Sitting and standing blood pressure measurements are not accurate for the diagnosis of orthostatic hypotension.

Hdl Handle:
http://hdl.handle.net/10147/206294
Title:
Sitting and standing blood pressure measurements are not accurate for the diagnosis of orthostatic hypotension.
Authors:
Cooke, J; Carew, S; O'Connor, M; Costelloe, A; Sheehy, T; Lyons, D
Affiliation:
Clinical Age Assessment Unit, Mid-Western Regional Hospital, Dooradoyle,, Limerick, Ireland. john.cooke@hse.ie
Citation:
QJM. 2009 May;102(5):335-9. Epub 2009 Mar 9.
Journal:
QJM : monthly journal of the Association of Physicians
Issue Date:
31-Jan-2012
URI:
http://hdl.handle.net/10147/206294
DOI:
10.1093/qjmed/hcp020
PubMed ID:
19273552
Abstract:
INTRODUCTION: Orthostatic hypotension (OH) is associated with troublesome symptoms and increased mortality. It is treatable and deserving of accurate diagnosis. This can be time consuming. The current reference standard for its diagnosis is head-up tilt (HUT) testing with continuous beat-to-beat plethysmography. Our objective was to assess the accuracy of sit-stand testing with semi-automatic sphygmomanometry for the diagnosis of OH. DESIGN: Retrospective test of diagnostic accuracy. METHODS: This was a retrospective study performed using a database maintained by a busy syncope unit. HUT testing was performed using an automated tilt table with Finometer monitoring. A 3 min 70 degrees HUT was performed following 5 min supine. Sitting blood pressure (BP) was measured following 3 min rest. Standing BP was measured within 30 s of assuming the upright posture. The results of sit-stand testing were compared with HUT testing as a reference standard. Both tests happened within 5 min of each other and patients underwent no intervention between tests. RESULTS: From a total of 1452 consecutive HUTs, we identified 730 with pre-test measures of sitting and standing BP. The mean age of this group was 70.57 years (SD = 15.1), 62% were female. The sensitivity of sit-stand testing was calculated as 15.5%, specificity as 89.9%, positive predictive value as 61.7%, negative predictive value as 50.2% and the likelihood ratio as 1.6. The area under the Receiver Operator Curve was 0.564. CONCLUSION: We have demonstrated that sit-stand testing for OH has very low diagnostic accuracy. We recommend that the more time-consuming reference standard method of diagnosis be used if the condition is suspected.
Language:
eng
MeSH:
Aged; Aged, 80 and over; Blood Pressure/*physiology; Blood Pressure Determination/methods; Female; Humans; Hypotension, Orthostatic/*diagnosis/physiopathology; Male; Middle Aged; *Posture; Predictive Value of Tests; Sensitivity and Specificity
ISSN:
1460-2393 (Electronic); 1460-2393 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorCooke, Jen_GB
dc.contributor.authorCarew, Sen_GB
dc.contributor.authorO'Connor, Men_GB
dc.contributor.authorCostelloe, Aen_GB
dc.contributor.authorSheehy, Ten_GB
dc.contributor.authorLyons, Den_GB
dc.date.accessioned2012-01-31T16:46:22Z-
dc.date.available2012-01-31T16:46:22Z-
dc.date.issued2012-01-31T16:46:22Z-
dc.identifier.citationQJM. 2009 May;102(5):335-9. Epub 2009 Mar 9.en_GB
dc.identifier.issn1460-2393 (Electronic)en_GB
dc.identifier.issn1460-2393 (Linking)en_GB
dc.identifier.pmid19273552en_GB
dc.identifier.doi10.1093/qjmed/hcp020en_GB
dc.identifier.urihttp://hdl.handle.net/10147/206294-
dc.description.abstractINTRODUCTION: Orthostatic hypotension (OH) is associated with troublesome symptoms and increased mortality. It is treatable and deserving of accurate diagnosis. This can be time consuming. The current reference standard for its diagnosis is head-up tilt (HUT) testing with continuous beat-to-beat plethysmography. Our objective was to assess the accuracy of sit-stand testing with semi-automatic sphygmomanometry for the diagnosis of OH. DESIGN: Retrospective test of diagnostic accuracy. METHODS: This was a retrospective study performed using a database maintained by a busy syncope unit. HUT testing was performed using an automated tilt table with Finometer monitoring. A 3 min 70 degrees HUT was performed following 5 min supine. Sitting blood pressure (BP) was measured following 3 min rest. Standing BP was measured within 30 s of assuming the upright posture. The results of sit-stand testing were compared with HUT testing as a reference standard. Both tests happened within 5 min of each other and patients underwent no intervention between tests. RESULTS: From a total of 1452 consecutive HUTs, we identified 730 with pre-test measures of sitting and standing BP. The mean age of this group was 70.57 years (SD = 15.1), 62% were female. The sensitivity of sit-stand testing was calculated as 15.5%, specificity as 89.9%, positive predictive value as 61.7%, negative predictive value as 50.2% and the likelihood ratio as 1.6. The area under the Receiver Operator Curve was 0.564. CONCLUSION: We have demonstrated that sit-stand testing for OH has very low diagnostic accuracy. We recommend that the more time-consuming reference standard method of diagnosis be used if the condition is suspected.en_GB
dc.language.isoengen_GB
dc.subject.meshAgeden_GB
dc.subject.meshAged, 80 and overen_GB
dc.subject.meshBlood Pressure/*physiologyen_GB
dc.subject.meshBlood Pressure Determination/methodsen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshHypotension, Orthostatic/*diagnosis/physiopathologyen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.mesh*Postureen_GB
dc.subject.meshPredictive Value of Testsen_GB
dc.subject.meshSensitivity and Specificityen_GB
dc.titleSitting and standing blood pressure measurements are not accurate for the diagnosis of orthostatic hypotension.en_GB
dc.contributor.departmentClinical Age Assessment Unit, Mid-Western Regional Hospital, Dooradoyle,, Limerick, Ireland. john.cooke@hse.ieen_GB
dc.identifier.journalQJM : monthly journal of the Association of Physiciansen_GB
dc.description.provinceMunster-

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