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- W2062093734 abstract "S E Caine and colleagues (Aug 8, p 458)1Caine SE Alsop K MacMahon M Overlooking orthostatic hypotension with routine blood-pressure equipment..Lancet. 1998; 352: 458Summary Full Text Full Text PDF PubMed Scopus (18) Google Scholar diagnose othostatic hypotension in 75% of 80 consecutive patients referred for unexplained falls, with the Finapres method. This method diagnoses an increased proportion of orthostatic hypotension compared with routine methods (sphygmomanometer and Dinamap measurement). In our view, the validity of these results needs to be discussed. The researchers use a new device but define orthostatic hypotension according to criteria of routine methods. Thus, a single drop in systolic blood pressure of 20 mm Hg or more among more than 120 systolic blood pressure values led to the diagnosis of orthostatic hypotension. We investigated orthostatic blood pressure response with the Finapres (Ohmeda, Englewood, CO, USA) method in 15 healthy young adults (eight men and seven women, mean age 30 years), to define physiological responses. Our recordings were made after 15 min supine rest, and beat to beat systolic blood pressure was recorded 60 s before and 180 s after standing. Results were expressed as changes from baseline, calculated as the mean of systolic blood pressure values obtained in the 60 s supine phase. We paid special attention to keeping the digital cuff of the device at heart level, to avoid any effect during orthostasis. As shown in the figure, an immediate drop of systolic blood pressure was common in healthy volunteers. In five of the 15 young adults, this drop was more than 20 mm Hg, although none had dizziness. Moreover, interindividual variability of systolic blood pressure response was important in the first 30 s after standing (figure). From our results we conclude that the diagnostic criteria used by Caine and colleagues to define othostatic hypotension from Finapres readings are not appropriate. We can agree that digital photoplethysmography is a promising diagnostic method; however, this method cannot be taken as the gold standard, since reliable criteria are not defined by strict methodological approaches. Diagnosis of orthostatic hypotensionAuthor's reply Full-Text PDF" @default.
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- W2062093734 date "1998-11-01" @default.
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- W2062093734 title "Diagnosis of orthostatic hypotension" @default.
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- W2062093734 doi "https://doi.org/10.1016/s0140-6736(05)61480-8" @default.
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