Which is preferable for orthostatic hypotension diagnosis in older adults: active standing test or head-up tilt table test?

Abstract

Background: Correct evaluation of orthostatic hypotension (OH) is crucial in geriatric practice, since OH is associated with mortality and morbidity. The study aimed to determine the most appropriate method for measuring blood pressure in transition from supine to upright position in order to diagnose OH in older adults. Methods: Active standing test (AST) and head-up tilt table (HUT) test as well as comprehensive geriatric assessment (CGA), including mini-mental state examination or the cognitive state test, mini-nutritional assessment, basic and instrumental activities of daily living, and Tinetti performance-oriented mobility assessment indexes, were performed in 290 geriatric patients. Results: The prevalence of OH during HUT and AST was 19% and 37%, respectively. In patients with OH during HUT, the frequency of dementia and recurrent falls were higher (P,0.05); on the other hand, the levels of serum vitamin D and albumin and estimated glomerular filtration rate were lower (P,0.05). However, all these parameters for OH during AST were not significant (P.0.05). Comparison of the groups according to CGA measurements revealed significant differences in terms of cognition, nutritional status, activities of daily life, and balance function in patients with OH only during HUT (P,0.05), but not during AST (P.0.05). The sensitivity, specificity, positive predictive value, and negative predictive values of AST were 49.0%, 65.5%, 25.0%, and 84.6% respectively, according to HUT. Conclusion:The results suggest that orthostatic blood pressure changes determined by HUT might be of higher clinical significance than that by AST in older adults. It might be important that the evaluation of OH by HUT should be included in daily geriatric practice.

Orthostatic hypotension and physical functioning in older adults: A systematic review and meta-analysis

“…Studies finding an association of OH with ADL dependence did not include more patients with cognitive impairment than studies finding no association. The prevalence of dementia was 42.9% in one study reporting an association (Gaxatte et al, 2017) compared to 27.0-44.9% in three studies reporting no association (Aydin et al, 2017;Jodaitis et al, 2015;Siennicki-Lantz et al, 1999). The mean Mini Mental State Examination score was 17.6-25.8 points in four studies finding an Cs: cross-sectional; P: prospective; R: retrospective; OH: consensus definition of orthostatic hypotension; OH 30/15 : drop of 30 and 15 mmHg in systolic or mean blood pressure, respectively; OH+: OH with symptoms; iOH: initial OH (systolic blood pressure drop of at least 40 mmHg and/or a diastolic blood pressure drop of at least 20 mmHg within 15 s after standing); sOH: systolic blood pressure drop of at least 20 mmHg; NR: not reported; AS: active stand; SS: sit to stand; PS: passive sit; HUT: head up tilt; LBNP lower body negative pressure (i.e.…”

“…- Aydin et al, 2017 Balance; gait; ADL Tinetti balance score: 13.5 (OH-, SD 2.8), 13.2 (OH+, SD 3.2), p = 0.384. Tinetti gait score: 10.2 (OH-, SD 1.7), 10.1 (OH+, SD 1.8), p = 0.570.…”

Changes in blood pressure, blood flow towards the head and heart rate during 90 deg head‐up tilting for 30 min in anaesthetized male rats

“…; Aydin et al . ), and HUT has been used to assess orthostatic tolerance in astronauts when they return to Earth from space (Buckey & Homick, ; Levin et al . ).…”

“…When rabbits aged 3 or 4 weeks grew up under 20 deg HDT for ß5 weeks, the number of afferent unmyelinated fibres in the left aortic nerves decreased and the baroreceptor reflex gain was also reduced as HR/ BP, the whole nerve activities of afferents in response to BP changes were smaller . The head-up tilting (HUT) test is one of the health checks for orthostatic tolerance in humans (Hughson et al 1994;Akimoto et al 2011;Aydin et al 2017), and HUT has been used to assess orthostatic tolerance in astronauts when they return to Earth from space (Buckey & Homick, 2003;Levin et al 2003). We previously reported that BP decreased and HR increased during 3 min of HUT in unconscious and conscious rats, and that changes in HR based on the baroreceptor reflex in anaesthetized rats were not observed after sinoaortic denervation (SAD; Waki et al 2009).…”

The Schellong test: detecting orthostatic blood pressure and heart rate changes in German-speaking countries

“…Schellong considered the responses in part (1) to depend on neurogenic regulation of peripheral blood vessels, part (2) on both neurogenic control of blood vessels and cardiocirculatory regulation, and part (3) on cardiac regulation only.…”