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Clin Neurophysiol. 2016 Apr;127(4):2102-7. doi: 10.1016/j.clinph.2015.12.017. Epub 2016 Jan 8.

Orthostatic hypertension: An underestimated cause of orthostatic intolerance.

Author information

1
Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea; Brain Research Institute, Keimyung University School of Medicine, Daegu, South Korea.
2
Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea; Brain Research Institute, Keimyung University School of Medicine, Daegu, South Korea. Electronic address: kha0206@dsmc.or.kr.

Abstract

OBJECTIVE:

To investigate the frequency and mechanism of orthostatic hypertension (OHT) in patients with orthostatic intolerance.

METHODS:

We retrospectively reviewed 1033 consecutive case series of orthostatic intolerance that underwent autonomic function tests including a head-up tilt test. OHT was defined as a paradoxical orthostatic increase in systolic blood pressure (BP) of at least 20 mmHg during the tilt. We collected autonomic parameters during the standardized autonomic function tests, which included the beat-to-beat derived hemodynamic parameters during the tilt table test and compared them with age and sex-matched normal controls and the orthostatic hypotension (OH) group with orthostatic symptoms.

RESULTS:

We identified 38 (3.7%) patients who showed OHT during the tilt. The increase in mean systolic BP during the tilt was 26.5 mmHg. Approximately 87% (33/38) of the OHT patients showed an increase in total peripheral resistance during the tilt. The mean increase in total peripheral resistance from a supine baseline was significantly higher in OHT patients compared to normal controls, but the OH group showed a decrease in mean total peripheral resistance during the tilt.

CONCLUSION:

A select few patients with orthostatic dizziness can show OHT during the tilt and they have signs of increased peripheral resistance.

SIGNIFICANCE:

OHT may be considered in the differential diagnosis of orthostatic intolerance.

KEYWORDS:

Autonomic nervous system diseases; Blood pressure; Hypertension; Orthostatic intolerance

PMID:
26806722
DOI:
10.1016/j.clinph.2015.12.017
[Indexed for MEDLINE]

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