[Prevalence of hypotension and symptomatic, orthostatic dysregulation in a patient sample of a medical polyclinic].

Orthostatic regulation and prevalence of symptomatic cardiovascular dysregulation was investigated in 200 patients at the outpatient clinic of the University of Zürich. Prevalence of correlations with age, diseases, medication and anamnestic data were analyzed separately. Our data show, that orthostatic drop of blood pressure suspected by anamnestic data can only rarely be verified by standardized orthostatic tests. An orthostatic dysregulation may occur without any symptoms whereas a regularly regulated orthostatic reaction may induce complaints. In analogy to earlier investigations low blood pressure values at rest (< 100/60) proved useless as indicators for orthostatic dysregulation: none of our patients showed low blood pressure values at rest, however, in 15% of them a regulation disorder was proven by symptomatic systolic blood pressure decrease. Mean prevalence of symptomatic orthostatic hypotension was 15.5%, in older patients of both sexes (> 60 years) 19%, in younger patients (< 40) 12%. As expected prevalence of diseases like diabetes (24%) and gastroenterologic disorders (24.1%) was particularly high. Vasoactive medication, on the contrary, had only low impact in this study. Only patients treated with ACE-inhibitors in combination with other antihypertensive drugs showed elevated tendency to symptomatic, orthostatic dysregulation. Orthostatic tests revealed symptomatic and pathologic results in 22.5% of patients with anamnestic symptoms of orthostatic disorder. Only 2.8 patients without any anamnestic hint had a similar positive response. So far none of the proposed criteria for diagnosis of symptomatic orthostatic hypotension has been generally accepted. This study showed that orthostatic complaints could be validated by the reaction of blood pressure and pulse rate in the orthostatic test. A blood pressure drop of more than 15 mmHg may lead to orthostatic complaints irrespective of the blood pressure at rest. Thus, in medical practise the orthostatic test is more useful than the blood pressure at rest.