthostatic syncope.",
keywords = "Adrenergic, Autonomic failure, Head-up tilt, Orthostatic hypotension, Syncope",
author = "Gehrking, {Jade A.} and Hines, {Stacy M.} and Benrud-Larson, {Lisa M.} and Opher-Gehrking, {Tonette L.} and Low, {Phillip Anson}",
year = "2005",
month = "4",
doi = "10.1007/s10286-005-0246-y",
language = "English (US)",
volume = "15",
pages = "71--75",
journal = "Clinical Autonomic Research",
issn = "0959-9851",
publisher = "D. Steinkopff-Verlag",
number = "2",

}

TY - JOUR

T1 - What is the minimum duration of head-up tilt necessary to detect orthostatic hypotension?

AU - Gehrking, Jade A.

AU - Hines, Stacy M.

AU - Benrud-Larson, Lisa M.

AU - Opher-Gehrking, Tonette L.

AU - Low, Phillip Anson

PY - 2005/4

Y1 - 2005/4

N2 - Objective: There is uncertainty as to the minimum duration of head-up tilt (HUT) needed to detect orthostatic hypotension (OH). The orthostatic duration has variably been recommended to be 1, 2, 3, and 5 minutes. The purpose of the current study was 1) to determine the minimum duration of HUT necessary to detect OH and 2) to identify different patterns of orthostatic blood pressure (BP) response in patients with OH. Design/methods: We evaluated the medical records of 66 consecutive patients (mean age 70.0±10.1 years; 64% male) seen at Mayo Clinic-Rochester from 2000-2001 who fulfilled the criteria for OH (systolic blood pressure [SBP] reduction ≥ 20mm Hg within 3 minutes of HUT) during routine clinical autonomic studies. All patients completed an autonomic reflex screen with continuous monitoring of heart rate and BP during supine rest and 5 minutes of 70 degree HUT. Severity of autonomic deficits was quantified with the Composite Autonomic Severity Score (CASS). Results: Overall, BP was the lowest at 1 minute with gradual and partial recovery over the following 4 minutes. Eighty-eight percent of patients (N=58) developed OH by 1 minute of HUT, with an additional 11% (N=7) developing OH by 2 minutes and the remaining 1% (N=1) developing OH by 3 minutes. We identified two broad patterns of SBP response to HUT. Forty-eight percent (N=32) of patients demonstrated an initial drop in SBP (≥ 20 mm Hg),which remained stable until tilt-back. Thirty-six percent (N=24) demonstrated an initial drop (≥ 20mm Hg) followed by a progressive decline in SBP until tilt-back. Repeated measures analysis of variance confirmed that the SBP change in response to HUT differed significantly among patients with a stable vs. progressive pattern [F(3,32)=25.1, p<0.001). Patients with the progressive pattern also had more severe adrenergic impairment on the CASS (p=0.03) and were more likely to have their tilt test terminated early (prior to 5minutes) due to presyncope (p<0.0001) than patients with the stable pattern. Conclusions: One minute of HUT will detect OH in the great majority (88%) of patients and three minutes will detect the balance. Orthostatic stress beyond 2 minutes is necessary to detect the pattern of progressive OH. Since this group has more severe adrenergic deficits than the group with stable OH, we suggest that the progressive pattern is due to greater impairment of compensatory reflexes. Recognition of the group with progressive fall in BP is important since this group may be at greater risk of orthostatic syncope.

AB - Objective: There is uncertainty as to the minimum duration of head-up tilt (HUT) needed to detect orthostatic hypotension (OH). The orthostatic duration has variably been recommended to be 1, 2, 3, and 5 minutes. The purpose of the current study was 1) to determine the minimum duration of HUT necessary to detect OH and 2) to identify different patterns of orthostatic blood pressure (BP) response in patients with OH. Design/methods: We evaluated the medical records of 66 consecutive patients (mean age 70.0±10.1 years; 64% male) seen at Mayo Clinic-Rochester from 2000-2001 who fulfilled the criteria for OH (systolic blood pressure [SBP] reduction ≥ 20mm Hg within 3 minutes of HUT) during routine clinical autonomic studies. All patients completed an autonomic reflex screen with continuous monitoring of heart rate and BP during supine rest and 5 minutes of 70 degree HUT. Severity of autonomic deficits was quantified with the Composite Autonomic Severity Score (CASS). Results: Overall, BP was the lowest at 1 minute with gradual and partial recovery over the following 4 minutes. Eighty-eight percent of patients (N=58) developed OH by 1 minute of HUT, with an additional 11% (N=7) developing OH by 2 minutes and the remaining 1% (N=1) developing OH by 3 minutes. We identified two broad patterns of SBP response to HUT. Forty-eight percent (N=32) of patients demonstrated an initial drop in SBP (≥ 20 mm Hg),which remained stable until tilt-back. Thirty-six percent (N=24) demonstrated an initial drop (≥ 20mm Hg) followed by a progressive decline in SBP until tilt-back. Repeated measures analysis of variance confirmed that the SBP change in response to HUT differed significantly among patients with a stable vs. progressive pattern [F(3,32)=25.1, p<0.001). Patients with the progressive pattern also had more severe adrenergic impairment on the CASS (p=0.03) and were more likely to have their tilt test terminated early (prior to 5minutes) due to presyncope (p<0.0001) than patients with the stable pattern. Conclusions: One minute of HUT will detect OH in the great majority (88%) of patients and three minutes will detect the balance. Orthostatic stress beyond 2 minutes is necessary to detect the pattern of progressive OH. Since this group has more severe adrenergic deficits than the group with stable OH, we suggest that the progressive pattern is due to greater impairment of compensatory reflexes. Recognition of the group with progressive fall in BP is important since this group may be at greater risk of orthostatic syncope.

KW - Adrenergic

KW - Autonomic failure

KW - Head-up tilt

KW - Orthostatic hypotension

KW - Syncope

UR - http://www.scopus.com/inward/record.url?scp=17844379265&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=17844379265&partnerID=8YFLogxK

U2 - 10.1007/s10286-005-0246-y

DO - 10.1007/s10286-005-0246-y

M3 - Article

C2 - 15834762

AN - SCOPUS:17844379265

VL - 15

SP - 71

EP - 75

JO - Clinical Autonomic Research

JF - Clinical Autonomic Research

SN - 0959-9851

IS - 2

ER -