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Europace Advance Access published online on August 24, 2007
Europace, doi:10.1093/europace/eum177
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© The European Society of Cardiology 2007. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Orthostatic hypotension: a new classification system

B.M.T. Deegan1,2,*, M. O’Connor3, T. Donnelly3, S. Carew3, A. Costelloe3, T. Sheehy3, G. ÓLaighin1,2 and D. Lyons3

1 Department of Electronic Engineering, National University of Ireland, Galway, Galway, Ireland; 2 National Centre for Biomedical Engineering Science, National University of Ireland, Galway, Galway, Ireland; 3 Blood Pressure Unit, Clinical Age Assessment Unit, Mid-Western Regional Hospital, Limerick, Ireland

Aims: Orthostatic hypotension (OH) is a common condition, which is defined as a reduction in systolic blood pressure of ≥20 mmHg or diastolic blood pressure of ≥10 mmHg within 3 min of orthostatic stress. Utilizing total peripheral resistance (TPR) and cardiac output (CO) measurements during tilt-table testing (Modelflow method), we classified OH into three categories, namely arteriolar, venular, and mixed. The principle defect in arteriolar OH is impaired vasoconstriction after orthostatic stress, reflected by absence of the compensatory increase in TPR. In venular OH, the predominant defect is excessive reduction in venous return, reflected by a large drop in CO after orthostatic stress with marked tachycardia. Mixed OH is due to a combination of both these mechanisms.

Methods and results: We analysed haemodynamic parameters of 110 patients with OH and categorized them as arteriolar, venular, or mixed. Significant differences between the groups were found for the magnitude and time to reach nadir of the systolic blood pressure drop post-head-up tilt. The mixed OH category had the largest systolic blood pressure reduction (42.5, 31.9, 53.3 mmHg, P < 0.001) and the longest nadir time (18.6, 20, 30.7 s, P = 0.002).

Conclusion: This is a practical classification tool and when validated physiologically, this system could be useful in directing treatment of OH.

Key Words: Orthostatic hypotension, Blood pressure, Cardiac output, Total peripheral resistance, Syncope, Tilt-table testing

* Corresponding author. Tel: +353 868013215; fax: +353 91494511.E-mail address: briandeegan{at}oceanfree.net

Manuscript submitted 27 April 2007. Accepted after revision 22 July 2007.


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