Department of Cardiology and Hypertension, Bordeaux University hospital.
University Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219.
J Hypertens. 2019 May;37(5):923-927. doi: 10.1097/HJH.0000000000001986.
Orthostatic hypotension is a common condition associated with adverse cardiovascular and cognitive prognosis. Screening for orthostatic hypotension consists of blood pressure measurements in supine (or sitting) and standing position during clinical consultations. As orthostatic hypotension is a poorly reproducible clinical condition, it is likely that the simple measurement carried out during consultations underestimates the true prevalence of the condition. The objective of this study is, therefore, to determine whether screening for orthostatic hypotension with home blood pressure measurements (HBPM) may improve orthostatic hypotension diagnosis without compromising the quality of the blood pressure readings.
We asked all patients with indications for HBPM in the hypertension unit and in a general medical practice to perform a series of home blood pressure measurements, ending each series with a measurement in standing position.
We recruited 505 patients of mean age 68 years of which 93% were hypertensive patients. The success rate of HBPM complying with the ESH criteria (12 out of 18 measurements) was 94.5%, which is comparable with previously published series of measurements. Ninety-one percent of patients measured their blood pressure at least once in standing position, and 88% of patients recorded all six standing measurements. Orthostatic hypotension prevalence defined as the presence of one episode of orthostatic hypotension was 37.47%, much higher than orthostatic hypotension prevalence measured in the same cohort in a clinic setting (15%).
The measurement of blood pressure in standing position during HBPM is feasible without altering the quality of the blood pressure readings in seated position. Our findings show that orthostatic hypotension is significantly more often detected at home by the patient than at the doctor's office, which may allow quicker initiation of preventive and therapeutic strategies.
体位性低血压是一种与不良心血管和认知预后相关的常见病症。体位性低血压的筛查包括在临床就诊时测量卧位（或坐位）和站立位的血压。由于体位性低血压是一种重现性差的临床病症，因此在就诊期间进行的简单测量可能低估了该病症的真实患病率。因此，本研究的目的是确定通过家庭血压测量（HBPM）筛查体位性低血压是否可以改善体位性低血压的诊断，而不会影响血压读数的质量。
我们要求高血压病房和普通内科有 HBPM 适应证的所有患者进行一系列家庭血压测量，每次测量结束时均测量站立位血压。
我们共招募了 505 名平均年龄为 68 岁的患者，其中 93%为高血压患者。符合 ESH 标准（18 次测量中 12 次）的 HBPM 成功率为 94.5%，与之前发表的测量系列相当。91%的患者至少一次测量了站立位血压，88%的患者记录了所有 6 次站立位测量值。定义为存在一次体位性低血压发作的体位性低血压患病率为 37.47%，远高于在同一队列的诊所环境中测量的体位性低血压患病率（15%）。
在 HBPM 期间测量站立位血压不会改变坐位血压读数的质量，这是可行的。我们的发现表明，患者在家中通过 HBPM 检测到体位性低血压的频率明显高于在医生办公室，这可能有助于更快地启动预防和治疗策略。
