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. 2015 Oct 20;85(16):1362-7.
doi: 10.1212/WNL.0000000000002030. Epub 2015 Sep 23.

Clinical implications of delayed orthostatic hypotension: A 10-year follow-up study

Christopher H Gibbons  1 , Roy Freeman  2
Affiliations

Clinical implications of delayed orthostatic hypotension: A 10-year follow-up study

Christopher H Gibbons et al. Neurology. .

Abstract

Objective: To define the long-term outcome of delayed orthostatic hypotension (OH).

Hypothesis: Delayed OH is an early and milder form of OH that progresses over time.

Methods: We reviewed the medical records of 230 previously reported patients who completed autonomic testing at our center from January 1, 2002, through December 31, 2003. All available information on clinical diagnosis, mortality, medication use, and autonomic testing were extracted and included in the reported outcomes. Standard criteria were used to define OH and delayed OH.

Results: Forty-eight individuals with delayed OH, 42 individuals with OH, and 75 controls had complete follow-up data. Fifty-four percent of individuals with delayed OH progressed to OH. Thirty-one percent of individuals with delayed OH developed an α-synucleinopathy. The 10-year mortality rate in individuals with delayed OH was 29%, in individuals with baseline OH was 64%, and in controls was 9%. The 10-year mortality of individuals who progressed to OH was 50%. Progression to OH was associated with developing an α-synucleinopathy, baseline diabetes, and abnormal baseline autonomic test results.

Conclusion: Delayed OH frequently progresses to OH with a high associated mortality.

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Figures

Figure 1
Figure 1. Study participants
Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) diagram of the participants involved in this study.
Figure 2
Figure 2. Summary of outcomes
Report of mortality by initial and 10-year follow-up diagnosis of the individuals included in the study. The orange boxes represent the original diagnosis of those individuals tested in 2002–2003. Many individuals did not have a diagnosis at that time. During 10 years of follow-up, they were diagnosed with a number of different disorders. The yellow boxes represent the individuals alive after 10 years of follow up subdivided by orthostatic hypotension group (the delayed orthostatic hypotension group is subdivided into those who progressed to orthostatic hypotension and those who continued to have delayed orthostatic hypotension). The green boxes at the bottom describe the individuals who died over the 10 years of follow-up, by orthostatic hypotension group. OH = orthostatic hypotension. *Other diseases include depression, hypertension, thyroid dysfunction, dyslipidemia, and irritable bowel disease.
Figure 3
Figure 3. Kaplan-Meier survival curve
Mortality rates over time are reported for individuals with orthostatic hypotension (OH), individuals with delayed OH (DOH) (total, and identified by progression or no progression to OH), and controls.
See this image and copyright information in PMC

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References

    1. Streeten DH, Anderson GH., Jr Delayed orthostatic intolerance. Arch Intern Med 1992;152:1066–1072. - PubMed
    1. Gibbons CH, Freeman R. Delayed orthostatic hypotension: a frequent cause of orthostatic intolerance. Neurology 2006;67:28–32. - PubMed
    1. Freeman R, Wieling W, Axelrod FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Auton Neurosci 2011;161:46–48. - PubMed
    1. Streeten DH, Anderson GH., Jr The role of delayed orthostatic hypotension in the pathogenesis of chronic fatigue. Clin Auton Res 1998;8:119–124. - PubMed
    1. Gibbons C, Freeman R. The evaluation of small fiber function-autonomic and quantitative sensory testing. Neurol Clin 2004;22:683–702, vii. - PubMed

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