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Updated: Jun 18, 2026
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Tilt Testing with Combined Lower Body Negative Pressure: a "Gold Standard" for Measuring Orthostatic Tolerance
Published on: March 21, 2013
Orthostatic hypotension and complaints: not a clear-cut relation
Boriana S Gagaouzova1,2,3, Ineke A van Rossum4, Fabian I Kerkhof4
1Department of Neurology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. b.s.gagaouzova@lumc.nl.
Summary
In classical orthostatic hypotension (cOH), recognized symptoms correlate with a greater blood pressure fall. This suggests a complex pathophysiology, not a simple relationship between low blood pressure and symptoms.
Area of Science:
- Cardiology
- Physiology
- Neurology
Background:
- Inconsistent findings exist regarding blood pressure (BP) fall and symptoms in classical orthostatic hypotension (cOH).
- Previous studies reported weak or absent correlations, or proposed specific BP cut-off values.
Purpose of the Study:
- To examine clinical cOH symptoms in relation to BP changes.
- To investigate haemodynamic parameters influencing BP in cOH patients with and without symptom recognition.
Main Methods:
- Retrospective analysis of 77 tilt test records in cOH patients.
- Comparison of haemodynamic parameters between patients with (n=40) and without (n=37) complaint recognition.
- Log-ratio analysis to explore relationships between haemodynamic changes and symptoms.
Main Results:
- A significantly larger BP fall was observed in patients with recognized complaints (49.2 vs 37.3, p=0.043).
- Log-ratio analysis indicated less total peripheral resistance increase and a greater BP decrease in the symptomatic group.
Conclusions:
- Recognized cOH complaints are linked to a more substantial BP drop, contrasting with prior research.
- The pathophysiology connecting low BP to symptom awareness is complex, likely involving critical factors like cerebral perfusion.
- The variability in this pathway implies that a simple correlation between low BP and symptoms in cOH should not be expected.
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