To assess the orthostatic changes of brachial and central blood pressure (BBP, CBP) and to determine the prevalence of orthostatic hypotension (OH) in hypertensive patients with carotid artery stenosis (CAS) and to identify factors associated with the presence of OH.
Design and method:
We examined 67 hypertensive patients with severe CAS (82 ± 9% NASCET) (39 males; 69 ± 8 years). 15 (22%) patients had type 2 diabetes mellitus (DM), 43 (64%) patients had coronary artery disease (CAD) history, 32 (48%) patients had previous stroke or transient ischemic attack (TIA). BBP, CBP were measured in supine position and after 5 min of active orthostasis by OMRON (Japan) and SphygmoCor (Australia). OH was defined as a > 20 mmHg fall in systolic BP or a > 10 mmHg fall in diastolic BP.
In active orthostasis OH were observed in 17 (25%) patients (when measuring BBP) and in 22 (33%) patients (when measuring CBP) (P = 0,005). In patients with OH systolic CBP (SCBP) decreased more than systolic BBP (SBBP) (-35,3 ± 13,9 vs -31,9 ± 13,8 mm Hg, P = 0,005). DM was associated with the presence of OH (r = 0,723, P = 0,05). Patients with DM had higher values of orthostatic changes of SCBP and SBBP than patients without DM (-23 ± 18,6 vs -10,9 ± 15,9 mm Hg, P = 0,017)/(-18,7 ± 20,6 vs -6,5 ± 15,9 mm Hg, P = 0,017). Patients with DM had higher values of orthostatic decline of SBBP than patients without DM (-27,1 ± 17,31 vs -15,8 ± 12,5 mm Hg, P = 0,024). Patients with CAD had higher values of orthostatic decline of SCBP than patients without CAD (-22,9 ± 17 vs -14,5 ± 10,6 mm Hg, P = 0,04). Antihypertensive treatment of beta-blockers was associated with the presence of OH (r = 0,231, P = 0,05). Previous stroke or TIA were not related to presence of OH (r = -0,32, P = 0,795).
Orthostatic hypotension is present in one quarter when measuring BBP and in about one third when measuring CBP of hypertensive patients with severe CAS. Magnitude of orthostatic fall for SCBP was higher than for SBBP. Diabetes mellitus was associated with the presence of OH. Coronary artery disease appears to be a risk factor for OH. These may be explained by more intensive treatment of beta-blockers in hypertensives with CAD.