Optimal diagnostic thresholds for diagnosis of orthostatic hypotension with a 'sit-to-stand test'.
J Hypertens
; 35(5): 1019-1025, 2017 05.
Article
in En
| MEDLINE
| ID: mdl-28129252
ABSTRACT
OBJECTIVE:
This study aimed to identify optimal blood pressure cut-offs to diagnose orthostatic hypotension during a sit-to-stand manoeuvre.METHODS:
This was a cross-sectional study of patients and healthy controls from the Vanderbilt Autonomic Dysfunction Center. Blood pressure was measured while supine, seated and standing. Blood pressure changes were calculated from supine-to-standing and seated-to-standing. Orthostatic hypotension was diagnosed on the basis of a supine-to-standing SBP drop at least 20âmmHg or a DBP drop at least 10âmmHg. Receiver operator characteristic (ROC) curves identified optimal sit-to-stand cut-offs.RESULTS:
Amongst the 831 individuals, more had systolic orthostatic hypotension [nâ=â354 (43%)] than diastolic orthostatic hypotension [nâ=â305 (37%)] during lying-to-standing. The ROC curves had good characteristics [SBP area under curveâ=â0.916 (95% confidence interval 0.896-0.936), Pâ<â0.001; DBP area under curveâ=â0.930 (95% confidence interval 0.909-0.950), Pâ<â0.001]. A sit-to stand SBP drop at least 15âmmHg had optimal test characteristics (sensitivityâ=â80.2%; specificityâ=â88.9%; positive predictive valueâ=â84.2%; negative predictive valueâ=â85.8%), as did a DBP drop at least 7âmmHg (sensitivityâ=â87.2%; specificityâ=â87.2%; positive predictive valueâ=â80.1%; negative predictive valueâ=â92.0%).CONCLUSIONS:
A sit-to-stand manoeuvre with lower diagnostic cut-offs for orthostatic hypotension provides a simple screening test for orthostatic hypotension in situations wherein a supine-to-standing manoeuvre cannot be easily performed. Our analysis suggests that a SBP drop at least 15âmmHg or a DBP drop at least 7âmmHg best optimizes sensitivity and specificity of this sit-to-stand test.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Posture
/
Blood Pressure
/
Hypotension, Orthostatic
Type of study:
Diagnostic_studies
/
Observational_studies
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adolescent
/
Adult
/
Aged
/
Aged80
/
Child
/
Child, preschool
/
Female
/
Humans
/
Infant
/
Male
Language:
En
Journal:
J Hypertens
Year:
2017
Document type:
Article
Affiliation country:
Estados Unidos