COMPARISON OF AMBULATORY BLOOD PRESSURE MONITORING IN PATIENTS WITH AUTONOMIC DYSFUNCTION VS PATIENTS WITHOUT AUTONOMIC DYSFUNCTION

Therapeutic Area

Preventive Cardiology Best Practices – clinic operations, team approaches, outcomes research

Background

Blood pressure (BP) patterns in patients with autonomic dysfunction (AD), particularly those with postural orthostatic tachycardia syndrome (POTS), remain an area of limited understanding. Utility in ambulatory blood pressure monitoring (ABPM) among patients with various forms of AD compared to patients without a diagnosis of AD remains unknown.

Methods

Patients referred for ABPM between 1/2019 and 7/2023 for a diagnosis AD with POTS, AD / Orthostatic Intolerance (OI) without POTS, or no AD were reviewed. Patient characteristics and ABPM data were analyzed. Statistical analysis was completed through test of trends. The primary outcome was to compare the incidence of uncontrolled 24-hour BP between patients with AD with POTS to those with AD/OI but without POTS and to those without AD. As a secondary outcome, nocturnal dipping status was assessed.

Results

A total of 243 patients were assessed and 62 (25.5%) had a diagnosis of AD, of which 37 (15.2%) had a diagnosis of POTS. Patients with POTS were predominantly female, younger, and of white ethnicity (Table). ABPM data revealed that 81% of patients with POTS and 73% of patients without AD maintained controlled BP over 24 hours, in contrast to just 24% of those with AD/OI but without POTS (p < 0.001). The mean 24-hour SBP for patients with AD with POTS (117.7 mmHg) and patients without AD (131.3 mmHg) were within normal values, in contrast to the 137.1 mmHg observed in those with AD/OI without POTS (p < 0.001). Abnormal dipping status was prevalent in 51% of the AD with POTS cohort, 68% of the AD/OI without POTS cohort, and 56% of the without AD cohort. Nocturnal non-dipping was prevalent in 46% of the AD with POTS cohort, 36% of the AD/OI without POTS cohort, and 37% of the without AD cohort.

Conclusions

Most patients with AD with POTS, and those without AD, demonstrate normal 24-hour BP readings on ABPM. However, ABPM detected a high incidence of uncontrolled 24-hr BP readings in patients with AD or Orthostatic Intolerance without POTS, prompting discussion of valuable utility of this test in this cohort.