Consensus criteria for definition of OH is a reduction of systolic blood pressure (BP) of at least 20 mmHg or diastolic BP of at least 10 mmHg within 3 minutes after standing up (2). The use of a tilt table in the head-up position at an angle of at least 60° was accepted as an alternative. The consensus conference recommended that the confounding variables of food ingestion, time of day, state of hydration, ambient temperature, recent recumbency, postural deconditioning, hypertension, medications, sex, and age be considered. OH may be symptomatic or asymptomatic. If the patient has
From: Contemporary Diabetes: Diabetic Neuropathy: Clinical Management, Second Edition Edited by: A. Veves and R. Malik © Humana Press Inc., Totowa, NJ
symptoms suggestive of, but does not have documented OH, BP measurements should be repeated.
The values chosen are reasonable screening values, but are associated with 5% false-positive values. A value of 30-mmHg decrease in systolic BP would reduce the frequency of false-positive values to 1% (3). Preferably, an autonomic laboratory study should be performed to confirm the presence of adrenergic failure. The clinician should further characterize OH in terms of frequency and severity of symptoms, standing time before the onset of symptoms, and presyncope and its influence on activities of daily living. Additionally, it is desirable to document whether OH is associated with supine hypertension and if there is a loss of diurnal variation in BP.
The prevalence of OH is not certainty known. For adults who have diabetes mellitus (combined type 1 and type 2 diabetes) from 1987 to 1997, 10% of patients with OH were evaluated. The mean age of the Rochester Diabetic Cohort over this decade was 60.6 ±11.7 years.
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