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Diagnosing orthostatic hypotension with continuous and interval blood pressure measurement devices
Anna C Breeuwsma1, Laura C Hartog2, Adriaan M Kamper3
1Diabetes Centre, Isala, Zwolle, The Netherlands.
Insights
Continuous blood pressure (BP) monitoring is crucial for diagnosing orthostatic hypotension (OH). While interval BP measurements showed similar prevalence, they lacked concordance with continuous monitoring, indicating continuous measurement is essential for accurate OH diagnosis.
Area of Science:
- Cardiology
- Clinical Physiology
Background:
- Orthostatic hypotension (OH) is characterized by a significant drop in blood pressure upon standing.
- International guidelines suggest continuous blood pressure (BP) monitoring for OH diagnosis, but interval measurements are common in practice.
Purpose of the Study:
- To compare the prevalence and diagnostic agreement of OH using interval versus continuous BP measurement devices.
- To evaluate the reliability of interval BP measurements as a substitute for continuous monitoring in OH diagnosis.
Main Methods:
- A study involving 104 patients (mean age 69 years) compared OH prevalence using interval and continuous BP measurement devices.
- Statistical analysis included calculating prevalence rates, P-values, Lin's concordance coefficients, and proportions of agreement.
Main Results:
- The prevalence of OH was 35.6% with interval measurement and 45.2% with continuous measurement (P=0.121).
- Concordance for systolic BP drop was moderate (0.47-0.59), and low for diastolic BP drop (0.33-0.42).
- Positive and negative agreement in OH diagnosis between the methods were 59.5% and 72.5%, respectively.
Conclusions:
- Despite similar observed prevalence, interval BP measurement cannot substitute continuous monitoring for diagnosing OH due to low concordance.
- Accurate diagnosis of orthostatic hypotension necessitates the use of continuous blood pressure monitoring devices.
Abstract:
Orthostatic hypotension (OH) is defined as a drop in systolic blood pressure (SBP) of ≥20 mm Hg and/or a drop in diastolic blood pressure (DBP) of ≥10 mm Hg within 3 min of standing. The international guidelines recommend ideally diagnosing OH with a continuous blood pressure (BP) measurement device, although in daily practice interval BP measurement devices are used more often. We aimed to investigate the difference in observed prevalence of OH between an interval and a continuous BP measurement device. A total of 104 patients with a mean age of 69 years were included. The prevalence of OH was 35.6% (95% CI: 26.4-44.8) with the interval BP measurement and 45.2% (95% CI: 35.6-54.8) with the continuous BP measurement device (P = .121). Lin's coefficient of concordance ranged from 0.47 to 0.59 for the drop in systolic blood pressure and from 0.33 to 0.42 for the drop in diastolic blood pressure. The positive proportion of agreement in diagnosis of OH between the interval and continuous measure was 59.5% and the negative proportion of agreement was 72.5%. Although the prevalence of OH was not significantly different between the continuous and the interval BP measurement devices using a similar amount of measurement, the concordance between interval and continuous measure is low resulting in low positive and negative proportions of agreement in the diagnosis of OH. We conclude that continuous BP measurement cannot be substituted by an interval BP measurement to diagnose OH.
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