Sitting and standing blood pressure measurements are not accurate for the diagnosis of orthostatic hypotension.
AffiliationClinical Age Assessment Unit, Mid-Western Regional Hospital, Dooradoyle,, Limerick, Ireland. email@example.com
Aged, 80 and over
Blood Pressure Determination/methods
Predictive Value of Tests
Sensitivity and Specificity
MetadataShow full item record
CitationQJM. 2009 May;102(5):335-9. Epub 2009 Mar 9.
JournalQJM : monthly journal of the Association of Physicians
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.
- The comparative usefulness of orthostatic testing and tilt table testing in the evaluation of autonomic-associated dizziness.
- Authors: Faraji F, Kinsella LJ, Rutledge JC, Mikulec AA
- Issue date: 2011 Jun
- Development and evaluation of new blood pressure and heart rate signal analysis techniques to assess orthostatic hypotension and its subtypes.
- Authors: Deegan BM, O'Connor M, Lyons D, OLaighin G
- Issue date: 2007 Nov
- Is there diurnal variation in initial and delayed orthostatic hypotension during standing and head-up tilt?
- Authors: Lewis NC, Atkinson G, Lucas SJ, Grant EJ, Jones H, Tzeng YC, Horsman H, Ainslie PN
- Issue date: 2011 Mar
- The degree and timing of orthostatic blood pressure changes in relation to falls in nursing home residents.
- Authors: Maurer MS, Cohen S, Cheng H
- Issue date: 2004 Jul-Aug
- Optimal diagnostic thresholds for diagnosis of orthostatic hypotension with a 'sit-to-stand test'.
- Authors: Shaw BH, Garland EM, Black BK, Paranjape SY, Shibao CA, Okamoto LE, Gamboa A, Diedrich A, Plummer WD, Dupont WD, Biaggioni I, Robertson D, Raj SR
- Issue date: 2017 May