Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome

https://doi.org/10.1016/j.autneu.2011.02.004Get rights and content

Introduction

In 1996, following a multi-specialty Consensus Conference sponsored by the American Academy of Neurology and the American Autonomic Society, a brief definition of orthostatic hypotension was published. This definition has been widely used and has withstood the test of time. Fifteen years later, advances in the understanding of orthostatic hypotension and disorders of orthostatic tolerance have made it necessary to clarify and expand the earlier definition. In this updated consensus statement, endorsed by the American Autonomic Society, the European Federation of Autonomic Societies, the Autonomic Research Group of the World Federation of Neurology and the Autonomic Disorders section of the American Academy of Neurology, we refine and update the definition, pathophysiology and clinical features of orthostatic hypotension. We also add the definitions of two highly prevalent disorders of orthostatic tolerance, neurally mediated (reflex) syncope and the postural tachycardia syndrome. This update is the product of a group of experts in the field but is not an evidence based clinical guideline.

Section snippets

Definition

Orthostatic hypotension is a sustained reduction of systolic blood pressure of at least 20 mm Hg or diastolic blood pressure of 10 mm Hg within 3 min of standing or head-up tilt to at least 60° on a tilt table. Orthostatic hypotension is a clinical sign and may be symptomatic or asymptomatic. In patients with supine hypertension, a reduction in systolic blood pressure of 30 mm Hg may be a more appropriate criterion for orthostatic hypotension because the magnitude of the orthostatic blood pressure

Syncope and transient loss of consciousness

There are several different mechanisms that result in transient loss of consciousness. Causes may be traumatic or nontraumatic; the latter include syncope, epileptic seizures, metabolic disorders, and very rarely a transient ischemic attack in the posterior circulation. The term syncope indicates a specific pathophysiology and should only be used to describe a transient loss of consciousness and postural tone resulting from global cerebral hypoperfusion with spontaneous and complete recovery

Definition

The postural tachycardia syndrome (POTS) is characterized by a sustained heart rate increment of ≥ 30 beats/min within 10 min of standing or head-up tilt in the absence of orthostatic hypotension. The standing heart rate for all subjects is often ≥ 120 beats/min. These criteria may not be applicable for individuals with low resting heart rates. For individuals aged 12–19 years the required increment is at least 40 beats/min. The orthostatic tachycardia may be accompanied by symptoms of cerebral

First page preview

First page preview
Click to open first page preview

References (0)

Cited by (0)

View full text