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Cited by 137Cardiovascular Syncope and Autonomic DisordersHeart Rate Variability and Autonomic ControlBalance, Gait, and Falls Prevention

Orthostatic hypotension: framework of the syndrome

Open access
Naschitz, Jochanan E, Rosner, Itzhak·2007·Postgraduate Medical Journal
DOI 10.1136/pgmj.2007.058198PMC PMC2600002
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Abstract

According to the 1996 consensus definition, orthostatic hypotension (OH) is diagnosed when a fall in systolic blood pressure of at least 20 mm Hg and/or diastolic blood pressure of at least 10 mm Hg within 3 min of standing is recorded. The elements of orthostatic blood pressure drop that are relevant to the definition of OH include magnitude of the drop, time to reach the blood pressure difference defined as OH, and reproducibility of the orthostatic blood pressure drop. In each of these elements, there exist issues that argue for modification of the presently accepted criteria of OH. Additional questions need to be addressed. Should one standard orthostatic test be applied to different patient populations or should tests be tailored to the patients' clinical circumstances? Are different OH thresholds relevant to various clinical settings, aetiologies of OH and comorbidity? Which test has the best predictive power of morbidity and mortality?

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Registry

Crossref · 10.1136/pgmj.2007.058198

Cites

102 of 102 references verified0 citation errors · 0 not checkable

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Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Changing from the supine to the upright position produces a displacement of blood from the thorax to the lower limbs and abdominal cavity that leads to a decrease in venous return and cardiac output.

    “Changing from the supine to the upright position produces a displacement of blood from the thorax to the lower limbs and abdominal cavity that leads to a decrease in venous return and cardiac output.”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [20]

    The opening section (labelled “O”; page unavailable) says that standing pools blood in the legs, reducing venous return and cardiac output. It does not describe displacement from the thorax or pooling in the abdominal cavity, so those anatomical details are not supported by our copy. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • When more frequent readings are required, as for initial orthostatic hypotension, continuous beat-to-beat non-invasive blood pressure measurement is needed.

    “When more frequent readings are required, as for initial OH, continuous beat-tobeat non-invasive BP measurement is needed. 20,103,104”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [20]

    The Blood pressure measurement techniques section describes non-invasive beat-to-beat monitoring with Finapres and says beat-to-beat tracking is generally favoured. It also notes a limitation of frequent cuff measurements. It does not say continuous monitoring is required specifically for initial orthostatic hypotension, so “needed” is stronger than the source supports. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Syncope due to OH is confirmed when syncope occurs while standing and there is concomitant significant OH.

    “Syncope due to OHis confirmed when syncope occurs while standing and there is concomitant significant OH. 18-24”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [20]

  • In the absence of compensatory mechanisms, a fall in blood pressure may lead to syncope.

    “In the absence of compensatory mechanisms, a fall in BP may lead to syncope. 20,103,104”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [20]

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Cites

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Research works printed but not linked: 6

  1. Rutan GH, Hermanson B, Bild DE, et al. Orthostatic hypotension in older adults: the cardiovascular health study. Hypertension 1992;19:508-19.
  2. Weinberg AD, Minaker KL. Dehydration: evaluation and management in older adults. JAMA 1995;274:1552-6.
  3. Mader S, Hornick T, Winger J. Effect of initial recumbent or sitting positions on postural blood pressure measurements [abstract]. Gerontologist 1987;27:206A.
  4. Gorelik O, Fishlev G, Litvinov V, et al. First morning standing up may be risky in acutely ill older inpatients. Blood Press 2005;14:139-43.
  5. Weiss A, Grossman E, Beloosesky Y, et al. Orthostatic hypotension: is it a consistent finding? Arch Intern Med 2002;162:2369-74.
  6. Robertson D. Orthostatic tachycardia and orthostatic intolerance. Am J Med Sci 1999;317:75-7.

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Authors
Naschitz, J. E., & Rosner, I.
Affiliations
Technion – Israel Institute of Technology (IL)
Corresponding author
Naschitz, Jochanan E
ORCID
Venue
Postgraduate Medical Journal
Publisher
Oxford University Press (OUP)
Published
2007-09-01
Volume
83
Issue
983
Pages
568-574
ISSN
  • 0032-5473 (ISSN-L)
  • 1469-0756
DOI
10.1136/pgmj.2007.058198
PMC
PMC2600002
OpenAlex
W2144504629
Cited by
137
References
102
Citations by year
2026: 4 · 2025: 6 · 2024: 5 · 2023: 5 · 2022: 4 · 2021: 8 · 2020: 10 · 2019: 11 · 2018: 15 · 2017: 11 · 2016: 5 · 2015: 11 · 2014: 12 · 2013: 11 · 2012: 5
FWCI
0.76
Type
journal article
Language
en
Open access
Licence
academic.oup.com/pages/standard-publication-reuse-rights (vor)
Locations
  • Postgraduate Medical Journal (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
Keywords
orthostatic hypotension, diagnostic criteria, reproducibility, predictive value, morbidity and mortality
MeSH terms
Blood Pressure, Blood Pressure Determination, Heart Rate, Humans, Hypotension, Orthostatic, Stress, Physiological, Syndrome, Reproducibility of Results

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