Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Nonspecific dizziness: frequency of supine hypertension associated with hypotensive reactions on head-up tilt

Journal of Human Hypertension volume 20, pages 157–162 (2006)Cite this article

Abstract

The clinical syndrome of supine hypertension associated with orthostatic hypotension (OH) in given individuals is recognized by specialists, but is underdiagnosed in the community. The objective of this study was to assess supine hypertension associated with hypotensive reactions on head-up tilt (SH-HRT) among patients evaluated for nonspecific dizziness. Consecutive patients with nonspecific dizziness were studied with a 10-min supine 30-min head-up tilt test. Supine hypertension (SH) was diagnosed when supine systolic blood pressure (SBP) was ⩾140 mmHg and/or supine diastolic blood pressure (DBP) was ⩾90 mmHg. Hypotensive reactions on tilt (HRT) were diagnosed when SBP decreased by ⩾30 mmHg on tilt and/or DBP decreased by ⩾15 mmHg. Of 430 patients tested, 42 (9.8%) had SH-HRT. The median age was 67 years; 37 had a pretest diagnosis of hypertension, with treatment. The median supine BP was 162/90 mmHg; the median nadir BP on tilt was 118/78 mmHg. Four SH-HRT patterns were recognized: (I) SH with typical neurogenic OH (n=6), (II) SH with vasovagal reaction on tilt (n=4), (III) SH with sustained HRT (n=28), and (IV) SH with mixed orthostatic-vasovagal reaction on tilt (n=4). Dizziness on tilt occurred in 25% of patients category III (SH with sustained HRT), while appearing universally in other SH-HRT patterns. In conclusion, nonspecific dizziness may be the chief complaint in patients with SH-HRT, a disorder often unrecognized by clinicians. Different patterns of SH-HRT on HUTT may reflect different aberrations in cardiovascular homeostasis and may require differentiated management strategies.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Biaggioni I, Robertson RM . Hypertension in orthostatic hypotension and autonomic dysfunction. Cardiol Clin 2002; 20: 291–301.

    Article  Google Scholar 

  2. Schutzman J, Jaeger F, Maloney J, Fouad-Tarazi F . Head-up tilt and hemodynamic changes during orthostatic hypotension in patients with supine hypertension. J Am Coll Cardiol 1994; 24: 454–461.

    Article  CAS  Google Scholar 

  3. Goldstein DS, Pechnik S, Holmes C, Eldadah B, Sharabi Y . Association between supine hypertension and orthostatic hypotension in autonomic failure. Hypertension 2003; 42: 136–142.

    Article  CAS  Google Scholar 

  4. Jordan J, Biaggioni I . Diagnosis and treatment of supine hypertension in autonomic failure patients with orthostatic hypotension. J Clin Hypertens 2002; 4: 139–145.

    Article  Google Scholar 

  5. Masuo K, Mikami H, Ogihara T, Tuck ML . Changes in frequency of orthostatic hypotension in elderly hypertensive patients under medications. Am J Hypertens 1996; 9: 263–268.

    Article  CAS  Google Scholar 

  6. Lagi A, Rossi A, Cornelli A, Roseti E, Cencetti S . Postural hypotension in hypertensive patients. Blood Pressure 2003; 12: 340–344.

    Article  Google Scholar 

  7. Fetter M . Assessing vestibular function: which tests, when? J Neurol 2000; 247: 335–342.

    Article  CAS  Google Scholar 

  8. Kroenke K, Lucas CA, Rosenberg ML, Scherokman B, Herbers Jr JE, Wehrle PA et al. Causes of persistent dizziness: a prospective study of 100 patients in ambulatory care. Ann Intern Med 1992; 117: 898–904.

    Article  CAS  Google Scholar 

  9. Brignole M, Alboni P, Benditt D, Bergfeldt L, Blanc JJ, Bloch Thomsen PE et al. Task Force Report. Guidelines on management (diagnosis and treatment) of syncope. Eur Heart J 2001; 22: 1256–1306.

    Article  CAS  Google Scholar 

  10. Low PA . Laboratory evaluation of autonomic functions. In PA Low (ed). Clinical Autonomic Disorders. Evaluation and Management, 2nd edn. Lippincott – Taven Publishers: Philadelphia, 1997, p. 191.

    Google Scholar 

  11. Kaufmann H . Consensus statement on the definition of orthostatic hypotension, pure autonomic failure and multiple system atrophy. Clin Auton Res 1996; 6: 125–126.

    Article  CAS  Google Scholar 

  12. Simon M, Gottschall R, Gugel M, Fritz H, Mohr S, Klein U . Comparison of transcutaneous and endtidal CO2-monitoring for rigid bronchoscopy during high-frequency jet ventilation. Acta Anaesthesiol Scand 2003; 47: 861–867.

    Article  CAS  Google Scholar 

  13. Gardner WN, Bass C . Controlled study of respiratory response during prolonged measurement in patients with chronic hyperventilation. Lancet 1986; ii: 826–830.

    Article  Google Scholar 

  14. Naschitz JE, Mussafia-Priselac R, Rubin Peck R, Peck S, Naftali N, Storch S et al. Hyperventilation and high blood pressure – is there a link? J Hum Hypertens 2005; 19: 381–387.

    Article  CAS  Google Scholar 

  15. Naschitz JE, Rosner I, Rozenbaum M, Gaitini L, Bistritzki I, Zuckerman E et al. The capnography head-up tilt test for evaluation of chronic fatigue syndrome. Semin Arthritis Rheum 2000; 30: 79–86.

    Article  CAS  Google Scholar 

  16. Curb JD, Labarthe DR, Cooper SP, Cutter GR, Hawkins CM . Training and certification of blood pressure observers. Hypertension 1983; 5: 610–614.

    Article  CAS  Google Scholar 

  17. O'Brien E, Petrie J, Littler WA, de Swiet M, Padfield PL, O'Malley K et al. British hypertension protocol: evaluation of automated and semi-automated blood pressure measuring devices with special reference to ambulatory systems. J Hypertens 1990; 8: 607–619.

    Article  CAS  Google Scholar 

  18. Lawson J, Johnson I, Bamiou DE, Newton JL . Benign paroxysmal positional vertigo: clinical characteristics of dizzy patients referred to a Falls and Syncope Unit. Q J Med 2005; 98: 357–364.

    Article  CAS  Google Scholar 

  19. Nedzelski JM, Barber HO, McIlmyl L . Diagnses in a dizzy unit. J Otolaryngol 1986; 15: 101–104.

    CAS  PubMed  Google Scholar 

  20. Herr RD, Zun L, Matthews JJ . A directed approach to the dizzy patient. Ann Emerg Med 1989; 18: 664–672.

    Article  CAS  Google Scholar 

  21. Ooi WL, Barrett S, Hossain M, Kelley-Gagnon M, Lipsitz LA . Patterns of orthostatic blood pressure change and their clinical correlates in a frail, elderly population. JAMA 1997; 277: 1299–1304.

    Article  CAS  Google Scholar 

  22. Horrocks PM, FitzGerald MG, Wright AD, Nattrass M . The time course and diurnal variation of postural hypotension in diabetic autonomic neuropathy. Diabet Med 1987; 4: 307–310.

    Article  CAS  Google Scholar 

  23. Loew F, Gauthey L, Koerffy A, Herrmann FR, Estade M, Michel JP et al. Postprandial hypotension and orthostatic blood pressure responses in elderly Parkinson's disease patients. J Hypertens 1995; 13: 1291–1297.

    Article  CAS  Google Scholar 

  24. Naschitz JE, Mazov I, Eridzhanyan L, Keren D, Rennert HS, Yeshurun D . hypotensive reactions on passive head-up tilt testing of hypertensive patients. J Hum Hypertens 1996; 10: 369–373.

    CAS  PubMed  Google Scholar 

  25. Rutan GH, Hermanson B, Bild DE, Kittner SJ, LaBaw F, Tell GS . Orthostatic hypotension in older adults. The Cardiovascular Heart Study. Hypertension 1992; 19: 508–519.

    Article  CAS  Google Scholar 

  26. Ward C, Kenny RA . Reproducibility of orthostatic hypotension in symptomatic elderly. Am J Med 1996; 100: 418–422.

    Article  CAS  Google Scholar 

  27. Vanhanen H, Thijs L, Birkenhager W, Bulpitt C, Tilvis R, Sarti C et al. Prevalence and persistency of orthostatic blood pressure fall in older patients with isolated systolic hypertension. Syst-Eur Investigators. J Hum Hypertens 1996; 10: 607–612.

    CAS  PubMed  Google Scholar 

  28. Streeten DH, Anderson Jr GH . Delayed orthostatic intollerance. Arch Intern Med 1992; 152: 1066–1072.

    Article  CAS  Google Scholar 

  29. Vagaonescu TD, Saadia D, Tuhrim S, Phillips RA, Kaufmann H . Hypertensive cardiovascular damage in patients with primary autonomic failure. Lancet 2000; 355: 725–726.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine A, The Bnai-Zion Medical Center and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

    J E Naschitz, R Mussafia-Priselac, Y Kovalev, N Zaigraykina, G Slobodin & N Elias

  2. Department of Nephrology, The Bnai-Zion Medical Center and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

    S Storch

  3. Department of Rheumatology, The Bnai-Zion Medical Center and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

    I Rosner

Authors
  1. J E Naschitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R Mussafia-Priselac
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y Kovalev
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N Zaigraykina
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G Slobodin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. N Elias
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S Storch
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. I Rosner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J E Naschitz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Naschitz, J., Mussafia-Priselac, R., Kovalev, Y. et al. Nonspecific dizziness: frequency of supine hypertension associated with hypotensive reactions on head-up tilt. J Hum Hypertens 20, 157–162 (2006). https://doi.org/10.1038/sj.jhh.1001947

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jhh.1001947

Keywords

This article is cited by

Search

Advanced search

Quick links