Turkiye Klinikleri Cardiovascular Sciences

.: ORIGINAL RESEARCH
The Relation Between Non-dipping Blood Pressure Pattern and Postural Orthostatic Tachycardia Syndrome in Hypertensive Patients
Hipertansif Hastalarda Non-dipping Kan Basıncı Biçimi ve Postüral Ortostatik Taşikardi Sendromu Arasındaki İlişki
Yurdaer DÖNMEZa, Hakan CAFb, Yahya Kemal İÇENa, Atilla BULUTa, Mevlüt KOÇa
aDepartment of Cardiology, University of Health Sciences, Adana Numune Training and Research Hospital, Adana, TURKEY
bClinic of Cardiology, Ağrı State Hospital, Ağrı, TURKEY
Turkiye Klinikleri J Cardiovasc Sci. 2019;31(2):77-83
doi: 10.5336/cardiosci.2018-63303
Article Language: EN
Full Text
ABSTRACT
 Objective: Postural orthostatic tachycardia syndrome (POTS) is an orthostatic intolerance with a pathophysiology that is likely to be heterogeneous. Hypertensive patients with a non-dipping pattern have an increased cardiovascular risk. There is a possibility that the same pathophysiological mechanisms may have a role in both POTS and the non-dipping pattern. To our knowledge, there are some studies showing the relation between POTS and non-dipping pattern in normotensive patients. However, data about this relation in hypertensive patients is limited. Our aim was to investigate the relation between 24-hour ambulatory blood pressure monitoring (ABPM) parameters and POTS in our study. Material and Methods: A total of 271 suitable patients were enrolled in our study. ABPM, Tilt table test, echocardiography, and laboratory tests were performed. Results: The study included 39 (14.3%) patients with POTS. There were no differences in the demographic variables, drug therapies, and laboratory as well as echocardiography parameters in all patients. Day-time, night-time, and 24-hour mean systolic and diastolic blood pressures and frequency of non-dipping pattern were significantly higher in patients with POTS. Day-time mean systolic blood pressure and non-dipping pattern were determined as independent predictors for POTS in multivariate logistic regression analysis. Conclusion: A relation was observed between POTS and non-dipping pattern in patients with hypertension, which needs further exploration in larger and detailed studies. Clinicians might be aware of POTS if their hypertensive patients complain of palpitations, lightheadedness, and fatigue in an upright position.

Keywords: Hypertension; postural orthostatic tachycardia syndrome; orthostatic intolerance; blood pressure monitoring; ambulatory
ÖZET
 Amaç: Postüral ortostatik taşikardi sendromu (POTS) bir ortostatik tolerans bozukluğudur. Bu sendromun patofizyolojisi muhtemelen heterojendir. Hipertansif hastalarda non-dipping patern varlığı kardiyovasküler riski artırmaktadır. Aynı patofizyolojik mekanizmaların, hem POTS hem de non-dipping paternde rol alması ihtimali mevcuttur. Bildiğimiz kadarıyla, normotansif hastalarda non-dipping patern ile POTS arasındaki ilişkiyi gösteren bazı yayınlar mevcuttur. Fakat hipertansif hastalarda bu ilişkiye dair veri kısıtlıdır. Amacımız hipertansif hastalarda 24 saatlik ambulatuvar kan basıncı ölçümleri (AKBÖ) ile POTS arasında bir ilişki olup olmadığını incelemekti. Gereç ve Yöntemler: 271 hasta çalışmamıza dâhil edildi. Tüm hastalara AKBÖ, Tilt masa testi, ekokardiyografi ve laboratuvar testleri yapıldı. Bulgular: 39 (%14,3) hastada POTS saptandı. Demografik veriler, ilaç tedavileri, laboratuvar ve ekokardiyografi parametreleri tüm hastalarda benzerdi. Gündüz, gece ve 24 saatlik ortalama sistolik ve diyastolik kan basınçları ve non-dipping profil sıklığı POTS olan hastalarda belirgin olarak daha yüksekti. Çok değişkenli lojistik regresyon analizinde, gündüz ortalama sistolik kan basıncı ve non-dipping kan basıncı profili POTS gelişimi için bağımsız öngördürücüler olarak saptandı. Sonuç: Hipertansif hastalarda nondipping profil ile POTS arasında bir ilişki gözlenmiştir. Bu ilişkinin varlığını araştırmak için daha büyük ve detaylı çalışmalara ihtiyaç vardır. Klinisyenler hipertansiyon hastalarında ayağa kalkınca meydana gelen çarpıntı, yorgunluk, sersemlik gibi şikâyetler varsa POTS açısından dikkatli olmalıdırlar.

Anahtar Kelimeler: Hipertansiyon; postural ortostatik taşikardi sendromu; ortostatik intolerans; kan basıncı izlemi; ambulatuar
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