Abstract
Background: We investigated whether changes in the pulse pressure (PP) reduction ratio during the head-up tilt test (HUTT) can aid in distinguishing neurogenic orthostatic hypotension (OH) from non-neurogenic OH. Methods: We enrolled consecutive patients with NOH and non-neurogenic OH between January 2015 and October 2018. We compared the Valsalva ratio, the presence or absence of late phase II and IV overshoot, the pressure recovery time, and the PP reduction ratio during HUTT between the two OH groups. Results: The expiratory–inspiratory (E:I) ratio and Valsalva ratio were significantly decreased in the NOH group (p = 0.026, p < 0.001, respectively). The absence of late phase II and phase IV overshoot was more frequent in the NOH group than in the non-neurogenic OH group (p = 0.001, p < 0.001, respectively). The pressure recovery time was significantly prolonged in the NOH group (p < 0.001), which exhibited increases in the PP reduction ratio (1—minimal PP/baseline PP) during the HUTT (p < 0.001). We calculated the cutoff point for the PP reduction ratio during HUTT, which exhibited an area under the receiver operating characteristic curve of 0.766 (0.659–0.840, 95% confidence interval). The cutoff value for the PP reduction ratio during HUTT (0.571) exhibited sensitivity of 0.879 and specificity of 0.516. Conclusions: Increases in the PP reduction ratio during HUTT may be a meaningful NOH laboratory marker.
Highlights
Orthostatic hypotension (OH) can be classified into neurogenic orthostatic hypotension (OH) (NOH) and nonneurogenic OH, according to its cause [1]
We evaluated data for a total of 122 patients who fulfilled the inclusion criteria for OH, including 64 patients in the NOH group and 58 patients in the non-neurogenic OH group
17% of NOH cases occur in patients over 65 years of age, while non-neurogenic OH can occur at any age [16]
Summary
Orthostatic hypotension (OH) can be classified into neurogenic OH (NOH) and nonneurogenic OH, according to its cause [1]. In the head-up tilt test (HUTT), NOH and non-neurogenic OH can be distinguished based on the presence or absence of compensatory increases in heart rate (HR) [1]. An absence of late phase II and phase IV overshoot accompanied by increases in pressure recovery time during the Valsalva maneuver generally suggests NOH [2,3]. We investigated whether changes in the pulse pressure (PP) reduction ratio during the head-up tilt test (HUTT) can aid in distinguishing neurogenic orthostatic hypotension (OH) from non-neurogenic OH. The pressure recovery time was significantly prolonged in the NOH group (p < 0.001), which exhibited increases in the PP reduction ratio (1—minimal PP/baseline PP) during the HUTT (p < 0.001). Conclusions: Increases in the PP reduction ratio during HUTT may be a meaningful NOH laboratory marker
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