The Prevalence of Orthostatic Hypotension in Cancer Patients

Abstract

Background: Orthostatic hypotension (OH) is associated with a higher risk of mortality in the general population; however, it has not been studied in the cancer population. This study aimed to assess the prevalence of OH in cancer patients compared to that in the noncancer population.

Methods: A total of 411 patients (mean age 63.5 ± 10.6 years) were recruited: patients with active cancer (n = 223) and patients hospitalised for other reasons, but without a cancer diagnosis (n = 188). Medical histories were collected and an orthostatic challenge test was performed. OH was defined as a blood pressure (BP) decrease upon standing of ≥20 mmHg for the systolic or ≥10 mmHg for the diastolic BP after 1 or 3 min; or a systolic BP decrease <90 mmHg.

Results: The prevalence of OH in the subjects with cancer was significantly higher than in the subjects without cancer (28.7% vs. 16.5%, respectively, p = 0.003). OH was the most common in the lung cancer patients (57.5%). In a single-variable analysis, the predictors of OH were cancer presence, age ≥ 65 years, and body mass index (BMI) ≥ 30 kg/m². In the multivariable model, the strongest independent predictor of OH was cancer status, which doubled the risk of OH, and BMI ≥ 30 kg/m² and diabetes.

Conclusions: Cancer patients are characterised by a high prevalence of OH. In this population, the recommendation of routine orthostatic challenge tests should be considered.

Keywords: blood pressure; cancer; orthostatic hypotension.

Figure 1

Outline of the methodology and diagnosis criteria of orthostatic hypotension. Abbreviations: BP, blood pressure; HR, heart rate.

Figure 2

Blood pressure (BP) and heart rate (HR) changes in orthostatic challenge test according to cancer status. During tilting, a significant fall in systolic blood pressure is noted in cancer patients compared to noncancer subjects (A). Diastolic BP, however, rises upon standing, and after 3 min of testing, is significantly higher in non-oncological group than in cancer patients (B). HR is increased during tilting, and after 1 min, is significantly greater in cancer than noncancer patients (C). Abbreviations: Delta BP—difference between BP in upright position and BP in supine position, calculated separately for systolic BP and diastolic BP. Delta HR—difference between HR in upright position and HR in supine position. Red lines—cancer group, blue lines—non-cancer group.

Figure 3

Prevalence of orthostatic hypotension according to the type of cancer. In lung cancer, orthostatic hypotension is significantly more prevalent compared to other cancer groups, except breast cancer.

Figure 4

Main causes of orthostatic hypotension in cancer patients (description in the text).