von Bartheld Martin B, Duffels Mariëlle G J, Handoko M Louis
Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Post Office Box 7057, 1007 MB Amsterdam, the Netherlands.
Department of Cardiology, Noord West Ziekenhuis Groep, Post Office Box 501, 1800 AM Alkmaar, the Netherlands.
Eur Heart J Case Rep. 2020 Dec 12;5(1):ytaa479. doi: 10.1093/ehjcr/ytaa479. eCollection 2021 Jan.
Orthostatic hypertension (OHT) is the clinical opposite to orthostatic hypotension and is an under-recognized and poorly understood clinical phenomenon. Patients may experience disabling symptoms such as dizziness, chest pain, and shortness of breath. In addition, OHT is associated with important clinical outcomes such as silent cerebral infarcts and cognitive decline.
We present the case of a 67-year-old female who experienced frequent drop attacks with and without transient loss of consciousness causing various injuries. A range of standard diagnostic procedures did not yield an explanation for her symptoms but head-up tilt (HUT) testing showed OHT and induced most of her symptoms. Upon initiation of doxazosin, an alpha-blocking drug, she was free of symptoms and blood pressure response was normal on the repeat HUT test.
To our knowledge, this is the first report of syncope due to OHT. Orthostatic hypertension is a heterogeneous condition and may occur in young, otherwise healthy individuals but also in older patients with cardiovascular comorbidities. It is thought that symptoms occur because of excessive venous pooling (causing a drop in cardiac output) or adrenergic hypersensitivity (resulting in cerebral vasoconstriction or acute rise in cardiac afterload). Since our patient had a marked response to an alpha-blocking agent, we think baroreflex hypersensitivity is the most likely cause of her complaints. Though syncope is probably rare, OHT should be regarded as a possible explanation of orthostatic symptoms.
直立性高血压（OHT）与直立性低血压在临床上相反，是一种未被充分认识且了解不足的临床现象。患者可能会出现头晕、胸痛和呼吸急促等致残症状。此外，OHT与无症状脑梗死和认知衰退等重要临床结局相关。
我们报告一例67岁女性病例，该患者频繁出现跌倒发作，伴或不伴有短暂意识丧失，导致多处受伤。一系列标准诊断程序均无法解释其症状，但直立倾斜试验（HUT）显示为OHT，并诱发了她的大部分症状。在开始使用α受体阻滞剂多沙唑嗪后，她症状消失，重复HUT试验时血压反应正常。
据我们所知，这是首例因OHT导致晕厥的报告。直立性高血压是一种异质性疾病，可能发生在年轻、其他方面健康的个体中，也可能发生在患有心血管合并症的老年患者中。据认为，症状的出现是由于静脉过度淤积（导致心输出量下降）或肾上腺素能超敏反应（导致脑血管收缩或心脏后负荷急性升高）。由于我们的患者对α受体阻滞剂有明显反应，我们认为压力反射超敏反应是她症状的最可能原因。尽管晕厥可能很少见，但OHT应被视为直立性症状的一种可能解释。
