Blood pressure reduction cut-points for orthostatic hypotension in stroke survivors using a sit-up test: a multicentre cross-sectional study.
Blood pressure reduction cut-points for orthostatic hypotension in stroke survivors using a sit-up test: a multicentre cross-sectional study.
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DOI：
10.1097/hjh.0000000000003305
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发表时间：
2023-01-01
影响因子：
4.9
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中科院分区：
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仰卧起坐测试用于评估中风幸存者的直立性低血压，这些幸存者如果不使用倾斜台就不能独立站立。然而，还没有研究确定使用该测试的直立性低血压的最佳切入点。因此，这项研究旨在检查仰卧起坐试验中SBP和DBP的下降，以检测中风患者的直立性低血压。从三家康复医院招募的38名中风患者接受了仰卧起坐和直立倾斜测试。收缩期和舒张期直立性低血压被定义为在直立倾斜试验中，收缩压和舒张压分别下降至少20和10 毫米汞柱。利用具有Youden指数的接收算子特征曲线来确定最佳切割点。8名和3名参与者分别表现为收缩和舒张期直立性低血压。仰卧起坐试验预测直立性低血压的最佳临界点为：收缩压降低10 [敏感性=87.5%(95%可信区间：47.4~99.7)，特异性=96.7%(82.8~99.9)]，舒张压降低5 mmHg[敏感性=100.0%(2 9.2~100.0)，特异性=88.6%(73.3~96.8)]。与常规的切点相比，通过仰卧起坐试验，较小的SBP和DBP降低切点可能更好地识别卒中患者的直立性低血压。本研究结果可为仰卧起坐试验的临床应用提供有价值的信息。
The sit-up test is used to assess orthostatic hypotension in stroke survivors who cannot stand independently without using a tilt table. However, no study has identified the optimal cut-points for orthostatic hypotension using the test. Therefore, this study aimed to examine the decrease in SBP and DBP during the sit-up test to detect orthostatic hypotension in individuals with stroke. Thirty-eight individuals with stroke, recruited from three convalescent rehabilitation hospitals, underwent the sit-up and head-up tilt tests. Systolic and diastolic orthostatic hypotension was defined as a decrease of at least 20 and 10 mmHg in the SBP and DBP, respectively, during the head-up tilt test. The receiver operator characteristic curve with the Youden Index was used to identify the optimal cut-points. Eight and three participants showed systolic and diastolic orthostatic hypotension, respectively. The optimal cut-points for orthostatic hypotension using the sit-up test were a decrease of 10 mmHg in SBP [sensitivity = 87.5% (95% confidence interval: 47.4–99.7), specificity = 96.7% (82.8–99.9)] and 5 mmHg in DBP [sensitivity = 100.0% (29.2–100.0), specificity = 88.6% (73.3–96.8)]. Compared with the conventional cut-points, smaller cut-points of a decrease in SBP and DBP may be better to identify orthostatic hypotension in individuals with stroke using the sit-up test. The findings of this study may provide valuable information for the clinical application of the sit-up test.