HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) CME: Take the course for this article: Volume 67, Number 1, July 11, 2006 Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Related articles in Neurology Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gibbons, C. H. Articles by Freeman, R. Search for Related Content PubMed PubMed Citation Articles by Gibbons, C. H. Articles by Freeman, R.

Delayed orthostatic hypotension

A frequent cause of orthostatic intolerance

From the Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

Address correspondence and reprint requests to Dr. Roy Freeman, Autonomic and Peripheral Nerve Laboratory, Department of Neurology, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA 02215; e-mail: rfreeman{at}bidmc.harvard.edu

Objective: To investigate the prevalence, symptoms, and neurophysiologic features of delayed orthostatic hypotension (OH).

Methods: Blood pressures (BP) were measured at 1-minute intervals on 230 patients during 60° head-up tilt for 45 minutes and standing for 5 minutes. OH was defined as a sustained fall in BP (20 mm Hg systolic or 10 mm Hg diastolic) and delayed OH as a sustained BP fall occurring beyond 3 minutes of standing or upright tilt table testing. Beat-to-beat BP, tests of cardiovagal function, and sympathetic-adrenergic function were performed.

Results: Of patients with OH, only 46% had OH within 3 minutes of head up tilt; 15% had OH between 3 and 10 minutes; and 39% had OH only after 10 minutes of tilt table testing. The magnitude and the temporal distribution of the BP fall did not differ between those with and without symptoms of orthostatic intolerance. Patients with OH beyond 10 minutes tended to be younger (p < 0.05), have smaller BP falls during phase II of the Valsalva maneuver (p < 0.01), and have greater phase IV overshoot (p < 0.01).

Conclusions: Delayed orthostatic hypotension occurred in 54% of our tested population and was associated with milder abnormalities of sympathetic adrenergic function, suggesting this disorder may be a mild or early form of sympathetic adrenergic failure.

Editorial, see page 8

Disclosure: The authors report no conflicts of interest.

Received January 9, 2006. Accepted in final form March 21, 2006.

Related articles in Neurology:

July 11 Highlights

Neurology 2006 67: 4-5. [Full Text]  

Delayed orthostatic hypotension: Is it worth the wait?

William P. Cheshire, Jr and Lawrence H. Phillips, II
Neurology 2006 67: 8-9. [Full Text]  

This article has been cited by other articles:

				R. Freeman Neurogenic Orthostatic Hypotension N. Engl. J. Med., February 7, 2008; 358(6): 615 - 624. [Full Text] [PDF]

				D Gupta and M D Nair Neurogenic orthostatic hypotension: chasing "the fall" Postgrad. Med. J., January 1, 2008; 84(987): 6 - 14. [Abstract] [Full Text] [PDF]

				J. E Naschitz and I. Rosner Orthostatic hypotension: framework of the syndrome Postgrad. Med. J., September 1, 2007; 83(983): 568 - 574. [Abstract] [Full Text] [PDF]

				Orthostatic Hypotension Redefined? Journal Watch Neurology, November 14, 2006; 2006(1114): 2 - 2. [Full Text]

				Delayed Orthostatic Hypotension Isn't Rare Journal Watch (General), August 15, 2006; 2006(815): 4 - 4. [Full Text]

				W. P. Cheshire Jr and L. H. Phillips II Delayed orthostatic hypotension: Is it worth the wait? Neurology, July 11, 2006; 67(1): 8 - 9. [Full Text] [PDF]