A cross-sectional study on upright heart rate and BP changing characteristics: basic data for establishing diagnosis of postural orthostatic tachycardia syndrome and orthostatic hypertension

Abstract

ObjectiveWe aimed to determine upright heart rate and blood pressure (BP) changes to suggest diagnostic criteria for postural orthostatic tachycardia syndrome (POTS) and orthostatic hypertension (OHT) in Chinese children.MethodsIn this cross-sectional study, 1449 children and adolescents aged 6–18 years were randomly recruited from two cities in China, Kaifeng in Henan province and Anguo in Hebei province. They were divided into two groups: 844 children aged 6–12 years (group I) and 605 adolescents aged 13–18 years (group II). Heart rate and BP were recorded during an active standing test.Results95th percentile (P95) of δ heart rate from supine to upright was 38 bpm, with a maximum upright heart rate of 130 and 124 bpm in group I and group II, respectively. P95 of δ systolic blood pressure (SBP) increase was 18 mm Hg and P95 of upright SBP was 132 mm Hg in group I and 138 mm Hg in group II. P95 of δ diastolic blood pressure (DBP) increase was 24 mm Hg in group I and 21 mm Hg in group II, and P95 of upright DBP was 89 mm Hg in group I and 91 mm Hg in group II.ConclusionsPOTS is suggested when δ heart rate is ≥38 bpm (for easy memory, ≥40 bpm) from supine to upright, or maximum heart rate ≥130 bpm (children aged 6–12 years) and ≥125 bpm (adolescents aged 13–18 years), associated with orthostatic symptoms. OHT is suggested when δ SBP (increase) is ≥20 mm Hg, and/or δ DBP (increase) ≥25 mm Hg (in children aged 6–12 years) or ≥20 mm Hg (in adolescents aged 13–18 years) from supine to upright; or upright BP≥130/90 mm Hg (in children aged 6–12 years) or ≥140/90 mm Hg (in adolescents aged 13–18 years).

Etiologies and Management of Postural Tachycardia Syndrome in Children

“…Typically patients will certainly have more signs after a stressor or a physical activity, but the precise triggers that cause the beginning of POTS are unidentified. For as much as 75 percent of patients, POTS signs could improve, and even disappear, by age 21 to 25 years (4) . When experiencing apparent postural orthostatic tachycardia disorder, it is very important to assess and omit additional causes of orthostatism (17) .…”

“…Therefore, the orthostatic HR requirement for the medical diagnosis of adult POTS might not be appropriate for children and adolescents and need to be reviewed. Singer et al (4) recommended that it appertained to use the requirements that the orthostatic HR increment ≥ 40 beats/min or absolute orthostatic HR ≥ 130 beats/min (for ages 13 years and younger), or ≥ 120 beats/min (for ages 14 years and older) within 5 min of head-up tilt, along with the symptoms of orthostatic intolerance for pediatric POTS. In a cross-sectional study, consisting of 1449 children and adolescents aged 6-18 years, Zhao et al (5) suggested that POTS need to be suggested in kids and adolescents when the orthostatic HR increment ≥ 40 beats/min, or absolute orthostatic HR ≥ 130 beats/min (for ages 12 years and younger), or ≥ 125 beats/min (for ages 13 years and older) within 10 min relocating from supine to upright setting.…”

2018 Chinese Pediatric Cardiology Society (CPCS) guideline for diagnosis and treatment of syncope in children and adolescents

“…While, patients with unexplained syncope need head-up tilt test (HUTT) or follow-up [12][13][14][15]. The HUTT can help in the diagnosis of VVS and its hemodynamic types, vasoinhibitory type (VI), cardioinhibitory type (CI) and mixed type (M) [17,18], POTS [18][19][20][21][22], OH [21], or OHT [22] (IIa; A).…”

“…In the standing test, first, the child lays supine for around 10-30 min for heart rate (HR), BP and ECG recordings. Then, the child is advised to stand for another 10 min, with simultaneous monitoring of HR, BP and ECG [20,22] (IIa; A). [22], OH [23] or OHT [22,24].…”

Baroreflex Sensitivity Predicts Short-Term Outcome of Postural Tachycardia Syndrome in Children

“…Its symptoms had significant associations with postural change. Main hemodynamic characteristics of POTS was a significant increase in heart rate at upright position compared with supine position, and the increase amplitude of heart rate is ≥40 heart beats/min, or the maximum heart rate is ≥120 heart beats/min [1]. Main clinical features are orthostatic intolerance symptoms, such as dizziness, amaurosis, chest tightness, pale complexion, blurred vision, long out-gassing and palpitation, and some children patients might even have syncope, seriously affecting daily life and academic records of children patients [2–3].…”