Hypotension Unawareness in Profound Orthostatic Hypotension
Hypotension Unawareness in Profound Orthostatic Hypotension
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DOI：
10.1016/j.amjmed.2008.10.040
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发表时间：
2009-06-01
影响因子：
5.9
通讯作者：
Chelimsky, Thomas C.
中科院分区：
文献类型：
--
作者：
Arbogast, Steven D.;Alshekhlee, Amer;Chelimsky, Thomas C.
背景技术背景：临床医生依赖于患者的病史时，考虑诊断体位性hypothesis.METHODS：患者的收缩压下降超过60毫米汞柱从基线期间的头向上倾斜试验被列入。根据倾斜试验中出现的症状对患者进行分类。定位的原因，体位性低血压，寻求在每一个group.Results：88（43%）患者有典型症状，49（24%）有不典型症状，68（33%）无症状。典型组、非典型组和无症状组的收缩压平均下降分别为88 mm Hg、87.5 mm Hg和89.8 mm Hg（P = 0.81）。患者报告重度头晕，频率与下肢不适相似。背痛和头痛也是常见的非典型主诉。在直立倾斜试验中，外周性自主神经功能障碍患者能够维持最长的直立位（21分钟，而中枢性自主神经功能障碍患者[15分钟]）（P = .005）。在直立倾斜试验中，自主神经功能障碍的原因和症状的发生之间没有相关性（P = 0.58）。结论：三分之一的严重直立性低血压患者在直立倾斜试验中完全无症状，另外四分之一的患者有非典型的主诉，不会导致医生诊断为直立性低血压。这些结果表明，他们可能没有提供足够的信息，诊断严重直立性低血压患者的一个子集，这种疾病。(C)2009 Elsevier Inc. All rights reserved.美国医学杂志（2009）122，574-580
BACKGROUND: Clinicians depend on history given by the patients when considering the diagnosis of orthostatic hypotension.METHODS: Patients with a decrease in systolic blood pressure more than 60 mm Hg from baseline during a head-up tilt table test were included. They were classified according to their symptoms during the head-up tilt table test. Localization of the cause of orthostatic hypotension was sought in each of these groups.RESULTS: Eighty-eight (43%) patients had typical symptoms, 49 (24%) had atypical symptoms, and 68 (33%) were asymptomatic. The average decrease in systolic blood pressure was 88 mm Hg, 87.5 mm Hg, and 89.8 mm Hg in the typical, atypical, and asymptomatic groups, respectively (P = .81). Patients reported severe dizziness with a similar frequency as lower extremity discomfort. Backache and headache also were common atypical complaints. Patients with peripheral cause of dysautonomia were able to sustain the longest upright position during the head-up tilt table test (21 minutes, compared with central dysautonomia [15 minutes]) (P = .005). There was no correlation between the cause of dysautonomia and the occurrence of symptoms during the head-up tilt table test (P = .58).CONCLUSION: A third of the patients with severe orthostatic hypotension are completely asymptomatic during the head-up tilt table test, and another quarter have atypical complaints that would not lead physicians toward the diagnosis of orthostatic hypotension. These findings suggest that they might not provide adequate information in diagnosing profound orthostatic hypotension in a subset of patients with this disorder. (C) 2009 Elsevier Inc. All rights reserved. The American Journal of Medicine (2009) 122, 574-580