Patients with orthostatic intolerance: relationship to autonomic function tests results and reproducibility of symptoms on tilt
Open accessAbstract
This study was designed to investigate the frequency and pattern of orthostatic symptoms during head-up tilt (HUT) in patients with orthostatic intolerance during daily life, and to identify the relationship between the orthostatic symptoms during HUT and autonomic parameters. We prospectively collected autonomic data from 464 patients with orthostatic symptoms. Adrenergic and cardiovagal function tests including HUT were performed. Based on HUT results, we divided patients into orthostatic hypotension (OH), postural tachycardia syndrome (POTS), or normal HUT groups. We also investigated orthostatic symptoms during HUT. Only 25% of the patients reported orthostatic symptoms during HUT and 75% were asymptomatic. Typical orthostatic symptoms such as orthostatic dizziness and blurred vision, and atypical symptoms like chest tightness and headache occurred in 86% and 66%, respectively. Patients with POTS had symptoms more frequently than patients with OH during HUT. There were no differences in degrees of BP or HR changes between symptomatic and asymptomatic groups within the OH and POTS groups. HUT fails to reproduce symptoms of orthostatic intolerance in the majority of patients. Clinicians need to be aware that most patients with OH are asymptomatic during HUT and patients with POTS are more likely to be symptomatic than patients with OH.
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Autonomic symptom reports are a poor indicator of actual autonomic abnormalities.
“Lee et al. concluded that autonomic symptom reports are a poor indicator of actual autonomic abnormalities (Lee et al., 2017”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Lee et al., 2017
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Freeman, R., Wieling, W., Axelrod, F. B., Benditt, D. G., Benarroch, E., Biaggioni, I., Cheshire, W. P., Chelimsky, T., Cortelli, P., Gibbons, C. H., et al. (2011) · Autonomic Neuroscience · doi:10.1016/j.autneu.2011.02.004 · Cited by 1,243 · see citing works
Self-citationPostural tachycardia syndrome (POTS)
LOW, P. A., SANDRONI, P., JOYNER, M., & SHEN, W. (2009) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2008.01407.x · Cited by 358 · see citing works
Self-citationA prospective, 1-year follow-up study of postural tachycardia syndrome
Kimpinski, K., Figueroa, J. J., Singer, W., Sletten, D. M., Iodice, V., Sandroni, P., Fischer, P. R., Opfer-Gehrking, T. L., Gehrking, J. A., & Low, P. A. (2012) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2012.02.020 · Cited by 81 · see citing works
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Research works printed but not linked: 24
- [1]Low P. A. & Benarroch E. E. Clinical autonomic disorders (Lippincott Williams & Wilkins, 2008).
- [2]Low PA Prospective evaluation of clinical characteristics of orthostatic hypotension Mayo Clin. Proc. 1995 70 617 622 10.4065/70.7.617 7791382 · DOI
- [3]Ward C Kenny RA Reproducibility of orthostatic hypotension in symptomatic elderly Am. J. Med. 1996 100 418 422 10.1016/S0002-9343(97)89517-4 8610728 · DOI
- [4]Arbogast SD Alshekhlee A Hussain Z McNeeley K Chelimsky TC Hypotension unawareness in profound orthostatic hypotension Am. J. Med. 2009 122 574 580 10.1016/j.amjmed.2008.10.040 19486719 · DOI
- [5]Kim HA Lee H Park KJ Lim JG Autonomic dysfunction in patients with orthostatic dizziness: validation of orthostatic grading scale and comparison of Valsalva maneuver and head-up tilt testing results J. Neurol. Sci. 2013 325 61 66 10.1016/j.jns.2012.11.019 23294495 · DOI
- [7]Low PA Composite autonomic scoring scale for laboratory quantification of generalized autonomic failure Mayo Clin. Proc. 1993 68 748 752 10.1016/S0025-6196(12)60631-4 8392653 · DOI
- [8]Novak P Quantitative autonomic testing J. Vis. Exp. 2011 53 2502 PMC3196175 21788940
- [9]Denq JC O’Brien PC Low PA Normative data on phases of the Valsalva maneuver J. Clin. Neurophysiol. 1998 15 535 540 10.1097/00004691-199811000-00013 9881927 · DOI
- [10]Novak P Assessment of sympathetic index from the Valsalva maneuver Neurology. 2011 76 2010 2016 10.1212/WNL.0b013e31821e5563 21646629 PMC3269073 · DOI · Paper page
- [11]Huang CC Sandroni P Sletten D Weigand S Low PA Effect of age on adrenergic and vagal baroreflex sensitivity in normal subjects Muscle Nerve. 2007 36 637 642 10.1002/mus.20853 17654557 · DOI
- [12]Kirbis M Meglic B Bajrovic FF Comparison of active standing test, head-up tilt test and 24-h ambulatory heart rate and blood pressure monitoring in diagnosing postural tachycardia Funct Neurol. 2013 28 39 23731914 PMC3812719
- [13]Novak V Novak P Spies JM Low PA Autoregulation of cerebral blood flow in orthostatic hypotension Stroke. 1998 29 104 111 10.1161/01.STR.29.1.104 9445337 · DOI
- [14]Benarroch EE Postural tachycardia syndrome: a heterogeneous and multifactorial disorder Mayo Clin. Proc. 2012 87 1214 1225 10.1016/j.mayocp.2012.08.013 23122672 PMC3547546 · DOI · Paper page
- [15]Benrud-Larson LM Sandroni P Haythornthwaite JA Rummans TA Low PA Correlates of functional disability in patients with postural tachycardia syndrome: Preliminary cross-sectional findings Health Psychol. 2003 22 643 648 10.1037/0278-6133.22.6.643 14640863 · DOI · Paper page
- [17]Ives CT Kimpinski K Higher postural heart rate increments on head-up tilt correlate with younger age but not orthostatic symptoms J. Appl. Physiol. 2013 115 525 528 10.1152/japplphysiol.00292.2013 23766503 · DOI
- [19]Lee H Kim HA Orthostatic hypertension: an underestimated cause of orthostatic intolerance Clin Neurophysiol. 2016 127 2102 2107 10.1016/j.clinph.2015.12.017 26806722 · DOI
- [20]Figueroa JJ Basford JR Low PA Preventing and treating orthostatic hypotension: as easy as A, B, C Clev Clin J Med. 2010 77 298 10.3949/ccjm.77a.09118 PMC2888469 20439562 · DOI
- [21]Stewart JM Autonomic nervous system dysfunction in adolescents with postural orthostatic tachycardia syndrome and chronic fatigue syndrome is characterized by attenuated vagal baroreflex and potentiated sympathetic vasomotion Pediatr Res. 2000 48 218 226 10.1203/00006450-200008000-00016 10926298 · DOI · Paper page
- [22]Khurana R Nicholas E Head-up tilt table test: how far and how long? Clin Auton Res 1996 6 335 341 10.1007/BF02556304 8985622 · DOI
- [23]McJunkin B Detecting initial orthostatic hypotension: a novel approach J Am Soc Hypertens. 2015 9 365 369 10.1016/j.jash.2015.02.006 25816712 PMC4470290 · DOI
- [24]Gurevich T Head-up tilt testing for detecting orthostatic hypotension: how long do we need to wait? Neuroepidemiology. 2014 43 239 243 10.1159/000368699 25531748 · DOI
- [25]Mayuga KA Butters KB Fouad-Tarazi F Early versus late postural tachycardia: a re-evaluation of a syndrome Clin Auton Res 2008 18 155 157 10.1007/s10286-008-0472-1 18470476 · DOI
- [26]Low PA Effect of age and gender on sudomotor and cardiovagal function and blood pressure response to tilt in normal subjects Muscle nerve. 1997 20 1561 1568 10.1002/(SICI)1097-4598(199712)20:12<1561::AID-MUS11>3.0.CO;2-3 9390669 · DOI
- [27]Low PA Neurogenic orthostatic hypotension: pathophysiology and diagnosis Am. J. Manag. Care. 2015 21 s248 257 26790109
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Knoop, I., Picariello, F., Jenkinson, E., Gall, N., Chisari, C., & Moss-Morris, R. (2023) · Autonomic Neuroscience · doi:10.1016/j.autneu.2022.103052 · Cited by 21 · see citing works
“Mean ± SD 13 ± 4 136 POTS - with symptoms during HUTT Without symptoms during HUTT Lee et al., 2017.”
InfluentialPeebles, K. C., Tan, I., Butlin, M., Collins, F., Tofts, L., Avolio, A. P., & Pacey, V. (2022) · American Journal of Medical Genetics Part A · doi:10.1002/ajmg.a.62705 · Cited by 14 · see citing works
- Authors
- Lee, H., Low, P. A., & Kim, H. A.
- Affiliations
- Keimyung University (KR)
- Mayo Clinic (US)
- Corresponding author
- Kim, Hyun Ah
- Venue
- Scientific Reports
- Published
- 2017-07-18
- Volume
- 7
- Issue
- 1
- Pages
- 5706-5706
- ISSN
- 2045-2322 (ISSN-L)
- PMC
- PMC5515942
- OpenAlex
- W2734671251
- Cited by
- 34
- References
- 3
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 7 · 2023: 6 · 2022: 4 · 2021: 2 · 2020: 3 · 2019: 2 · 2018: 3 · 2017: 1
- FWCI
- 2.52
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Scientific Reports (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Research Foundation (2014R1A5A2010008)
- Keimyung University
- Ministry of Science, ICT and Future Planning (No. 2014R1A5A2010008, 2014R1A5A2010008)
- National Research Foundation of Korea (2014R1A5A2010008, No. 2014R1A5A2010008)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Keywords
- orthostatic intolerance, orthostatic hypotension, postural orthostatic tachycardia syndrome, head-up tilt, autonomic function testing, orthostatic dizziness, chest tightness, headache, adrenergic function, blood pressure changes, heart rate changes
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Autonomic Nervous System, Blood Pressure, Child, Female, Heart Rate, Humans, Hypotension, Orthostatic, Male, Middle Aged, Prospective Studies, Valsalva Maneuver, Reproducibility of Results, Tilt-Table Test, Orthostatic Intolerance, Postural Orthostatic Tachycardia Syndrome
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