Developing a nomogram to identify patients at risk of orthostatic hypotension in Chinese patients

This study aimed to explore the factors associated with orthostatic hypotension and to develop a nomogram to predict the risk of orthostatic hypotension.

Orthostatic hypotension is defined as a fall in systolic blood pressure (SBP) of at least 20 mmHg or diastolic blood pressure (DBP) of at least 10 mmHg within 3 min of standing. In this cross-sectional analysis, 1708 patients were collected from January 2016 to June 2018. These patients were divided into the orthostatic hypotension group and the non-orthostatic hypotension group. The variables were selected by least absolute shrinkage and selection operator (LASSO) regression. The characteristic variables selected in the LASSO regression were analyzed using multivariable logistic regression to construct the predictive model. The predictive model was displayed using a nomogram. The model performances were evaluated by the area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis.

The prevalence of orthostatic hypotension was 14.3% in this study. The LASSO and multivariable logistic regression analyses suggested that age, diabetes duration, seat SBP, supine SBP, and albumin were associated with orthostatic hypotension. The AUC of the nomogram was 0.796 [95% confidence interval (CI): 0.759-0.834] in the training set and 0.832 (95% CI: 0.780-0.885) in the validation set. Calibration curves were drawn and showed acceptable predictive performance, and the decision curve analysis showed that the proposed nomogram had strong clinical applicability.

Age, diabetes duration, seat SBP, supine SBP, and albumin were associated with orthostatic hypotension. The nomogram model established by the factors provided an effective way to forecast the risk of orthostatic hypotension.