P-505: Cardiovascular autonomic function in 422 patients with orthostatic symptoms

• Published in: American journal of hypertension Vol. 16; no. S1; p. 221A
• Main Authors: Maule, Simona, Catalfamo, Edoardo, Colle, Sara Del, Leotta, Giannina, Caserta, Mimma, Tredici, Mirko, Rabbia, Franco, Veglio, Franco
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.05.2003
• Subjects: autonomic function; orthostatic hypotension; supine hypertension
• ISSN: 0895-7061; 1879-1905; 1941-7225
• DOI: 10.1016/S0895-7061(03)00678-2

The objective of the study was to evaluate retrospectively the prevalence of orthostatic hypotension (OH) and supine hypertension of patients referred to our Autonomic Laboratory with suspected autonomic dysfunction (AD). Standard cardiovascular tests (deep breathing, lying to standing, Valsalva manoeuvre, postural blood pressure) were performed to quantify autonomic function. According to their clinical presentation, 422 patients (221 males, median age 60 years, range 21-79 years) were classified into 4 groups: without neurological features (n=122), with parkinsonian features (n=145), with peripheral neuropathy (n=100) and with other neurological features (n=55). AD was mild in 9% and moderate to severe in 20% of the population. OH was isolated in 14% and associated with AD in 16% of the patients. Supine hypertension was present in 45% of the patients. Cardiovascular function was normal in 57% of the population. Prevalence of OH (isolated and with AD) was higher in patients with supine hypertension (43%) than with normal blood pressure (19%) (p=0.001). Prevalence of isolated OH and AD increased with age (OH: 0% before 40 years, 14% over 40 years; p=0.01; AD: 7% before 40 years, 21% over 40 years; p=0.02). Patients with peripheral neuropathy and parkinsonian features showed the highest prevalence of AD, 36% e 27% respectively. In conclusion, supine hypertension was very frequent in our patients; its presence may impair baroreceptor function and worsen orthostatic tolerance. OH, both isolated and with AD, was also a common feature. Autonomic assessment and identification of OH and supine hypertension, especially in the elderly, is necessary for determining the prognosis and for appropriate therapeutic intervention.