ORIGINAL ARTICLEEvaluation of Orthostatic Hypotension: Relationship of a New Self-report Instrument to Laboratory-Based Measures
Section snippets
PATIENTS AND METHODS
Data were collected in 2 stages. In the first stage, we collected data from a consecutive series of patients with neurogenic orthostatic hypotension who were seen in the Mayo Clinic Autonomic Reflex Laboratory in Rochester, Minn, from August to October 2002. Orthostatic hypotension was defined as a sustained reduction in systolic BP of 20 mm Hg or greater within 3 minutes of head-up tilt.7 The second stage consisted of a consecutive series of patients referred to the Mayo Autonomic Reflex
SAMPLE CHARACTERISTICS
Our study consisted of 145 patients with a mean age of 60.8 years (SD, 15.5 years) and an even distribution of men and women (52% men). (Three patients were excluded because they had known orthostatic intolerance due to postural tachycardia syndrome; the focus of this study was on orthostatic intolerance due to orthostatic hypotension.) The racial breakdown was 98% white, 1% African American, and 1% Asian, which is representative of our patient population.
Of these 145 patients, 97 (67%) had
DISCUSSION
To our knowledge, this is the first study to compare a self-report grading scale for orthostatic intolerance in patients with putative orthostatic hypotension to a laboratory-measured composite score of autonomic deficits. The simple 5-item questionnaire proved to be of good internal consistency and demonstrated a unitary factor structure. It also had robust correlations with autonomic deficits (CASS), resulting in good sensitivity and specificity compared to the CASS adrenergic subscore. The
CONCLUSIONS
Our 5-item questionnaire provides reasonable correlations with laboratory scores in patients with orthostatic hypotension. Although some correlations were not as robust as we might have expected, the results are not surprising. Orthostatic hypotension may be the dominant clinical symptom in some patients, but in others it may be a minor problem and may be hidden in a complex of other symptoms. The impact of orthostatic hypotension can vary substantially from patient to patient depending on the
APPENDIX 1
Sudomotor subscore
Any of the following alterations
Single QSART site abnormal or Length-dependent pattern (distal sweat volume <⅓ of forearm or proximal leg values) or Persistent sweat activity at foot (TST, anhidrosis present but <25%) Any of the following alterations
Single QSART site <50% of lower limit of normal Two or more QSART sites reduced (TST anhidrosis, 25%-50%) Two or more QSART sites <50% of lower
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Cited by (89)
Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies
2023, Autonomic Neuroscience: Basic and ClinicalOrthostatic hypotension: A review
2017, Nephrologie et TherapeutiqueCitation Excerpt :Finally, and most importantly, orthostatic hypotension should be searched repeatedly in patients with reported falls, especially in elderly patients [43]. However, orthostatic hypotension remains largely underdiagnosed, and a 5-item self-report screening questionnaire has been developed to help physicians detect its symptoms and evaluate and follow-up its severity (Table 1) [44]. Orthostatic testing should take place in a quiet room, at a temperature between 20 and 24 °C.
- 1
This study was supported in part by grants 5K23 RR15537 (P.S.), NS32352, NS44233, and NS43364 (P.A.L.), and T32 HD07447 (L.M.B.-L.) from the National Institutes of Health and M01 RR00585 from the Mayo Clinic General Clinical Research Center.