Influence of comorbidities and medication use on tilt table test outcome in elderly patients

The tilt table test (TTT) is a useful diagnostic tool in people with unexplained syncope, dizziness, and falls. However, preexisting comorbidities and medications affecting hemodynamic response might affect TTT outcome (i.e. presence or absence of vasomotor syncope). We studied the influence of these compounding factors on TTT outcome.

One hundred and sixty-four elderly patients with a mean (+/-SD) age of 80.0 +/- 6.1 years (M:F 104:60) underwent TTT. Heart rate and blood pressure were recorded continuously using a noninvasive device (Task Force Monito, CNS systems, Graz, Austria). Predictors of TTT outcome in a backward regression analysis included age, gender, comorbidities (chronic heart failure, hypertension, diabetes, and cerebrovascular disease), and drugs (beta-blockers, angiotensin-converting enzyme inhibitors, calcium channel blockers, diuretics, digoxin, opioids, antidepressants, and nonsteroidal antiinflammatory agents).

TTT was positive in 30 patients (18.3%). None of the above factors were a significant predictor of TTT outcome. The use of calcium channel blockers predicted a drop in systolic blood pressure after 2 minutes of TTT (P = 0.048, R(2)= 0.018). However, this was not associated with significant changes in heart rate and did not influence TTT outcome.

The TTT outcome was not influenced by comorbidities or medications. TTT is a reliable diagnostic tool in a population characterized by significant comorbidities and polypharmacy.