Advertisement

Clinical Autonomic Research

, Volume 27, Issue 1, pp 31–39 | Cite as

Reliability of orthostatic beat-to-beat blood pressure tests: implications for population and clinical studies

  • C. Finucane
  • G. M. Savva
  • R. A. Kenny
Research Article

Abstract

Objective

To assess the test–retest reliability of orthostatic beat-to-beat blood pressure responses to active standing and related clinical definitions of orthostatic hypotension.

Methods

A random sample of community-dwelling older adults from the pan-European Survey of Health, Ageing and Retirement in Europe, Ireland underwent a health assessment that mimicked that of the Irish Longitudinal Study on Ageing. An active stand test was performed using continuous blood pressure measurements. Participants attended a repeat assessment 4–12 weeks after the initial measurement. A mixed-effects regression model estimated the reliability and minimum detectable change while controlling for fixed observer and time of day effects.

Results

A total of 125 individuals underwent repeat assessment (mean age 66.2 ± 7.5 years; 55.6% female). Mean time between visits was 84.3 ± 23.3 days. There was no significant mean difference in heart rate or blood pressure recovery variables between the first and repeat assessments. Minimum detectable change was noted for changes from resting values in systolic blood pressure (26.4 mmHg) and diastolic blood pressure (13.7 mmHg) at 110 s and for changes in heart rate (10.9 bpm) from resting values at 30 s after standing. Intra-class correlation values ranged from 0.47 for nadir values to 0.80 for heart rate and systolic blood pressure values measured 110 s after standing.

Conclusion

Continuous orthostatic beat-to-beat blood pressure and related clinical definitions show low to moderate reliability and substantial natural variation over a 4–12-week period. Understanding variation in measures is essential for study design or estimating the effects of orthostatic hypotension, while clinically it can be used when evaluating longer term treatment effects.

Keywords

Reliability Orthostatic blood pressure Impaired blood pressure stabilisation Orthostatic hypotension Syncope 

Notes

Acknowledgements

The authors would like to acknowledge the contribution of the participants and members of the TILDA and SHARE teams. Funding for TILDA was received from the Atlantic Philanthropies, the Irish Government and Irish Life plc. The TILDA-SHARE collaboration was funded by National Institute for Ageing Grant No. R21 AG040387.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Supplementary material

10286_2016_393_MOESM1_ESM.docx (485 kb)
Supplementary material 1 (DOCX 484 kb)

References

  1. 1.
    Moya et al (2009) Guidelines for the diagnosis and management of syncope (version 2009): the task force for the diagnosis and management of syncope of the European society of cardiology (ESC). Eur Heart J 30(21):2631–2671CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I et al (2011) Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res 21(2):69–72CrossRefPubMedGoogle Scholar
  3. 3.
    Finucane C, O'Connell MD, Fan CW, Savva GM, Soraghan C, Nolan H, Cronin H, Kenny RA (2014) Age-related normative changes in phasic orthostatic blood pressure in a large population study: findings from The Irish Longitudinal Study on Ageing (TILDA). Circulation 130(20):1780–1789CrossRefPubMedGoogle Scholar
  4. 4.
    Romero-Ortuno R, Cogan L, O’Shea D, Lawlor BA, Kenny RA (2011) Orthostatic haemodynamics may be impaired in frailty. Age Ageing 40(5):576–583CrossRefPubMedGoogle Scholar
  5. 5.
    Frewen J, Finucane C, Savva GM, Boyle G, Kenny RA (2014) Orthostatic hypotension is associated with lower cognitive performance in adults aged 50 plus with supine hypertension. J Gerontol Biol Sci Med Sci 69(7):878–885CrossRefGoogle Scholar
  6. 6.
    Romero-Ortuno R, O’Connell MD, Finucane C, Soraghan C, Fan CW, Kenny RA (2013) Insights into the clinical management of the syndrome of supine hypertension–orthostatic hypotension (SH-OH): the Irish longitudinal study on ageing (TILDA). BMC Geriatr 13(1):73CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Frith J, Newton JL, Parry SW (2014) Measuring and defining orthostatic hypotension in the older person. Age Ageing 43(2):168–170CrossRefPubMedGoogle Scholar
  8. 8.
    Wieling W, Krediet CTP, van Dijk N, Linzer M, Tschakovsky ME (2007) Initial orthostatic hypotension: review of a forgotten condition. Clin Sci 112(3):157–165CrossRefPubMedGoogle Scholar
  9. 9.
    Lagro J, Laurenssen NCW, Schalk BWM, Schoon Y, Claassen JAHR, Rikkert MGMO (2012) Diastolic blood pressure drop after standing as a clinical sign for increased mortality in older falls clinic patients. J Hypertens 30(6):1195–1202CrossRefPubMedGoogle Scholar
  10. 10.
    Schwartz GL, Turner ST, Moore JH, Sing CF (2000) Effect of time of day on intraindividual variability in ambulatory blood pressure. Am J Hypertens 13(11):1203–1209CrossRefPubMedGoogle Scholar
  11. 11.
    O’Brien E, Waeber B, Parati G, Staessen J, Myers MG (2001) Blood pressure measuring devices: recommendations of the European society of hypertension. BMJ 322(7285):531–536CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Hutcheon JA, Chiolero A, Hanley JA (2010) Random measurement error and regression dilution bias. BMJ 340:c2289–c2299CrossRefPubMedGoogle Scholar
  13. 13.
    Cronin H, O’Regan C, Finucane C, Kearney P, Kenny RA (2013) Health and aging: development of the Irish longitudinal study on ageing health assessment. J Am Geriatr Soc 1(61):S269–S278CrossRefGoogle Scholar
  14. 14.
    Whelan BJ, Savva GM (2013) Design and methodology of the Irish longitudinal study on ageing. J Am Geriatr Soc 1(61):S265–S268CrossRefGoogle Scholar
  15. 15.
    Delaney L, Harmon C, Kelleher C, Kennedy J, Gannon B, O’Shea E (2008). SHARE Ireland first results [Internet]. University College Dublin. Geary Institute. http://researchrepository.ucd.ie/handle/10197/1204 (cited 30 Sep 2014)
  16. 16.
    Soraghan CJ, Fan CW, Hayakawa T, Cronin H, Foran T, Boyle G et al (2014) TILDA signal processing framework (SPF) for the analysis of BP responses to standing in epidemiological and clinical studies. EMBS International Conference on Biomedical and Health Informatics (BHI), Valencia, pp 793–796Google Scholar
  17. 17.
    Wieling W, van Brederode JF, de Rijk LG, Borst C, Dunning AJ (1982) Reflex control of heart rate in normal subjects in relation to age: a data base for cardiac vagal neuropathy. Diabetologia 22(3):163–166CrossRefPubMedGoogle Scholar
  18. 18.
    Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I et al (2005) The Montreal Cognitive Assessment MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53(4):695–699CrossRefPubMedGoogle Scholar
  19. 19.
    Newson R, ALSPAC Study Team (2003) Multiple-test procedures and smile plots. Stat J 3(2):109–132Google Scholar
  20. 20.
    Radloff LS (1977) The CES-D scale a self-report depression scale for research in the general population. Appl Psychol Meas 1(3):385–401CrossRefGoogle Scholar
  21. 21.
    Hartwig MS, Cardoso SS, Hathaway DK, Gaber AO (1994) Reliability and validity of cardiovascular and vasomotor autonomic function tests. Diabet Care 17(12):1433–1440CrossRefGoogle Scholar
  22. 22.
    Ziegler D, Laux G, Dannehl K, Spüler M, Mühlen H, Mayer P et al (1992) Assessment of cardiovascular autonomic function: age-related normal ranges and reproducibility of spectral analysis, vector analysis, and standard tests of heart rate variation and blood pressure responses. Diabet Med 9(2):166–175CrossRefPubMedGoogle Scholar
  23. 23.
    Gabbett TJ, Gass GC (2005) Reliability of orthostatic responses in healthy men aged between 65 and 75 years. Exp Physiol 90(4):587–592CrossRefPubMedGoogle Scholar
  24. 24.
    Mancia G, Bombelli M, Facchetti R, Madotto F, Corrao G, Trevano FQ et al (2007) Long-term prognostic value of blood pressure variability in the general population: results of the pressioni arteriose Monitorate e Loro associazioni study. Hypertension 49(6):1265–1270CrossRefPubMedGoogle Scholar
  25. 25.
    Conway J, Boon N, Davies C, Jones JV, Sleight P (1984) Neural and humoral mechanisms involved in blood pressure variability. J Hypertens 2(2):203–208CrossRefPubMedGoogle Scholar
  26. 26.
    Smith JJ, Porth CJ (1991) Posture and the circulation: the age effect. Exp Gerontol 26(2–3):141–162CrossRefPubMedGoogle Scholar
  27. 27.
    Smit AAJ, Halliwill JR, Low PA, Wieling W (1999) Pathophysiological basis of orthostatic hypotension in autonomic failure. J Physiol 519(1):1–10CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Fan CW, Savva GM, Finucane C, Cronin H, O’Regan C, Kenny RA (2012) Factors affecting continuous beat-to-beat orthostatic blood pressure response in community-dwelling older adults. Blood Press Monit 17(4):160–163. doi: 10.1097/MBP.0b013e328356821f CrossRefPubMedGoogle Scholar
  29. 29.
    Frith J (2015) Diagnosing orthostatic hypotension: a narrative review of the evidence. Br Med Bull 115(1):123–134. doi: 10.1093/bmb/ldv025 CrossRefPubMedGoogle Scholar
  30. 30.
    Naschitz JE, Rosner I (2007) Orthostatic hypotension: framework of the syndrome. Postgrad Med J 83:568–574CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Weiss A, Chagnac A, Beloosesky Y et al (2004) Orthostatic hypotension in the elderly: are the diagnostic criteria adequate? J Hum Hypertens 18:301–305CrossRefPubMedGoogle Scholar
  32. 32.
    Belmin J, Abderrhamane M, Medjahed S et al (2000) Variability of blood pressure response to orthostatism and reproducibility of the diagnosis of orthostatic hypotension in elderly subjects. J Gerontol A Biol Sci Med Sci 55:M667–M671CrossRefPubMedGoogle Scholar
  33. 33.
    van Wijnen VK, Harms MP, Go-Schön IK, Westerhof BE, Krediet CT, Stewart J, Wieling W (2016) Initial orthostatic hypotension in teenagers and young adults. Clin Auton Res 26(6):441–449 (Epub 2016 Sep 16) CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Costa A, Bosone D, Ramusino MC, Ghiotto N, Guaschino E, Zoppi A, D’Angelo A, Fogari R (2016) Twenty-four-hour blood pressure profile, orthostatic hypotension, and cardiac dysautonomia in elderly type 2 diabetic hypertensive patients. Clin Auton Res 26(6):433–439 (Epub 2016 Sep 13) CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Department of Medical Physics and BioengineeringMercer’s Institute for Successful Ageing, St. James’s HospitalDublinIreland
  2. 2.The Irish Longitudinal Study on Ageing (TILDA), Department of Medical GerontologyTrinity CollegeDublinIreland
  3. 3.School of Health Sciences, Norwich Research ParkUniversity of East AngliaNorwichUK

Personalised recommendations